Component Title: Compare Plans
Compare Plans
Find the right medical and dental insurance coverage for you. Choose from individual and family plans including Bronze, Silver, Gold, and Platinum. You may now be eligible for free or low-cost New York State-sponsored plans or qualify to receive higher tax credits to reduce your monthly premium under the American Rescue Plan.
Health insurance coverage for Metal level plans (Bronze, Silver, Gold, and Platinum) are essentially the same. The difference is how much you choose to pay each month as an upfront cost. A lower monthly payment (Bronze) usually means a higher cost of care when you go to a doctor. A higher monthly payment (Platinum) generally means that you’ll pay less for each visit to the doctor.
The Essential Plan is a free option for people who meet certain income eligibility guidelines. The plan costs $0 for eligible individuals, but offers the same essential benefits as other health plans. It has no deductible, so the plan starts paying for your health care right away, and you get free preventive care like routine doctor exams and screenings to keep you healthy.
Univera Healthcare MyHealthSM is a Medicaid program sponsored by New York State. It provides very low-cost health insurance for individuals and families who are eligible. You will have a Primary Care Provider (PCP) who will provide most of your care at little or no cost, and you will have access to a network of more than 13,000 other doctors, urgent care centers, hospitals and specialists when needed.
Free or low-cost coverage for children. Depending on your family’s income, your children up to age 19 may qualify for free or low-cost health insurance coverage sponsored by New York State.
Our dental plans for individuals and families include coverage for preventive services like cleanings, fluoride treatments and sealants, routine services such as exams, x-rays and fillings as well as coverage for more comprehensive care like select crowns and root canals. You can see any dentist, but if you see a dentist that is outside of our network, you will pay more out of pocket for care.
Medicare is the federal health insurance program for people who are 65 or older; or certain younger people with disabilities; or individuals with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
Component Title: When to Enroll
When to Enroll
If you are buying an Individual or Family plan directly from an insurance company or from the NY State of Health Marketplace, there are set dates where you can buy or change your insurance. This is called the Open Enrollment Period. You may also be eligible to apply during a Special Enrollment Period if you experience certain life events.
If you are eligible for Medicaid, Child Health Plus, or the Essential Plan, you can enroll at any time during the year. Unless you experience certain life events during the year, you can typically only buy, change, or renew your Individual & Family plan between November 1 and January 31. However, due to COVID-19, NY State may extend Open Enrollment.
When you experience certain life events, you may qualify to buy or change your health insurance coverage outside of the annual open enrollment time period. Those events include things such as having a baby, getting married or divorced, moving from one service area to another, or losing coverage from your employer. If you have a special enrollment period, in most cases you have 60 days to enroll in a plan.
Component Title: What is Covered?
What is Covered?
Our Qualified Health Plans include prescription drug coverage and home delivery, telemedicine, free preventive care, dental and vision coverage for children, and access to 100% of hospitals and 98% of doctors in our area.
Enjoy the convenience of filling your prescriptions by phone or online and having them delivered to your home. You can save up to 33% on prescriptions and order up to a 90-day supply of medication at one time.
Telemedicine, powered by MDLIVE, allows you to see a board-certified doctor by phone or video on your schedule, anytime, anywhere including from your own home.
Our preventive health program can help you stay healthy and reduce your risks for certain illnesses. Our members have access to health screenings, interactive tools and programs for weight management, improved fitness, getting rid of lower back pain, quitting smoking, and more.
Component Title: Managing Prescriptions
Managing Prescriptions
Our plans offer extensive prescription drug coverage, including home delivery. Members also have access to licensed clinical pharmacists who are available to answer medication-related questions. The cost of prescription drugs varies by plan. Find out which drugs are covered and how much they cost.
Enjoy the convenience of filling your prescriptions by phone or online and having them delivered to your home. You can save up to 33% on prescriptions and order up to a 90-day supply of medication at one time.
Our licensed, clinical pharmacists are available to answer medication-related questions from members and their physicians.
When you need a prescription, you may be able to cut down on your health care costs. Generic drugs are safe, effective, and approved by the FDA. They just cost you less.
The cost of prescription drugs varies widely, even for medications that are used to treat the same condition. Our medication guide for members was developed to help you and your doctor select lower cost options that are just as effective, saving you money.
Component Title: Get Help Paying
Get Help Paying
Good news! Under the American Rescue Plan, expanded tax credits are still available to New Yorkers who buy a health plan through NY State of Health. These credits were extended to 2025 under the Inflation Reduction Act. Individuals can access higher tax credits, reducing their monthly premiums. This includes many higher-income New Yorkers who did not previously qualify.
