What's covered: All approved plans in the state must cover the same package of benefits, called essential health benefits. In New York, the benefits include:
- Outpatient services, such as doctor visits or tests done outside a hospital. This includes diagnosis and treatment for infertility and second opinions on a cancer diagnosis.
- Emergency services
- Hospital stays, including weight loss surgery
- Pregnancy and baby care
- Mental health and substance abuse services, including behavioral health treatment. This includes diagnosis and treatment of autism and bereavement counseling.
- Prescription drugs, including generic and brand-name drugs using mail order for up to a 90-day supply.
- Rehab and habilitative services, those that help people recover from an accident or injury and those that help people with developmental issues. This includes physical, speech, and occupational therapy.
- Lab tests
- Preventive and wellness services, along with those that help people manage chronic conditions. This includes some coverage for gym memberships and diabetes education and care.
- Services for children, including dental and eye care
Some services not included: acupuncture, cosmetic surgery, long-term care, non-emergency care when traveling outside the U.S., and weight loss programs.
Health Insurance Advisor: Check out Web MD’s Health Insurance Advisor to compare different kinds of plans based on your needs.
Financial Aid and Medicaid
You may be eligible for financial aid to help pay for insurance or for government sponsored insurance. Here’s what’s available:
Premium Subsidies (also known as Tax Credits): You may qualify for a subsidy -- money to help pay your health insurance premium each month. The subsidy may be sent directly to your health insurance company and is available only if you buy your insurance in the Marketplace. In general, you'll be eligible if you're single and make about $45,960 or less a year, or if you have a family of four and make about $94,200 or less a year. Subsidies are based on your estimated household income for 2014.
You also may be eligible for cost-sharing subsidies that will reduce your costs when you get medical care. Cost sharing subsidies are available only if you buy a silver-level plan.
Medicaid: Some states, including New York, expanded Medicaid so more people can get health insurance coverage. You may be eligible if your yearly gross income is no more than about $15,856 for one person and $32,499 for a family of four.
CHIP: The Children’s Health Insurance Program, called Child Health Plus in New York, provides coverage for children of some families who have a low income but are not eligible for Medicaid. Visit your state's Marketplace to find out if you qualify.
Check with New York State of Health to see if you are eligible for these programs.