Health Care Reform Frequently Asked Questions

2014 Open Enrollment Extension for Healthfirst Leaf Plans

I still have questions.

We can help. Call us at 1-888-974-9901 (TTY: 1-888-542-3821) Monday to Friday, 8am – 8pm, or stop in to one of our Community Offices

If I miss the new deadline or don’t have a valid reason, can I still buy health insurance through the NY State of Health Marketplace before the next Open Enrollment Period?

No. Unless you are Medicaid-eligible or buying insurance for a child, you must have a major life-changing event, called a Qualifying life Event (QLE), to buy insurance through the NY State of Health Marketplace*.

Qualifying Life Events include:

  • Job loss
  • Employer no longer offers coverage
  • Marital change (divorce, legal separation, marriage, annulment, death of spouse)
  • Becoming ineligible for Medicaid or Child Health Plus
  • Expiration of COBRA
  • Birth, adoption, or placement for adoption
  • Becoming a citizen, national, or lawfully present individual
  • Permanent move to an area that has different health plan options
  • Marketplace staff or contractor enrollment error
  • Other exceptional circumstances as defined by the United States Department of Health & Human Services

If you don’t have a Qualifying Life Event, you must wait for the next open enrollment period, which begins on November 15, 2014 for coverage that starts on January 1, 2015.

 

*Please note you must apply within 60 days of  Qualifying Life Event.

Does the open enrollment extension apply to Medicaid, Child Health Plus, and Medicare?

No. New York State-sponsored programs, including Medicaid Managed Care and Child Health Plus, do not have an Open Enrollment deadline and applicants can apply any time throughout the year. 

When is my next chance to buy insurance through the NY State of Health Marketplace if I am not eligible for Medicaid?

The next Open Enrollment period for individuals and families begins on November 15, 2014 for coverage that starts on January 1, 2015. 

Enrollment, Eligibility, and Affordability

What if I can’t afford healthcare coverage?

Depending on your income and family size, you may be eligible to receive financial assistance from the federal government.  Financial help may be available for:

  • Individuals earning up to $45,960 each year
  • Couples who earn up to $62,000 each year
  • A family of four, who earn up to $94,200 a year 

Is my doctor part of the Healthfirst Leaf Network?

Healthfirst has a large network that includes thousands of doctors and specialists.  You can find a doctor and even create your own directory with our online Doctor Look-up Tool.

How can I enroll?

If you have a Qualifying Life Event, a Healthfirst representative can help you sign up for a Healthfirst Leaf Plan.

  • Click here to fill out a form and one of our representatives will contact you within 1 to 2 business days.
  • Call us at 1-888-250-2220, Monday–Friday, 8am-8pm.  We can make an appointment to visit you in your home or another location convenient to you.
  • Visit one of our many Community Offices where a representative will help you understand your health plan options. 

What services will be covered?

Healthfirst Leaf Plans cover most medically necessary and preventive services.  These are called “Essential Health Benefits,” which include:

1.       Doctor visits

2.       Emergency services

3.       Hospitalization

4.       Maternity and newborn care

5.       Mental health and substance abuse disorder services

6.       Prescription drugs

7.       Rehabilitative and habilitative services and devices

8.       Lab and imaging services

9.       Wellness visits and check ups

10.    Children’s health, including vision and dental services

Does Healthfirst offer plans on the NY State of Health?

Yes! Healthfirst Leaf Plans on the NY State of Health are for individuals and families who live in New York City or Nassau County, and they’re designed to meet all income and coverage needs.

Depending on which Leaf Plan you choose, your level of coverage (how much Healthfirst pays for covered medical expenses) will vary:

  • Healthfirst Platinum Leaf- $0 annual deductible, low copays, and an annual out-of-pocket limit of $2,000
  • Healthfirst Gold Leaf- $600 annual deductible, modest copays, and an annual out-of-pocket limit of $4,000
  • Healthfirst Silver Leaf Plans- $2,000 annual deductible, modest copays, and an annual out-of-pocket limit of $5,500.  Subsidies are available that can help reduce the Silver Leaf copays and deductibles.
  • Healthfirst Bronze Leaf- $3,000 annual deductible, 50% coinsurance, and an annual out-of-pocket limit of $6,350
  • Healthfirst Green Leaf– A health plan for people under 30 years of age.  After reaching the annual deductible of $6,350, there is no copay or coinsurance.

To get more detailed information about a specific Healthfirst Leaf Plan, please click one of the options above.  

When can I sign up for coverage?

Open Enrollment for 2014 ended on March 31, 2014. Open Enrollment for 2015 will begin on November 15, 2014 and run through February 15, 2015.

However, if you have a Qualifying Life Event (QLE), you will be able to get healthcare without waiting until the next Open Enrollment period. 

 

Who is eligible to enroll in a Healthfirst Leaf Plan?

Healthfirst offers plans for everyone: single people, couples living together, families, small business owners, and more.

To be eligible to enroll in a Healthfirst Leaf Plan on the NY State of Health, individuals must:

  • Live within the five boroughs of New York City or Nassau County. At this time, Healthfirst Leaf Plans are not available to those who live in Suffolk County.
  • Be uninsured or underinsured. People are considered underinsured if their insurance plan does not cover the Essential Health Benefits outlined by the Affordable Care Act, or if they spend more than 9.5% of their yearly income on premiums for healthcare coverage provided by their employer.
  • Not be eligible for Medicare
  • Currently purchase their own health insurance (for example, they don’t have insurance offered by their employer or another government program)

Benefits of Healthfirst, Why Health Insurance is Important

Why Healthfirst?

Healthfirst is a not-for-profit community organization sponsored by some of the most prestigious and nationally recognized hospitals and medical centers in New York. With nearly a million members and growing, Healthfirst has been serving communities throughout New York City for over 20 years. With access to thousands of doctors and specialists, you’re sure to find the service you need nearby. Each of our community offices is fully staffed with representatives who can answer your questions – in many different languages – about our health insurance plans and programs, whether you are a member or not.

Do I have to buy health insurance?

Starting in 2014, most people will be required to have health insurance or pay a tax penalty, or fee, if they don’t. There are very few exemptions.   

I am young and healthy. I don’t need insurance.

Everybody uses the healthcare system at some point in his or her life. You never know when an accident might happen or you might get sick and need to go to the hospital or see a doctor. When that day comes, the expenses could be financially devastating, and you and your family might not be able to afford the care you need. If you are young and single and don’t have any dependents you still should have insurance.  If you get sick or have an accident, your family or other people who care about you could be forced into financial ruin in order to cover your medical expenses.  Health insurance also gives you access to free preventive services and primary care to keep you healthy. Getting covered will give you peace of mind. It is better for your health, your wallet, and your future.

General ACA and New York State of Health Questions

What is a Qualified Health Plan?

A Qualified Health Plan (QHP) is a plan that has been approved by New York State to be sold on the NY State of Health.  At Healthfirst, our QHPs are called Healthfirst Leaf Plans.

All Healthfirst Leaf Plans cover these ten categories of Essential Health Benefits:

1.       Doctor visits

2.       Emergency services

3.       Hospitalization

4.       Maternity and newborn care

5.       Mental health and substance abuse disorder services

6.       Prescription drugs

7.       Rehabilitative and habilitative services and devices

8.       Lab and imaging services

9.       Wellness visits and check ups

10.    Children’s health including vision and dental

How do I know if I can get health insurance through the NY State of Health?

The great news is that insurance through the NY State of Health is for just about anybody who doesn’t have insurance or who is underinsured. This includes people who:

  • Live in New York State
  • Are not eligible for Medicare
  • Are a U.S. citizen or legal resident
  • Are uninsured or underinsured. People are considered underinsured if their insurance plan does not cover the Essential Health Benefits outlined by the Affordable Care Act, or if they spend more than 9.5% of their yearly income on premiums for healthcare coverage provided by their employer.
  • Currently buy insurance on their own 

I’m an immigrant. Can I get insurance through the NY State of Health

Yes, there are many ways to get help if you don’t speak English. At Healthfirst, our representatives are trained Certified Application Counselors (CACs) who are able to communicate with you in your language and will be located in communities throughout New York City and Nassau County.

You can call Healthfirst at 1-888-250-2220, Monday-Friday, 8am-8pm.  Our representatives speak Spanish, Chinese, Russian, and many other languages.  We can even make an appointment to visit you in your home or another location convenient to you.

The NY State of Health  website will be available in English, followed by Spanish. You can also call the NY State of Health customer service center at 1-855-355-5777. 

Can I get help if I don’t speak English?

Yes, there are many ways to get help if you don’t speak English. At Healthfirst, our representatives are trained Certified Application Counselors (CACs) who are able to communicate with you in your language and will be located in communities throughout New York City and Nassau County.

You can call Healthfirst at 1-888-250-2220, Monday-Friday, 8am-8pm.  Our representatives speak Spanish, Chinese, Russian, and many other languages.  We can even make an appointment to visit you in your home or another location convenient to you.

The New York State of Health  website will be available in English, followed by Spanish. You can also call the New York State of Health customer service center at 1-855-355-5777. 

Will there be an option for parents to choose a plan for their children?

Yes, parents will be able to choose a plan for their children.  Parents can enroll their children in:

  • a Healthfirst Leaf Plan family plan
  • a child-only Healthfirst Leaf Plan
  • a Child Health Plus plan
  • or in Medicaid, depending on eligibility

What happens if I apply through the NY State of Health and lose my job or have a change in income?

Life-changing events are also called Qualified or Qualifying Life Events (QLE). These kinds of events can include birth or adoption, marriage, divorce, a new job, a raise or change in hours, or job loss. When you have an event like this, you will be able to go back to the NY State of Health to see if you qualify for different health plans or to get help paying for your health plan.

If you need help at any time, you can call Healthfirst at 1-888-250-2220, Monday-Friday, 8am-8pm, and we can help you pick a plan that is right for you.

What if I can’t afford health insurance?

You can get help paying for your health insurance depending on your family size, income, and the health plan you choose. This help is also referred to as a “subsidy” or “federal tax credit.” People with incomes up to $45,960 for an individual and $94,200 for a family of four may be eligible for help. 

To find out if you qualify for a subsidy, you can:

  • Call us at 1-888-250-2220, Monday – Friday, 8 am – 8 pm.  We can make an appointment to visit you in your home or another location convenient to you.
  • Visit one of our many Community Offices where a representative will help you understand your health plan and subsidy options. 

You can also go directly to the NY State of Health website or call the NY State of Health customer service center at 1-855-355-5777.

What about Individuals who make more than $45,960 or families of four who earn more than $94,200?

Individuals who make more than $45,960 or families of four who earn more than $94,200 will be able to purchase health insurance through the NY State of Health but will not be eligible to receive a subsidy.

What are key dates for purchasing health insurance through the NY State of Health?

Open Enrollment for 2014 ended on March 31, 2014. Open Enrollment for 2015 will begin on November 15, 2014 and run through February 15, 2015.

However, if you have a Qualifying Life Event (QLE), you will be able to get healthcare without waiting until the next Open Enrollment period. 

Do I need to renew my insurance every year?

Yes, you will need to renew your insurance every year. You will get a reminder ahead of time asking you to renew your insurance plan.

To renew your insurance, you can:

  • Call us at 1-888-250-2220, Monday – Friday, 8 am - 8 pm.  We can make an appointment to visit you in your home or another location convenient to you.
  • Visit one of our many Community Offices where a representative will help you understand your health plan options. 

You can also go directly to the NY State of Health website to view your choices, or call the NY State of Health customer service center at 1-855-355-5777.

What are Obamacare, the Affordable Care Act, and Healthcare Reform?

All of these terms refer to the federal law that was passed in March 2010 — as well as any state laws passed to implement it. These laws are intended to help more people get access to affordable healthcare coverage and receive better medical care.

What is the NY State of Health?

New York State created a health insurance marketplace, or exchange, called NY State of Health, to help individuals and small businesses shop for health insurance. The NY State of Health website opened on October 1, 2013.

On the NY State of Health website, consumers can shop for health plans, like Healthfirst Leaf Plans.

What can I do at the NY State of Health website?

On the NY State of Health, you can: 

  • Compare plans and choose the one that best fits your needs and budget
  • Fill out an application to enroll in any plan offered
  • Get help online, over the phone, or in person.  If you need help enrolling, please call Healthfirst at 1-888-250-2220, Monday – Friday, 8am – 8pm
  • You can find out which tax credits and other subsidies you may be eligible for to help lower the cost of your healthcare

People without internet access can also call the NY State of Health customer service center at 1-855-355-5777.    


* This information should be used as a guide and is subject to change based on rules and regulations released from the New York State Department of Financial Services and the United States Department of Health and Human Services. For the most up to date information, please refer to http://healthbenefitexchange.ny.gov/ or http://www.healthcare.gov/marketplace/index.html