The NY State of Health opened a special enrollment period allowing individuals who are uninsured to enroll in a Qualified Health Plan, as well as allowing a grace period to pay for a health plan’s monthly premium.
If you are a Benefits Plus subscriber, for additional information on Qualified Health Plans, refer to Health Programs, Affordable Care Act, Plans on the Marketplace & Who Qualifies, Qualified Health Plans. For subscription information visit: https://bplc.cssny.org/home/subscription_options.
Typically, open enrollment in NYS runs from November 1st through January 31st of the following year. However, New York State created an “exceptional circumstances” special enrollment period for anyone who is uninsured during the COVID pandemic. The 2022 open enrollment period was expected to last from November 16, 2021 – January 31, 2022, however it has been extended indefinitely as a result of the continued renewal of the federal Public Health Emergency. See this press release from NY State of Health.
Individuals apply for coverage through NY State of Health on-line at https://nystateofhealth.ny.gov, by phone at 855-355-5777, or by working with Navigators: https://info.nystateofhealth.ny.gov/ipanavigatorsitelocations.
For additional information on special enrollment periods visit: https://info.nystateofhealth.ny.gov/resource/questions-and-answers-coronavirus-special-enrollment-period-english
No Cost Sharing for COVID-19 Testing
There is no cost-sharing for COVID-19 testing for individuals enrolled in qualified health plans.
Effective January 15, 2022, Qualified Health Plans must cover either at-home antigen covid tests per member per month at no cost to the member. If the plan has a network in place for these tests, the plan will pay up to $12/test (i.e., $12 for one test, $24 for a pack of 2 tests). If they don’t have a network in place to supply the tests, they will have to reimburse the full cost of the tests (i.e., if they charge $35 for a box of 2, that will be covered). Plans can pay for the cost up-front or reimburse you.
There is no limit to the number of tests (at-home or lab-based) that a plan will cover per month if they are ordered by a health care provider following an assessment.
When Household Circumstances Have Changed
Households should update their account within 60 days of the change on the NYS of Health Marketplace. Anyone who has experienced a change in income, employment or other major life event, may qualify for more financial help that could lower their health insurance costs.
Payment of Plan Premiums
Individuals enrolled in subsidized or unsubsidized coverage in NYS may have more time to pay their health insurance premiums during the COVID-19 emergency. For more information on this grace period visit the Department of Financial Services at https://www.dfs.ny.gov/press_releases/pr202003301 and the NYS of Health Marketplace.
For a fact sheet, click here.
PREMIUM TAX CREDIT (PTC)
Temporary improvement as a result of the American Rescue Plan:
- To qualify for the PTC, typically households must have income below 400% of the federal poverty level (FPL). The American Rescue Plan Act is increasing the amount of the premium tax credit for those with incomes up to 400% FPL. In addition, the ARPA expands the availability of the premium tax credit to eligible individuals whose income is above 400% FPL for 2021 and 2022. These households will not have to pay more than 8.5% of their modified adjusted gross income towards the cost of health insurance premiums.
- Individuals already enrolled through NY State of Health at these income levels will be notified to update their information with NYSoH. Lower premiums should have been reflected on invoices beginning in May 2021. They can update their income online, by calling NYSoH, or with a Navigator.
NYSoH automatically updated payment information in June, retroactive to January 2021. Those who have been enrolled in a QHP who are eligible for this these benefits will be able to claim the Premium Tax Credit (PTC) when they file their taxes.
- If there is an excess advance Premium Tax Credit for 2020, the household is not required to report it on the 2020 tax return. They will not have to pay back any extra premium subsidy they may have received.
- For individuals who received unemployment benefits at any time during 2021, their income will be treated at no higher than 133% FPL for the PTC. That is, any income above 133% FPL will not be counted and they can receive the maximum premium tax credit allowed. They can obtain a silver tiered plan for no premium or use the premium tax credit towards a higher-tiered plan.
NY State of Health Fact Sheets
Impact of COVID-19 Cash Aid on the Premium Tax Credit and Cost Sharing Reduction Subsidy
Click here for details on how the CARES Act Economic Impact payments (EIP), the American Rescue Plan Act payments, and Pandemic Unemployment Compensation affects benefit eligibility.