2014 News & Updates
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NYSOH Releases Enrollment Zip Code Level Data Tool
Updated: October 3, 2014
On October 3, 2014, the NY State of Health (NYSOH) released its zip code level enrollment tool. The data tool calculates enrollment numbers as of September 19, 2014. The end-user is allowed to enter up to ten zip codes at one time. Each zip code's enrollment data is then combined into the following three categories: Quality Health Plans (QHPs), Medicaid and Child Health Plus (CHP).
The zip code level data tool is a read-only Excel spreadsheet and is available for download.
NYSOH Announces 2015 Health and Dental Plans Offered in the Marketplace
Updated: September 26, 2014
With the beginning of open enrollment steadfastly approaching on November 15, 2014, the New York State of Health (NYSOH) announced on September 22, 2014, the insurers offering health and dental plans to individuals and small business owners in 2015.
Get a listing of health and dental plans offered on the individual and the small business marketplace in 2015.
You can also access an interactive map showing plans by county that will be offered in the Marketplace .
NYSOH Releases County-Level Enrollment Data from Open Enrollment 2013
Updated: September 9, 2014
On September 9, 2014, the NY State of Health (NYSOH) released detailed county-level data on the nearly 1 million New Yorkers who enrolled in health coverage during the Marketplace's first open enrollment period (October 1, 2013 through April 15, 2014).
Each data sheet features enrollment numbers by public and private coverage including those that enrolled in qualified health plans with or without premium tax credits, and percentages by metal tier and insurer.
You can access county specific data by clicking on the respective county below:
Access the statewide map.
IRS Releases Draft Forms for Individuals, Businesses and Insurers to Report on Health Insurance in 2014
Updated: August 10, 2014
On July 24, 2014 the IRS released draft forms for the 2014 tax filing season (returns due April 15, 2015) for individuals, small businesses, large employers and insurance issuers to report on health insurance in accordance with the Affordable Care Act (ACA) requirements.
For individual taxpayers:
A draft of the new Individual Income Tax Return Form 1040 includes lines for listing calculated net premium tax credits for those who are either owed more in tax credits from purchasing insurance through an ACA marketplace or must pay back some of the tax credits they received in advance. The Premium Tax Credit Form 8962 form is used to calculate the taxpayer's final premium tax credit amount for the tax filing year.
The 1040 also includes lines to report coverage for the year, as required by the ACA, by checking "full-year coverage" or listing a calculated shared responsibility payment (the penalty for not having coverage). The Health Coverage Exemptions Form 8965 allows individuals who were uninsured for all or part of the prior year to document any exemption from the penalty that they can claim.
For small businesses:
The Credit for Small Employer Health Insurance Premiums Form 8941 will allow small business who purchased health insurance for their employees on the ACA small business marketplace to calculate their health care tax credit.
For entities that provide health care coverage to individuals or employees:
The IRS released drafts of the forms that the ACA marketplaces (1095-A), insurance issuers (1095-B) and self-insuring large businesses (1095-C) will have to fill out for each of the individuals for whom they provide coverage. This information will be used to verify full-year coverage for all individuals filing income tax returns and to verify premium tax credit calculations.
The IRS has not yet released official instructions for filling out these forms and plans to do so in August 2014.
All draft tax forms can be found on the IRS website.
IRS Releases Average Cost of Bronze Level Plan For Determining Tax Penalties in 2014
Updated: August 10, 2014
The IRS has established the maximum amount taxpayers may have to pay if they or a family member is uninsured in 2014. The 2014 tax filing year (returns due April 15, 2015) will be the first year for which tax penalties for not having health insurance will be required.
The maximum tax penalty for each family member who was uninsured in 2014 will be $204 per month, or $2,448 annually, up to a maximum of $12,240 per family. $12,240 is the penalty for a family of five, but even if the family size is greater than five, a taxpayer will not pay more than this amount.
Under the Affordable Care Act (ACA), taxpayers have to pay a penalty (called a shared responsibility payment) for the months in which they, their spouse, or their tax dependents did not have coverage.
The penalty cannot exceed the cost of purchasing coverage, so the maximum penalty is determined by calculating the average premium for bronze levels plans offered through all ACA marketplaces across the country. The IRS calculated the maximum penalty for 2014 by taking a weighted average of the average Bronze level plan offered in ACA marketplaces in each county or county equivalent for a 21 year old individual who does not smoke.
Read the regulations from the IRS.
Learn more about calculating the tax penalty on our site.
Financial Aid for Hospital Services
Updated: August 10, 2014
Individuals and families that have income below 300% of the federal poverty level and do not have insurance are eligible for discounts and financial assistance from hospitals in New York State.
All hospitals must provide financial assistance for New York State residents for emergency care. Each hospital must also provide financial assistance for residents in their primary service area. Details about primary service areas of individual hospitals can be found on the NY State Department of Health website.
Discounts and financial assistance are determined on a sliding scale based on an individual's income. This means that those with lower incomes will receive larger discounts than those with higher incomes. Some hospitals extend discounts to individuals who are above 300% of the federal poverty level or who have health insurance but are not able to fully pay co-pays and deductibles.
Individuals who earn less than 100% of the federal poverty level cannot be charged for a child's or pregnant woman's clinic and emergency room visits, and cannot be charged more than $15 for an adult's emergency room or clinic visit.
Hospitals cannot take an individual's home, car, a retirement or college savings accounts cannot be taken into account when determining their income level. For example, a hospital may not foreclose on a patient's home to collect a bill.
Hospitals must provide patients with information on the available financial assistance. Upon request, hospitals must provide application forms in accessible languages and provide patients with assistance in filling them out as necessary. Patients have 90-days from the date that the service was provided by the hospital to request an application and 20 days to file the application once they receive it.
Join Us at the South Hollis Library on July 10th to Find Out About Your Health Insurance Options
Last updated: July 7, 2014
Come and join OCHIA at the South Hollis Library healthcare open house to find out what coverage you qualify for in the NY State of Health, the Official Health Plan Marketplace.
**Where:** South Hollis Library in Queens
**When:** Thursday, July 10th at 2:00 - 5:00pm
Trained navigators will be on site to help you enroll in Medicaid, Child Health Plus, or if you have qualifying, event private health insurance.
Preregistering at 718 465-6779 is suggested but not required. See Flyer
NYS Releases Health Insurance Marketplace Enrollment Report
Last Updated: June 25, 2014
On June 25, 2014, the NY State of Health (NYSOH) released a report on who enrolled in the marketplace during the first open enrollment period,
This report, entitled NY State of Health: The Official Marketplace 2014 Open Enrollment Period, provides information on the nearly 1 million people who enrolled through the NYSOH from October 1, 2013 to April 15, 2014, including how many people received financial assistance the which health plans they enrolled in. The report also contains information on enrollment into the marketplace by small businesses and their employees.
In addition to the report, NYSOH released several infographics:
The following table summarizes NYSOH enrollment activity for public health insurance and private health insurance in NYC.
| | Bronx | Kings | New York | Queens | Richmond | All NYC |
| Medicaid |
62,404 |
98,149 |
44,640 |
92,371 |
11,223 |
308,787 |
| CHP |
790 |
8,553 |
2,562 |
8,503 |
1,432 |
24,840 |
| QHPs |
16,419 |
53,219 |
38,413 |
50,386 |
6,879 |
165,316 |
| All Programs |
82,613
|
159,921 |
85,615 |
151,260 |
19,534 |
498,943 |
Enrollment in NY State of Health in NYC, by Program type, during Open Enrollment (October 1, 2013 - April 15, 2014)
Read more about the report in the state's press release.
Data on Immigrants & Health Insurance Coverage in NYC
Last updated: June 25, 2014
The NYC Department of City Planning presented on the great diversity that is New York City at HRA OCHIA's June 25th Partners' Meeting. In this presentation, Joel Alvarez and Adam Attar reviewed new data on immigrants in the City, where they live, where they come from, and what languages they speak. They also presented on health insurance coverage among immigrants overall and different immigrant groups, including where many uninsured immigrants live in the City.
Additionally, information on projections work that the Department does to forecast how the City will look in 2020 and 2040 was shared, as well as how to find a lot of useful data reports, maps and tools on their website.
Download their presentation, their latest report The Newest New Yorkers, or access data from the report using their online interactive map.
New Special Enrollment Period for Individuals Who Have COBRA
Date: May 28, 2014
Individuals enrolled in COBRA have through July 1, 2014 to switch to a plan in the NY State of Health. To take advantage of this new, time-limited opportunity to enroll in Marketplace coverage (called a special enrollment period), you must call the NY State of Health at 855-355-5777.
For some people, coverage through NY State of Health may cost less than their COBRA coverage. Eligible individuals can also receive tax credits and cost-sharing reductions to lower their costs through the NY State of Health. After July 1st, people who have COBRA must wait until November 15th, when the next open enrollment period starts, to change to a Marketplace plan. The Consolidated Omnibus Budget Reconciliation Act – or COBRA, for short – allows people losing job based coverage to continue it for a limited period of time. Learn more about COBRA on our website.
This special enrollment period for people who have COBRA was created by the federal government to address concerns that these individuals were not provided with clear enough information about their coverage options. Specifically, there was concern that the notices people received when they were losing their job-based coverage did not state clearly enough that instead of continuing their coverage under COBRA, they could enroll in Marketplace coverage. For persons already enrolled in COBRA, there was a concern that people did not know they could switch to Marketplace coverage during open enrollment. New York's Marketplace is called NY State of Health. More information about this special enrollment period is available from the federal notice and New York State of Health FAQ on Special Enrollment Addendum.
The federal government has also revised COBRA notices to make information about the Marketplace clearer. View model language for the new COBRA general notice and election notice on the U.S. Department of Labor website.
Department of Health & Human Services Posts Enrollment Data for New York's First Open Enrollment Period
Date: May 5, 2014
The federal Department of Health & Human Services has published marketplace enrollment numbers for public and private coverage for the Affordable Care Act's first open enrollment period (October 1, 2013 - March 31, 2014), including special enrollment period activity through April 19, 2014.
Similar to previous data, 31% of young adults age 18 to 34 enrolled in the marketplace for health insurance. Additionally, 56% of individuals chose silver tier plans. Consumers earning less than 250% had incentives to select silver plans. Cost sharing reductions were only available to eligible residents if they enrolled in a silver plan.
This document provides more detailed enrollment information for open enrollment.
Recently Had A Life Changing Event? NY State of Health issues FAQs on Special Enrollment Periods
Date: May 2, 2014
Recently had a life changing event? You may qualify for a special enrollment period. Some qualifying events including having a baby or gaining a dependent, getting married or divorced, losing your health coverage or permanently moving to New York State may allow you to purchase private coverage outside of open enrollment. The NY State of Health has compiled a list of Frequently Asked Questions (FAQ) on Special Enrollment to help consumers understand their options.
If you had a life changing event you must act to newly enroll in coverage or change your health plan within a 30 to 60 day window, depending upon the circumstance.
The NY State of Health is allowing individuals who experienced delays applying for coverage until April 15th to complete their application.
Updated: March 28, 2014
The NY State of Health announced that residents need to complete their application for private insurance by 11:59pm on Monday, March 31, 2014 to avoid a federal tax penalty.
Residents who have taken steps to apply for coverage by March 31st, but who experienced delays through no fault of their own, may have until the end of the day on April 15th to complete their application. This FAQ provides more information about obtaining an extension.
After these deadlines, residents can only enroll in private health insurance if they experience a qualifying event that makes them eligible for a special enrollment period. Qualifying events include such events as getting married, having a baby or adopting a child, moving permanently to New York State, or losing other health insurance.
Without a qualifying event, individuals must wait to enroll in private coverage until the next open enrollment period, which begins November 15th.
Adults eligible for Medicaid and Child Health Plus can use the NY State of Health to get coverage at any time during the year.
Small businesses can purchase a plan to cover their employees all year round.
New Federal Rules Help Married Domestic Violence Survivors' Access Premium Tax Credits
Last updated: March 28, 2014
On March 26, 2014, the federal government announced that married domestic violence survivors may qualify for premium tax credits using the 'married filing separately' federal tax status.
These survivors of domestic violence may also be eligible for a special enrollment period that allows them to apply for coverage through May 31, 2014. Call the NY State of Health Customer Service Center at 1-855-355-5777 for more information and help applying.
Residents with incomes up to 400 percent of the federal poverty level (currently $45,960 for an individual) may be eligible for premium tax credits for health insurance policies offered through the NY State of Health.
Generally, married individuals must file taxes jointly to claim a premium tax credit.
This new tax filing rule allows married survivors of domestic violence who do not file taxes with their spouse to be eligible for tax credits. To learn more about the rule change, read the IRS notice or U.S. Treasury fact sheet.
NYC Urges Uninsured New Yorkers to Get Covered Before March 31st
Last updated: March 10, 2014
"Get Covered!" is a citywide awareness campaign to motivate uninsured New Yorkers to sign up for health insurance before open enrollment ends on March 31, 2014.
With the deadline approaching to enroll in a health plan this year, a final push is on to get as many people signed up as soon as possible for health insurance through the state's online marketplace, NY State of Health, over the next three weeks.
The NYC Health Department reports that nearly 20% of adults in the City are uninsured, and nearly 40% of adults who speak Spanish as their primary language at home do not have health insurance.
The City's media campaign includes ads in English and Spanish that provide examples of New Yorkers who are now eligible for free or lower-cost coverage under the Affordable Care Act.
Learn more about what the Affordable Care Act offers Immigrants, Young Adults, Sole Proprietors, and Small Businesses, including information on premium tax credits and cost-sharing reductions (in English). Information is also available in Arabic, Bengali, Chinese, French, Haitian Creole, Korean, Russian, Spanish, and Urdu.
Find out how to apply
Read the Press Release for the City's "Get Covered!" awareness campaign.
Federal Government Announces Changes to the Employer Mandate
Last updated: February 4, 2014
Under the Affordable Care Act, employers with 50 or more full-time employees must offer affordable and adequate health benefits or pay fines. This "employer shared responsibility" requirement (also called an employer mandate) was originally scheduled to go into effect this year (2014) but has already been postponed until 2015.
On February 10, 2014, the federal government announced that it would further delay and modify this requirement. In its final regulations, medium size employers with 50 to 99 employees will now have until 2016 instead of 2015 to provide their workers' health insurance.
In addition, larger employers with 100 or more employees will have additional time to cover all of their full-time workers. In 2015, they will have to cover 70% of full-time employees in order to avoid paying a penalty. In 2016 and beyond, they must offer insurance to 95% of full-time employees.
To learn more, read the U.S. Treasury fact sheet or the IRS's final regulations and questions and answers.
Making the Affordable Care Act Work for You!
On Wednesday, February 12, 2014, the Office of Citywide Health Insurance Access (OCHIA), the Small Business Administration, the New York State of Health (NYSOH) and Community Service Society will provide tips on how to navigate the new insurance landscape and determine the best health care coverage options for you and your employees under the Affordable Care Act. There will also be Navigators present who can answer your questions and help you apply for health insurance for yourself or your business.
See our flyer for more information and register today!
Most people in NYC under age 65 must now apply for Medicaid through the NY State of Health
Last Updated: January 10, 2014
As of January 1, 2014, most pregnant women, children, and non-elderly adults (under age 65) must apply for Medicaid coverage through NY State of Health. The Human Resources Administration (HRA) will continue to accept applications for Medicaid for persons over 65, individuals who have Medicare, and people of any age who need Medicaid related to a disability or blindness. Learn more.
FAQ for Residents with Insurance through NY State of Health's Individual (NYSOH) Marketplace
Last Updated: January 2, 2014
If you are newly insured through the NY State of Health, the Marketplace has published a new set of Frequently Asked Questions about using coverage that starts January 1, 2014.
It includes helpful tips and information on:
- Finding out if your doctor is in your plan's network
- Prescription coverage and access
- Procedures for obtaining emergency care
- Health plan customer service
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