New York Health Insurance Marketplace in 2023

Key Points:

• Over 200 thousand New York state residents enrolled,
• 12 of insurance companies to choose from,
• The lowest deductible for the cheapest Silver plans is $1,750.

Changes in the cheapest Silver plans on the New York health insurance marketplace in 2023:

• Monthly premium has gone up across New York, by an average of 1%,
• Annual deductible amount has gone up by an average of $71,
• Maximum out-of-pocket amount has gone up on average by $778.

Does New York Have a HealthCare Marketplace?

Yes, New York has an official state-based healthcare marketplace - NYStateOfHealth. New York State of Health marketplace helps individuals, families, and small businesses obtain Affordable Care Act-compliant health insurance coverage. It also serves as a tool to qualify for Medicaid, Child Health Plus, and the Essential Plan.

Who Is Eligible for Coverage Through the New York State of Health Marketplace?

All residents (citizens and lawfully present immigrants) of New York are eligible for coverage through the New York State of Health marketplace, as long as they are not incarcerated.

When Is The Open Enrollment Period On The New York State of Health Marketplace?

The open enrollment period on the NY State of Health marketplace exchange is from 16 November through 31 January. If you need to get coverage outside of this timeframe, you must meet additional requirements to qualify for a Special Enrollment Period application.

How Many People Have Enrolled Through New York’s Health Insurance Marketplace in 2023

During the open enrollment period of 16 November, 2022 - 31 January, 2023: 212,580 New Yorkers obtained coverage through the NY State of health marketplace either for themselves alone or for their families.

Which Health Insurance Companies Offer Coverage on the New York State of Health Marketplace in 2023?

In 2023, twelve insurers offer health insurance plans to the residents of New York through the NY State of Health, a state-based health marketplace:

• Capital District Physicians’ Health Plan (CDPHP)
• Emblem Health (Health Insurance Plan of Greater New York)
• Excellus Health Plan (Blue Cross Blue Shield)
• Fidelis (New York Quality Health Care Corp.)
• Healthfirst
• Health Plus (Empire Blue Cross Blue Shield)
• Highmark Western and Northeastern New York (Blue Cross Blue Shield)
• Independent Health Benefits Corporation
• MetroPlus Health Plan
• MVP Health Plan
• Oscar
• UnitedHealthcare of New York

Cheapest Silver Health Insurance Plans in New York in 2023

The offering of the cheapest silver plans on the NY State of Health insurance marketplace has changed across all counties. In 2022, six insurers shared the cheapest Silver plans across the state. In 2023, just 4 insurers are seen as the cheapest:

• Excellus lost its spot as the cheapest Silver plan provider in Delaware County, where it was replaced with Fidelis’ Silver plan.
• Fidelis grew its market share by 19%, offering the cheapest Silver plan to the residents of 56 counties.
• Highmark lost the cheapest plan spot in Montgomery County, leaving it with 1 county where it is still the cheapest,
• iDirect lost all 7 of its cheapest positions to Fidelis.
• Independent Health gave up its cheapest spot in Erie County to Fidelis.
• MVP Health Plan took over Montgomery County from Highmark.

Note: Comparison is made using the cheapest Silver plan for a 35-year old individual.

How Did Individual Health Insurance Premiums Change in New York in 2023?

As a whole, New York health insurers have increased the price in 2023 by an average of 9.7%. Meanwhile the cost of the cheapest Silver plans in New York has gone up in some counties and down in others, with an average increase of $5.67 per month ($68.04 per year).

In 39 New York counties the cheapest silver plan premium has decreased in price. The decreased amount is as little as $2.91 per month to as much as $39.01. In 9 of the counties this resulted in savings of $488.12 per year.

In 23 New York counties the cheapest Silver plan has gone up in price, by an average of $55.48 per month (increasing the annual average cost by $665.76)

The largest price increase was seen from Highmark’s Destination 65 plan in Clinton County, where the price was increased by over 24%, from $578.66 to $713.57.

2023 Subsidies for Health Insurance on New York State of Health Marketplace

New York residents who earn between 100% and 400% of the Federal Poverty Level (FPL) qualify for subsidies on the NY State of Health Marketplace. The subsidies can come in the form of Premium Tax Credits (PTCs), which lower the monthly premium cost, or Cost Sharing Reductions (CSRs), to help lower the overall out-of-pocket expenses by offering plans with lower co-payments, deductibles, and maximum out-of-pocket (MOOP) amount.

How Did Individual Health Insurance Annual Deductible Change on New York State of Health for 2023

The annual health insurance deductible for the cheapest New York Silver health plan has changed by an average of $71, from an average of $1,887 in 2022 to $1,958 in 2023:

• Excellus raised its deductible on the cheapest Silver plans by anywhere from $400 to $1,125.
• Fidelis Silver health plans raised their deductible for some plans and lowered it in other counties. In 42 counties the deductible was raised: in 40 by $450 (from $1,300 in 2022 to $1,750 in 2023), in 2 by $850 (from $4,450 in 2022 to $5,300 in 2023). In 13 counties the deductible went down: in 7 by $500 (from $2,250 to $1,750), in 1 by $1,750 (from $3,500 to $1,750), and 5 by $2,700 (from $4,450 to $1,750 in 2023).
• Highmark’s cheapest plan raised the deductible by $700 (from $1,800 per year to $2,500).
• MVP Premier Plus Saver went up by $300 (from $2,500 in ‘22 to $2,800 in ‘23).

In 2023, the lowest deductible for the cheapest Silver plans across all New York counties is $1,750. At $5,300, Bronx and King counties have the highest deductibles on their cheapest silver health plans.

How Did Health Insurance Maximum Out of Pocket (MOOP) Change in New York for 2023

In 2023, the average amount of Maximum Out of Pocket (MOOP) for the cheapest silver health plans on NY State of Health Marketplace has increased for all plans, by an average of $778 (from $8,277 to $9,055).

• While the federal MOOP in 2023 is set at the maximum of $9,100, a number that got adopted by the majority of the state’s cheapest Silver plans, 3 of the NY counties that are served by Excellus’ plans, offer lower amounts to their residents (Herkimer, Otsego, and Tompkins):
• The largest change with MOOPs came from MVP Premier Plus, in Schoharie County, where the MOOP for the cheapest Silver plan has shot up from $5,700 in 2022 to $9,100 in 2023.
• In the seven counties where Fidelis took over the lead for the cheapest Silver plans from iDirect, it raised the MOOP by $2,150 (from $6,950 to $9,100).
• In the 1 county (Clinton) where Highmark retained the cheapest offering of the Silver health plan, MOOP got raised by $400 (from $8,700 in 2022 to $9,100 in 2023).

Health Insurance Outside of the New York State of Health Marketplace

If you know for sure that your income is too high and it disqualifies you from any possible subsidies through Cost Sharing Reductions and/or Premium Tax Credits on the NY State of Health Marketplace, then you may choose to shop for coverage off-market. You can purchase full-price health insurance coverage directly from the insurers and through New York-licensed health insurance agents and brokers.

If you are buying an ACA-compliant policy off-market in New York, it will abide by the same rules as it does on the marketplace, including the need to shop for it during the Open or Special enrollment periods (based on qualifications). If the policy does not have an enrollment period or if you are being asked qualifying health history questions - then you are likely applying for non-ACA-compliant insurance and should consult with an agent for advice.