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What the Affordable Care Act Means For Individuals In New York

Beginning Jan. 1, 2014, you are required to have health insurance coverage.

The law allows a few exceptions to this individual mandate. Those with religious objections to receiving health insurance benefits, the incarcerated, undocumented immigrants and members of an Indian tribe may apply for an exemption through the NY State of Health insurance exchange or on their tax return.

The uninsured may be assessed a penalty.

Most individuals will be assessed a penalty on their tax return for failure to comply with the individual mandate. Households suffering severe financial hardship or those with incomes less than the income tax filing threshold ($10,000 for individuals, $20,000 for adults) are exempt from the penalty. For all others:

  • 2014 penalty – $95 per adult and $47.50 per child (maximum $285 per family) or 1% of household income, whichever is greater.
  • 2015 penalty – $325 for adults and $162.50 for children (maximum $975 per family) or 2 % of household income.
  • 2016 penalty – $695 for adults, $347.50 for children (maximum $2,085 per family) or 2.5 percent of household income.
  • 2017 and beyond – The 2016 penalty will be increased by the cost of living.

The penalty is pro-rated by the number of months in the year you are without insurance. There is no penalty for a single gap in coverage that is less than three months.

Most New Yorkers with health insurance will see little change.

If you currently have coverage through employment, or a public program such as Medicare, Medicaid or Tri-Care, you most likely will not see a change in your health insurance. Healthy New York members will be able to find coverage through NY State of Health. Most health insurance providers that participate in the Healthy New York program are offering policies on the exchange.

Some New Yorkers may find their current policies cancelled.

The new law  require insurers  cover preventative services, such as annual checkups and cancer screenings, without a co-payment. Lifetime caps on benefits have also been eliminated. If you purchase a health plan on the individual market, your policy might not cover these and other New York State required benefits. In this instance, your insurer will cancel your current policy and offer you a new one with expanded coverage. You always have the option of shopping for a new policy on the exchange.

New Yorkers that need health insurance have new options.

The NY State of Health website is the portal to New York's official Health Plan Marketplace. A total of 17 insurers are participating in the New York exchange, offering several different plans in each county. Individuals may purchase policies at group rates by enrolling through the exchange. The cost of health insurance on the New York exchange varies by level of coverage and region.

You will need your biographical and financial information to enroll through New York State of Health.

To shop for a health plan on the NY State of Health exchange, you will need a NY government ID. You may already have a government ID if you receive state benefits such as unemployment insurance or SNAP and you access these accounts online. If you already have an ID, you will access the healthcare exchange using the same user ID and password.

If you do not have a NY government ID, you will create a user name and password when you register at the NY State of Health website. When you register, you will be asked basic biographical information such as your name, address, and age. You will not be required to enter any personal medical information, although you must indicate if you use tobacco. Insurers are allowed to charge higher rates for smokers.

Check the box that asks if you want help paying for health insurance.

This will bring you to a screen that asks for your income information. A copy of last year's tax return will help you provide the most accurate figures. Entering your income information will allow the website to calculate the amount of subsidies for which you are eligible.

Four levels of coverage are offered through New York State of Health.

You will be asked to select the "metal level" plans you wish to view. The least expensive plans are the Bronze tier, which covers 60 percent of medical costs. The Silver level covers 70 percent, the Gold level covers 80 percent, and the Platinum level covers 90 percent. Catastrophic plans, which have low premiums and high deductibles, are available to adults younger than 30.

Use the "compare plans" function to review your options.

Once you've selected the level of coverage you prefer, you will be brought to a screen that lists the different policies offered in your region of New York. By selecting the check boxes by several plans, you will be able to see a side-by-side comparison of costs, deductibles, co-pays and coverage.

Access the database of insurance companies to determine if your doctor is included in a plan.

Go directly to the insurer's website to determine which doctors and healthcare facilities participate in the plan. You will find this information on the insurer's website by following the "providers" link.

You do not need to make an immediate decision.

If you want coverage effective Jan. 1, 2014, you have until Dec. 15 to enroll. Open enrollment continues through the end of March 2014. All the information you have entered will be saved in your account until you are ready to make a purchase.

Locate a certified navigator for personal assistance in selecting and enrolling.

Health care facilities across the state have trained and certified professionals that are able to assist with selection and enrollment. Locate the nearest navigator here. You may also access the NY State of Health exchange by calling (855)355-5777. The helpline is open Monday through Friday, 8 a.m.- 8p.m and Saturday 9 a.m. – 1 p.m.

Gillian Burdett is a freelance writer in New York. Her writing focuses on education, public policy and family issues. Her work can be found here.

Gillian Burdett is a freelance writer covering all things home and living. Her work can be found on

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