What is the Individual marketplace?

New York State of Health, the Official Health Plan Marketplace, is a new way for people to shop for, compare and enroll in health coverage. It is also the only place to get financial assistance provided by the federal government to lower the cost of your health coverage.

To shop in the Marketplace, you:

• Must live in New York
• Must be a U.S. citizen, national or lawfully present immigrant (Different immigration rules may apply if you are eligible for Child Health Plus or NYS Medicaid or the Essential Plan based on your income)
• Cannot be currently incarcerated. (Different rules may apply if you are eligible for Medicaid based on your income.)
• Cannot be applying for coverage of nursing home care or care provided in a Residential Treatment Facility for Children and Youth, Developmental Center or Intermediate Care Facility for the Developmentally Disabled.

What is available through the individual marketplace?

The Marketplace gives you an easy way to compare health insurance plans so you can choose the one that’s right for your health needs and your budget. Health insurance offered through the Marketplace will include a comprehensive set of benefits and coverage.

What kind of assistance is available?

In the Marketplace, you can apply for help to lower the cost of your health coverage.

The Marketplace will also see if you qualify for free or low-cost coverage from Medicaid, the Essential Plan or Child Health Plus.

Enter your zip code in the View Plans Now section above to see if you qualify for financial assistance and the types of plans available to you.

What are Insurance Affordability Programs?

Insurance Affordability Programs include Medicaid, Child Health Plus, the Essential Plan, Advance Premium Tax Credits, and Cost-Sharing Reductions. The Marketplace will determine if you qualify for any of these programs, which can lower the cost of your coverage.

When can consumers enroll?

When you can enroll depends on which program you are eligible for, which is based on age, income and other factors. Enrollment is open all year if you are eligible for: Medicaid, Child Health Plus, and the Essential Plan. You can enroll in a Qualified Health Plan during the annual Open Enrollment Period, or a Special Enrollment Period, if you are eligible.

What health insurance is available to consumers who are incarcerated?

If you are incarcerated (except for pending disposition), you are not eligible to purchase health insurance through the Marketplace. You may, however, be eligible for public health insurance programs, such as Medicaid during this time. During incarceration, Medicaid coverage is limited to inpatient hospitalizations provided off the grounds of the correctional facility. The correctional facility is responsible for all other medical care and treatment provided to you.

What if you need coverage for nursing home care?

You cannot apply for coverage of nursing home care through the Marketplace. You need to apply for Medicaid coverage of nursing home care through your local department of social services. Or, through MILC’s ABD Facilitated Enroller program – we are happy to help!

Please Note:If you already have coverage through Medicaid or Essential Plan through NY State of Health, you may qualify for coverage of nursing home care for a limited time through your health plan. Please contact your health plan for more information.

What if you need coverage in a Residential Treatment Facility for Children and Youth, Developmental Center or Intermediate Care Facility for the Developmentally Disabled?

A Medicaid application can be completed after you are admitted to a Residential Treatment Facility for Children and Youth, Developmental Center or Intermediate Care Facility for the Developmentally Disabled. For application assistance, please contact the director of the facility in which you are placed.

MILC is able to provide in-person assistance free of charge to all Franklin County, NY residents who would like help to enroll in a health insurance plan through the NYSOH.

 Services are free, confidential, unbiased, and local!

Site locations and schedules will be updated monthly at:

http://info.nystateofhealth.ny.gov/IPANavigatorSiteLocations

For more information on Health Care Reform, Navigation assistance, and to schedule your free one-on-one appointment with a Navigator – contact MILC Malone Outreach today!