Estimating Your Tax Credit
The NY State of Health Tax Credit and Premium Estimator link now directs you to the NYSOH Plan Preview tool. However, this tool is unavailable from 1am until 8am each day when NYSOH goes down for scheduled maintenance or if you are outside of the United States.
The Kaiser Family Foundation also has a web based subsidy calculator. It does not appear to take into account the new Essential Plan, but will let you know what your income is as a percentage of the Federal Poverty Level.
Am I eligible for a Cost Sharing Reduction (CSR) Silver Plan?
New York has created a Basic Health Plan. New plans, called Essential Plans, have replaced the lowest two levels of CSR Silver Plans.
- If your income is less than 138% of the Federal Poverty Level, you are eligible for Medicaid in New York. You will not be eligible for an Advanced Tax Credit or Cost Sharing Reduction Silver Plan. If you are not eligible for Medicaid, you might be eligible for Essential Plan 3 or Essential Plan 4.
- If your income is between 138% and 150% of the Federal Poverty Level, you will be eligible for an Essential Plan 2. Essential Plan 2 has a $0 monthly premium, a $0 deductible and $200 Out-of-Pocket Maximum. Some insurance provider offer a varation that includes Adult Dental and Vision coverage for an additional cost. You will not be eligible for an Advance Tax Credit or Cost Sharing Reduction Silver Plan.
- If your income is between 150% and 200% of the Federal Poverty Level, you will be eligible for an Essential Plan 1. Essential Plan 1 has a $20 monthly premium, a $0 deductible and $2,000 out-of-pocket maximum. Some insurance providers offer a varation that includes Adult Dental and Vision coverage for an addtional cost. You will not be eligible for an Advance Tax Credit or Cost Sharing Reduction Silver Plan.
- If your income is between 200% and 250% of the Federal Poverty Level, you will be eligible for a Cost Share Reduction Silver Plan with a 73% Actuarial Value.
Now that you've estimated your Advance Tax Credit...
Time to shop for plans! Check out the insurance plans offered on the NY State of Health Marketplace in your county. You'll want to make a jot down your estimated tax credit somewhere - you'll need to subtract it from the full premium estimate your subsidized premium.
Alternatively, you can use NYSOH's new Plan Preview tool to shop plans anonymously. However, this tool is unavailable from 1am until 8am each day when NYSOH goes down for scheduled maintenance or if you are outside of the United States. Also, the plan details that NYSOH show for silver plans in the do not show Cost Sharing Reductions even if you have them estimate your financial assistance.
In order to receive a tax credit, you must purchase your health insurance through the NY State of Health Official Marketplace. If you do not want to apply online, call 1-855-355-5777 to apply over the phone or request a paper application. Customer Service is available Monday-Friday from 8am to 8pm and Saturday from 9am to 1pm. Be prepared to wait on hold. Also NY State of Health's online application is unavailable every night from 1am until 8am when the Federal Resources necessary to complete the application are offline.
Certified Navigators (who have been trained to guide people through the application process) or a Certified Broker (who have the professional knowledge and skills to help you select an insurance plan) can assist you with your application. NY State of Health provides this information about Brokers and Navigators . Unfortunately, NY State of Health's Broker & Navigator search tool does not work when the website is undergoing its nightly maintenance - try back between 8am and 10pm if you see the website is unavailable message.
If you are earn more than 400% of the Federal Poverty Level, or are otherwise not eligible for a tax credit, you can bypass the NY State of Health and purchase a plan directly from an insurance carrier or through a broker. This might save you a considerable amount of time and frustration.