Navigating the new health insurance options under the Affordable Care Act

October 16, 2013 Heather Chin
Share this:

When the New York Health Exchange launched online on October 1, demand to register to buy health and/or dental insurance was so high that the website slowed down or wasn’t operating properly for days. Now that user traffic has leveled out, here is a breakdown of the resources you’ll need to help yourself, your family and/or your business navigate these insurance waters.

First, visit or Use your email address and create a password to begin the application process. Have your W-2 and other tax paperwork on hand to answer questions that will determine your plan eligibility.

Purchased plans go into effect beginning January 1, 2014.

For Individuals

There are four tiers of insurance plans:

•Platinum – 90 percent coverage with high premium, low out-of-pocket costs;

•Gold – 80 percent coverage;

•Silver – 70 percent coverage;

•Bronze – 60 percent coverage with low premium, high out-of-pocket costs.

Silver is considered the standard plan level in most states.

In New York, premium tax credits are available if your income is between 133 (about $24,000 for a family of four) to 400 percent (around $94,200 for a family of four) of the Federal Poverty Level (FPL).

Participating insurance companies include: Affinity, EmblemHealth, Empire Blue Cross Blue Shield, Fidelis Care, Health Republic, Healthfirst, MetroPlus, Oscar and United.

Penalties for not enrolling in health insurance starts at $95 for individuals, or one percent of your income, and increases to $325/two percent income in 2015 and $695/2.5 percent in 2016.

Insurance plans cover 10 core service categories: ambulatory patient care (i.e. doctor’s visits and outpatient services), emergency, hospitalization, lab services, maternity and newborn care, mental health and substance abuse disorders, prescription drugs, pediatrics, preventive and wellness and chronic disease management, and rehabilitative care.

For help with your application, visit one of several Health Navigator sites.

For Employers

The employer mandate to provide insurance to employees applies to businesses with at least 50 full-time workers, and this insurance coverage would begin in 2015. The penalty for not complying with the mandate includes a $2,000 to $3,000 fine per employee.

Participating insurance companies include: Health Republic (freelancers), MetroPlus and United.

If you have fewer than 50 full-time workers, the mandate does not apply to you, but you can shop for a plan through the state’s sub-exchange in the Small Business Health Insurance Options Program (SHOP). New York is one of the few states that have opened the SHOP exchange ahead of the federal government’s planned 2015 roll-out.

Employers who have fewer than 25 employees making an average salary of under $50,000 per year may qualify for tax credits on employer-sponsored insurance packages. Tax credits can cover between 35 and 50 percent of costs.

To learn more about tax credits and other Small Business Administration and health provisions that may affect you, visit

Leave a Comment

Leave a Comment