Answers to Questions You May Have

Family Health Plus is for adults 19-64 years old, such as:

• Single adults;
• Couples without children;
• Parents who live in New York State.

To apply for Family Health Plus, you must be a United States citizen or fall under one of many immigration categories.

Even if you have a higher income, you may still be able get Family Health Plus coverage. It depends on how many people are in your family. Click below or call us to find out if you can apply for Family Health Plus.

> Click here to learn more about who can apply for Family Health Plus Eligibility

It is free to join Family Health Plus. Copayments may be required for some services.

• A Healthfirst representative will contact you. They will tell you if you and/or your family can apply for Family Health Plus. Then Healthfirst will send your application to your local Department of Social Services. 
• The local Department of Social Services will review your application. Then they will let you know which health insurance program is right for you.
• You will get a letter from Healthfirst to confirm your health insurance plan. We will also send you a welcome letter. It will include the date you can start using your health plan, and a member ID card.
  • If you need health care before your ID card arrives, you can use the Healthfirst welcome letter to show your doctor that you have health insurance.
• You will also get a handbook from your health plan. The handbook will tell you what services are covered by your plan and how you can get health care.

Family Health Plus is an insurance program offered by Healthfirst.  It provides good health care to adults 19-64 years old who do not have health insurance and who do not qualify for Medicaid. New York State sponsors this program.  

Family Health Plus covers doctor checkups, hospital visits, prescription medicines, and other health services. There are low co-payments for some Family Health Plus services.  

> Click here to learn more about Family Health Plus

If you have health insurance through a government or school district benefit plan, you can’t be covered by Family Health Plus. However, if you have health insurance through another kind of job, you may qualify for some aid. The Family Health Plus Premium Assistance program can help you pay for extra insurance costs such as premiums, deductibles, coinsurance, and copayments. Call us to learn more about this special program.

To apply for Family Health Plus, you will need to complete an application and provide proof of certain information. Contact our Member Services department to schedule an appointment with a Healthfirst representative, or visit a community office near you.

You must renew your Family Health Plus coverage every year. We will send you a letter to remind you it is time to renew your plan. This letter will include a deadline date, and a renewal form.  It is very important for you to mail the renewal form to us by the deadline date. If you don’t, your health insurance plan will end.

> Cick here to learn more about how to renew your Family Health Plus Plan

Managed care covers many health needs, including doctor checkups, emergency services, hospital visits, and special services, such as vision care. 

> Click here to see a full list of what is covered by Medicaid Managed Care

You can apply for Medicaid by:

• Calling our Member Services department to schedule an appointment; or
• Visiting us at a community office near you.

Just call us, or visit one of our community offices. We’re here to help you.

> Click here to learn more about who can apply for Medicaid Managed Care

You must renew your Medicaid coverage every year. We will send you a letter to remind you it is time to renew your plan. This letter will include a deadline date, and a renewal form.  It is very important for you to mail the renewal form to us by the deadline date. If you don’t, your health insurance plan will end.

> Click here to learn more about how to renew your Medicaid Managed Care Plan

Medicaid Managed Care (or “Medicaid”) is a program offered by Healthfirst for New York residents who can’t afford to pay for health care. This program lets you choose a doctor who will make sure you get the health care you need. New York State sponsors this program.

> Click here to learn more about Medicaid Managed Care

You may be covered by Medicaid if:

• You meet certain Income requirements;
• You live in the Healthfirst service area:
  • Bronx, Brooklyn, Manhattan, Queens, Richmond, Nassau and Suffolk counties;
• You are a legal U.S. citizen.

• Proof of age, such as your birth certificate;
• Proof of United States citizenship or alien status;*
• Recent paycheck stubs (if you are working);
• Proof of income from any of the following:
  • Social Security
  • Supplemental Security Income (SSI)
  • Veterans’ Benefits (VA)
  • Retirement
• Proof of where you live.  This can include any of the following:
  • Rent receipt
  • Landlord statement
  • Mortgage statement
  • Mail with your address on it
• Health insurance benefit card or the policy (if you have any other health insurance).

* = Note: Medicaid may cover you, even if you have alien status. You must be pregnant, or need emergency treatment. This must be certified by a doctor. Other requirements may apply.

• A Healthfirst representative will contact you. They will tell you if you and/or your family can get Medicaid. Then Healthfirst will send your application to your local Department of Social Services. 
• The local Department of Social Services will review your application. Then they will let you know which health insurance program is right for you.
• You will get a letter from Healthfirst to confirm your health insurance plan.  We will also send you a welcome letter.  It will include the date you can start using your health plan, and a member ID card.
  • If you need health care before your ID card arrives, you can use the Healthfirst welcome letter to show your doctor that you have health insurance.
• You will also get a handbook from your health plan.  The handbook will tell you what services are covered by your plan, and how you can get health care.

Yes. Once a year, you will be asked to send us a “re-certification” form that proves you still qualify for the Healthy NY program. We will notify you when this form is due, and provide you with the forms you need.

You will need to give us the following documents:

• A certification form;
• Proof of employment status, or status as a sole proprietor;
• Proof of New York State residency;
• Proof of income for the last 4-6 weeks.

Examples of documents we will accept include:

Yes. If your insurance covers only medical benefits or only hospital benefits, you may qualify for Healthy NY. If your insurance covers both medical AND hospital benefits, you will not qualify for Healthy NY.

Not sure? Call us and we can tell you if you may qualify for Healthy NY.

Yes, you can still enroll in Healthy NY.

Adult children who are 18 years of age or older do not have to include their parents’ income. They are only required to list their income. Also, if they live with a spouse, they must list the spouse's income.

Yes. If the Child Health Plus program covers your child, you can still qualify for Healthy NY. It may even save you money to enroll your child in Child Health Plus, while you and your spouse enroll in Healthy NY.

To learn more about Child Health Plus, please call us at 1-800-698-4543.

Yes, you will still be covered. Changes in household income and employment status during an enrollment year do not mean you will lose your coverage.

However, at the end of the year, there will be a “re-certification” process.  Your eligibility will be reviewed. If you no longer qualify, you will not be able to continue in the Healthy NY program. 

Note: Household income requirements change every year. This is to account for inflation. Please call us if you have questions about income requirements or re-certification.

No. You have 1 full year to meet the deductible before it resets. The year begins on the date you start coverage, and continues to reset every year on that date.

Any money you have spent towards your deductible will count.  But once the new deductible amount goes into effect you will need to meet that increased amount before regular coverage for services begins.

Your employer provides health insurance if they arrange for you to have comprehensive group health insurance (covering medical and hospital benefits) and contribute toward the cost of the insurance.

If you have had coverage from one of these programs, you can still enroll in Healthy NY.

Yes. You can get coverage for certain dependents. This includes dependent children up to age 26.

• Medicaid provides health insurance to low-income children and adults. They may or may not have jobs.
• Family Health Plus provides health insurance to low-income adults ages 19-64. These adults do not have health insurance, but make too much money to qualify for Medicaid.
• Child Health Plus offers health insurance to children under age 19. These children’s families are at higher income levels than those required under Medicaid or Family Health Plus.
• Healthy NY offers health insurance to adults who have jobs, but do not have insurance. These adults have higher income levels than those required under Medicaid or Family Health Plus.