ABCs of Health Care Reform

The Affordable Care Act, or ACA (the U.S. health care reform law) makes quality, affordable health care more widely available and offers financial help to those who need it most. It also requires most U.S. residents to have health insurance or pay a penalty.

Get to know the ABCs of health care reform — and how it benefits you:

+ Affordability

The ACA set up "exchanges" in each U.S. state. These are online marketplaces where people can purchase insurance and access the financial assistance available through the ACA. New York's exchange is called the NY State of Health Marketplace.

See if you qualify for any of the following types of financial assistance on the Marketplace:

  • Lower costs, including:
    • Tax credits to help pay premiums (monthly cost of a health plan)
    • Cost-sharing subsidies to help pay any applicable deductible, copays and coinsurance
  • Essential Plan. At a $0 or $20 premium, this plan is available to adult individuals age 21 and older (but not families) who are eligible based on income and other factors.
  • Medicaid. A health plan with a $0 premium, and benefits at little to no cost. Due to health care reform, more people are now eligible for Medicaid.
  • Child Health Plus. This is a low-cost plan for young people age 19 or younger.

+ Benefits

Individual health insurance plans offer access to quality, affordable health care coverage.

  • Preventive care at no extra cost. 100% coverage for certain preventive care services received from an in-network doctor.*

  • 10 essential health benefits. Coverage for 10 categories of essential health benefits, including doctor visits, hospital care, prescription drugs, lab services, maternity care, and mental health and substance use services.

  • Pre-existing conditions covered. Guaranteed coverage for qualifying individuals with a pre-existing condition, at the same premium cost as anyone else.

  • Extended dependent coverage. Children and young adults can stay on a parent’s insurance up to the first month after their 26th birthday. In New York, this extends through their 29th birthday, for an added cost.

+ Choice

Depending on your eligibility, you can choose from several types of health plans, through various channels, to meet your needs. Use our Affordable Care Advisor to explore our plans and start enrolling.

Here are the different ways to enroll:

  • Through the NY State of Health Marketplace. This is New York State's health insurance exchange. It offers qualifying individuals lower-cost coverage from private health insurers. You can purchase plans here even if you don't qualify for financial assistance. Depending on your eligibility, you can choose from "metal plans" (Platinum, Gold, Silver and Bronze), catastrophic plans, $0 or $20 Essential Plan, Medicaid and Child Health Plus.
  • Directly from health insurers like EmblemHealth. If you don't qualify for financial assistance, you can purchase a plan directly from us, including "metal plans" (Platinum, Gold, Silver and Bronze), a catastrophic option or Medicare Advantage if you're 65 or older.
  • Through your employer, if insurance is offered. If the employer's insurance is considered too costly based on your income, you may be able to sign up for health insurance through the NY State of Health Marketplace. Check with your health benefits administrator at work.

*Non-preventive care services received from an in-network health care provider may be subject to any applicable deductible, copay or coinsurance.

Have questions?

Check our FAQs for answers on EmblemHealth's individual and family plans on and off the NY State of Health Marketplace.