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The NY State of Health has announced that beginning January 1, 2016, they will be offering new plans for individuals whose incomes fall between 100% and 200% of the Federal Poverty Level (FPL) called “Essential Plans.”


Carriers have been invited to participate in these plans, however we have not yet been informed as to which carriers will be participating and what their respective networks will be. 


Individuals whose income falls below 200% of FPL will no longer be eligible to enroll in a Qualified Health Plan (QHP) and receive a tax credit (subsidy).


Currently, individuals enrolled in Silver plans whose income falls between 138% and 250% of the FPL are receiving cost-sharing reductions.  With the introduction of Essential Plans, cost-sharing reductions will ONLY be available for individuals on Silver plans whose incomes fall between 200% and 250% of FPL through the New York State of Health Marketplace/Exchange.   


To determine whether you are between 100-200% of the Federal Povery Level use the below chart and mutiply your % of the federal poverty level by 2 as the below limits ARE THE FEDERAL POVERTY LEVELS





















If you order to receive a tax credit at the time of enrollment, you must provide your projected adjusted gross income for the year in which you are enrolled.  Many freelancers and sole proprietors have fluctuating income during the year and their income may vary significantly from one year to the next, therefore it is important that we discuss how projected income will determine which plan you are eligible for. 


Below is a summary of the benefits, coverages and cost-sharing information for the Essential Plans:


















































While we do not have information on participating carriers and networks, we have been advised that networks will be substantially different from those of current Qualified Health Plans (QHPs). Furthermore, essential plans are not serviceable by brokers, so while we will be advising our current clients who are eligible for these new plans, we will be unable to take on new clients who fall between the income parameters for Essential Plans unless they are willing to forfeit their subsidy.


For more information please call JayMar Insurance at (516) 605-2757



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