Weigh pros, cons of coverage categories
When it comes to picking a health insurance policy, it’s good to have options. Weighing yours is one of the most important things you can do during open enrollment, which ends Jan. 31 for residents of New York State. By doing so, you can determine which plan best fits your needs for the year ahead.
By law, all plans in the insurance marketplace cover the same 10 essential health benefits: ambulatory patient services; emergency services; hospitalization; pregnancy, maternity and newborn care; mental health and substance use disorder services; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.
But how much you pay for those services, versus how much your insurance provider pays, will vary depending on what category of coverage you sign up for — bronze, silver, gold or platinum. The cost-sharing breakdown between plans is: Plans Beneficiary pays Provider pays
When your share of the costs is lower, your premium — the amount you pay monthly for your plan — is higher. The reverse is true for plans, such as bronze or silver, where you cover more of your medical expenses out of pocket should you find yourself in need of care, but pay a lower bill monthly for your coverage.
On average, premiums in New York State will increase by nearly 14% in 2018, according to Donna Frescatore, executive director of New York State of Health. However, she says people who enroll in silver plans, the most popular metal tier, will see their premiums decrease by an average of 5% once they factor in all their potential financial aid subsidies.
There are two ways to offset the cost of your monthly premium and out-ofpocket expenses. The first is through an advanced premium tax credit (APTC). Everyone whose annual income is up to 400% of the federal poverty level qualifies for an APTC.
When you apply for a plan during open enrollment, you’ll be asked to estimate your annual income for the year ahead. You’ll receive an APTC based on that figure, which will be put toward lowering your monthly premium charge every month.
The second way to save is through costsharing reductions (CSR), which are extra savings on top of your APTC. Anyone whose income is up to 250% of the federal poverty level is eligible to receive CSR benefits, but in order to claim them, they must sign up for a silver plan.
In New York State, anyone whose annual income falls at or below 200% of the federal poverty level is eligible to enroll in New York State of Health’s Essential Plan program. Through the program, premiums are capped at $20 for state residents who make $23,540 or less as an individual, or $48,500 or less as a household of four.
Find more information at nystateofhealth.ny.gov.