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The costs of health care continue to climb, so health insurance is essential. You might not think that you can afford health care if you live on a limited budget. However, thanks to the institution of the Affordable Care Act, low-cost health insurance plans are easier to find than ever before.
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Quick Look – Health Insurance in New York
- Fidelis Healthcare – Get a quote
- Empire Blue Cross – Get a quote
- United healthcare – Get a quote
- Univera Healthcare – Get a quote
What is Health Insurance?
Health insurance is a type of coverage that subsidizes the cost of your medical care. Each month, you pay your health insurance company a premium to maintain coverage. Then, after you receive routine or emergency medical care, your health insurance provider covers a percentage of your care costs.
It’s important to note that you must first meet your deductible before your health insurance starts to cover your care costs. A deductible is a set amount of money you must spend before your insurance kicks in. After you reach your deductible, you’ll only need to pay your coinsurance costs under most plans. The lower your deductible, the higher your premium, and vice versa.
Average Cost of Health Insurance in NY
The average individual on a private health insurance plan pays around $440 each month for coverage. The average family plan holder pays around $1,168 per month. However, the specific amount you’ll pay depends on a number of factors, including your location, the people on your plan and your deductible.
Types of Health Coverage
There are multiple types of health insurance plans. Understanding the difference between each plan type can help you select the best provider depending on your needs. Let’s take a look at 4 of the most common types of health insurance plans.
- Health maintenance organization (HMO) plans: HMO plans require that you stay within the insurance company’s network of service providers. HMO plans give you the least amount of freedom to choose the health care professionals you work with but also involve the least amount of paperwork. HMO plans are also usually some of the cheapest plans.
- Preferred provider organization (PPO) plan: Like an HMO plan, PPO plans include a network of preferred providers who are within the organization’s network. You may see doctors and specialists outside of your plan’s network — but you’ll pay an additional fee for service. PPO plans require a bit more paperwork if you visit a provider outside of your network, but you can earn discounts if you visit health care providers in your network. PPO plans are more expensive than HMO plans.
- Point-of-service (POS) plan: A POS plan is similar to a blend between an HMO and a PPO. POS plans allow you to see any primary care doctor you want to. Similar to a PPO plan, you’ll save money if you choose an in-network care provider, but you can pay extra to see an out-of-network doctor. Unlike a PPO plan, you’ll need to get a referral to see a specialist from your primary care provider like you would with an HMO. POS plans give you a bit more freedom to choose providers and also keep costs lower than a PPO.
- Catastrophic plan: You may be able to get a catastrophic plan If you’re under the age of 30. Catastrophic plans have high deductibles, but you’ll get 3 primary care visits before the deductible applies. You’ll also get free preventive care even if you haven’t met your deductible. From there, you’ll have a very high deductible on your plan — $7,350 for an individual and $14,700 for a family in 2018. Your health insurance provider pays for 100% of your care costs once you meet that deductible. You may only see in-network doctors with a catastrophic plan.
Keep in mind that not every health insurance provider offers every type of plan. Some providers only offer 1 plan type, while others offer all 4. Make sure you consult with your plan provider and understand the plan’s structure before you lock yourself into health insurance.
What Does Health Insurance Cover?
The Affordable Care Act (ACA) instituted a number of controls on health insurance plans and providers. One of the biggest changes is that every health insurance plan, regardless of tier or provider, must offer at least some coverage for 10 “essential benefits.” Those benefits are:
- Ambulatory care and services: This is outpatient care that you receive before being admitted to the hospital.
- Emergency services: Insurance providers must provide coverage for emergency care from any provider, regardless of whether the hospital is in your network or not. Your insurance provider cannot require you to see any specific care provider in the event of an emergency.
- Hospitalization: This includes both planned and emergency surgeries as well as overnight stays.
- Prescription drugs: Your health insurance provider must offer coverage for prescription drugs. However, they may require you try less expensive generic drugs before moving onto more expensive brand name treatments. Your doctor may request an appeal to skip this step if he or she believes that generic treatments will be dangerous or ineffective.
- Laboratory services: Laboratory services include things like blood work and imaging tests.
- Pregnancy, maternity and newborn care: This includes care before and after birth as well as labor services.
- Mental health and substance abuse treatments: All plans must cover behavioral health therapy, mental and behavioral health inpatient services and substance abuse treatments. Your insurance provider cannot place annual or lifetime spending limits on the treatment of a certain condition or disease.
- Preventive and wellness services: This includes things like blood pressure screenings, vaccinations, boosters and STD screenings.
- Rehabilitative and habilitative services and devices: This includes physical and occupational therapy as well as mobility devices and aids.
- Pediatric care: Health insurance providers must provide dental and vision coverage for children but are not required to provide these services for adults. You may be able to purchase vision and dental coverages as add-ons.
These are the bare minimum services that every type of ACA-compliant plan must cover. Keep in mind that if you purchase a short term health insurance plan, these requirements don’t apply.
What Does Health Insurance Not Cover?
Most health insurance plans don’t cover the following treatments and therapies:
- Travel vaccinations: Your insurance provider must offer coverage for vaccines that are medically necessary. Boosters, flu shots and immunizations are crucial parts of most health care providers’ lists of medically necessary treatments. However, vaccines that are only required for international travel may not be covered under your plan.
- Weight loss surgery: There is no federal mandate that requires private health insurance plan providers to offer coverage for bariatric surgery. Do you think someone on your plan might need bariatric surgery in the future? Consult with insurance representatives before you enroll in a plan.
- Cosmetic surgery: No insurance plan provides coverage for procedures that aren’t medically necessary. This includes injectables, fat reduction surgeries and other types of cosmetic enhancements.
- Dental, vision and hearing coverage: ACA-compliant plans must only provide dental and vision coverage for children. Need dental, vision or hearing protections for adults on your plan? You may be able to purchase an add-on package with your health insurance provider.
These are just a few examples of items that aren’t covered by most health insurance providers. Unless a particular treatment is included as an essential benefit under the ACA, there is no guarantee that your insurance provider will cover it. Consult your representative for more information about what is and isn’t covered under your plan.
Cheapest Health Insurance Providers in NY
Now that you understand how health insurance works, let’s take a look at some of the best health insurance plans in New York that offer affordable rates.
1. Fidelis Care
Fidelis Care may offer an affordable plan option if you need cheap health insurance in NY and you qualify for both Medicare and Medicaid.
Fidelis Care’s Dual Advantage plan helps policyholders seamlessly bridge the gaps between Medicare and Medicaid with almost no out-of-pocket costs. This is why it’s an excellent choice for anyone with a disability or who lives on a fixed income.
Fidelis Care also offers some of the most affordable private plan options in New York, which makes it a top choice for affordable health insurance in New York.
2. Empire BlueCross
You can often save money by choosing a catastrophic plan if you’re young and relatively healthy. Empire BlueCross offers comprehensive catastrophic plans, and its website easily allows you to see if you can qualify and get a quote.
Empire BlueCross is a fantastic resource if you want to save money and manage your health care on your own. Empire can offer a wealth of information on everything from preventive treatments to care scheduling.
Plans are even available for as little as $49 per visit for the most basic coverage options.
3. United Healthcare
United Healthcare might be the health care provider for you if you value expansive networks.
United’s affordable HMO plans include an impressive selection of care providers — it’s one of the largest health insurance providers in the nation.
United Healthcare also offers a number of plan choices which range from short term gap coverage to Medicaid options.
United Healthcare blends affordability with a large network and is one of the top providers for HMO plans and beyond.
4. Univera Healthcare
Another viable option for low-cost health insurance plans is Univera Healthcare, which offers individual, family and Medicare plans.
Univera Healthcare’s Essentials plan includes premiums as low as $0 per month and additional discounts on deductibles for low-income families.
Univera Healthcare offers plans throughout New York state — so no matter where you are, you’ll likely be able to find an office close to you. Plus, all of Univera’s plans offer free preventive care, including shots, checkups and screenings.
Finding Affordable Coverage For You
The question of how to get health insurance used to involve endlessly comparing policy inclusions and exclusions. ACA-compliant plans have greatly simplified things for you. However, remember that these standards only apply to permanent health care plans. Remember to carefully read the plan’s terms and conditions if you’re considering a low-cost short term plan.