Health Benefits

Qualified Health Plans on the NYS of Health Marketplace: Changes under COVID-19

T + T

Summary

The NY State of Health has 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. Open enrollment has been extended to December 31, 2021.

If you are a Benefits Plus subscriber, for additional information on Qualified Health Plans, refer to Benefits Plus, 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.

Open Enrollment

Typically, open enrollment in NYS runs from November 1st through January 31st of the following year. However, New York State has created an “exceptional circumstances” special enrollment period for anyone who is uninsured during the COVID pandemic. The Open Enrollment Period for New Yorkers to enroll in private health insurance has been extended through December 31, 2021.

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.

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 will expand 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 then 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. They can update their income online, by calling NYSoH, or with a Navigator.
  • NYSoH will update automatically in June, retroactive to January 2021. Those who have been enrolled in a QHP who are eligible for this this benefit 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 receive 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

How COVID-19 Cash Aid Impacts the Premium Tax Credit and Cost Sharing Reduction Subsidy

ECONOMIC IMPACT PAYMENTS

Neither the CARES Act Economic Impact payments (EIP) nor the American Rescue Plan Act payments will count when determining eligibility for the premium tax credit or the cost sharing reduction benefit.

PANDEMIC UNEMPLOYMENT COMPENSATION

The $300 per week in Pandemic Unemployment Compensation will count when determining eligibility for the premium tax credit and the cost sharing reduction benefit. The base Unemployment Insurance benefit, including PUA, also counts as unearned income.