How Insurance Works

NY State of Health – Picking a Health Plan That’s Right for You


Are you enrolling in health insurance
through the NY State of Health Marketplace? If so you will have a
choice of health plans at different levels and from different insurers. There are six important factors to consider when picking a Qualified Health Plan: Number One: Your premium, the monthly payment you make to the health plan after you receive any financial help you are eligible for through the Marketplace. Number Two: Out of pocket costs. What you pay when you receive medical care. Here’s some terms you should know when it comes to out of pocket costs: Annual Deductible: The amount you pay before your health
plan begins to pay for health care services. Some plans have no annual
deductible. Co-pay: The fixed amount you pay for each doctor visit prescription or other service. The health plan pays the rest. Co-insurance: The percent you pay for a covered health
care service. The health plan pays the rest. Not all plans have coinsurance. All plans have an out-of-pocket maximum. This amount is the most you have to pay in a year for covered services. Also all health plans must cover a set of
preventive services like shots and screening tests at no cost to you. Number Three: Metal Level Health plans come in four a metal levels. Platinum typically has the highest premium but the lowest out-of-pocket costs. Bronze typically has the lowest premium but the highest out-of-pocket costs. Number Four: Covered Services All health plans cover 10 essentiall health care services, such as emergency services and
prescriptions. Some plans cover extra services such as dental or vision care for adults. Number Five: Provider Network Find out which health care providers, such as doctors and hospitals participate in the health plan. It can be expensive to use health care providers outside of your health plan’s
network. Number Six: Drug Formulary Check the health plan’s drug formulary, or list of covered drugs to see if the
medicines you take are covered and how much you will pay
each time you get a prescription filled. If you qualify to enroll in the
Essential Plan, Medicaid, or Child Health Plus, you may have no monthly costs and
you get the same coverage no matter which of the available health plans you
choose. You will still want to check the health plan’s provider network and drug formulary. For more information visit the NY State of Health website, call our Customer Service Center, or visit one of our In-person Assistors. You can also call the health plan for more information. We’re here to help you find the plan
that fits your needs!


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