Individual NY Health Insurance vs New York State of Health (NYSOH)

One question we get at our Medford health insurance agency all the time is this: “Should I enroll for individual health insurance on exchange through the NY State of Health, or should I just enroll directly with a health insurance company off exchange?” While this seems like a difficult question to answer, I will explain below how you can easily decide which option is best for your own situation.

Individual Health Insurance on Long Island and NYC can be obtained EITHER through the NYSOH – called in the industry ‘on exchange’, or directly from the carriers themselves in what is referred to as ‘off exchange’. The answer to the question of which option is best for you lies in your income and how many household members are enrolling.

If you are applying as an individual (no dependents), your household income needs to be under $45,960 to be eligible for any subsidy or financial help paying premiums. If you are applying as a family of four, your family income can be no more than $94,200. Here are the household income limits for 1-4+ enrolling members:

$45,960 for Individuals

$62,000 for 2 members enrolling

$78,200 for 3 members enrolling

$94,200 for Family of 4 or more

The main points to keep in mind are knowing how many are ENROLLING in your household, and what your HOUSEHOLD income is.

Now that you have determined your household income, and you know how many in your household are applying for coverage, you are ready to determine if you should apply for coverage ON exchange or OFF exchange. If your income falls below the limits outlined, then it is in your best interest to enroll on the NYSOH website as it is the only way to claim any subsidy. However, if you make more than the amounts noted, or if you simply do not wish to go thru the hour application process and share all of your financial and personal information with the website, then it might be best to apply off exchange.

Whatever the answer is for your particular situation, a broker can you find it. We are here to assist you with whatever route makes the best sense for you, and know that you pay the same premiums and no additional costs to use a broker in NY, so take advantage of the knowledge and experience a broker can provide!