What types of individual health plans does EmblemHealth offer?
EmblemHealth offers New Yorkers a wide range of plan choices, as described below. Your eligibility may depend on certain factors, such as income, age, and the county you live in.
- Both Standard and Nonstandard plans: Standard plans are those whose benefits and out-of-pocket costs are defined by New York State and are the same across insurers offering these plans in the State. Nonstandard plans are those whose benefits and out-of-pocket costs are defined by the health insurer offering the plans and are unique to that insurer.
- Both on and off the Marketplace: We offer four types of standard metal plans, two nonstandard metal plans (EmblemHealth Silver Value and EmblemHealth Bronze Value), a catastrophic option (EmblemHealth Basic), and dental and vision plans for adults and kids. These plans offer the same benefits both on and off the Marketplace. Review our plans.
- On the Marketplace only: We offer the Essential Plan (lower-cost plan for individuals only), Medicaid ($0 premium) and Child Health Plus (lower-cost plan for young people under age 19).
- Off the Marketplace only: We offer Medicare Advantage for individuals age 65 and older, and individuals younger than 65 with certain disabilities.
What's the difference between the metal plans?
All the standard metal plans (Platinum, Gold, Silver and Bronze) and the catastrophic option offer the same medical benefits, but with different cost-sharing (deductible, copays and coinsurance). In general, the higher your premium (monthly plan cost), the lower your cost-sharing — and vice versa.
- Visit the doctor often? You may want to choose a plan that costs more per month (like Platinum or Gold), but has lower out-of-pocket costs.
- Don't see the doctor often? You might choose a plan that costs less per month (like Silver or Bronze), but has higher out-of-pocket costs.
What's the difference between the EmblemHealth "metal" plans and the Essential Plan?
Qualified Health and Essential Plans have similar health benefits, but different ways of providing financial assistance. With the Qualified Health metal plans (Platinum, Gold, Silver and Bronze) you may be eligible for tax credits to lower your monthly premium or cost-sharing subsidies to lower your out-of-pocket costs (deductible, copay and coinsurance). With the Essential Plan, the cost savings are built in, through a $0 or $20 premium, no deductible, and copays as low as $0.
Which doctors are in EmblemHealth's network?
Our Qualified Health plans use our Select Care and Prime network, and our Essential Plan uses our Enhanced Care Prime network. All three networks include thousands of experienced primary care physicians and specialists, plus facilities and leading hospitals. This includes AdvantageCare Physicians, a multispecialty physician group practice providing team-based care at 35 locations throughout NYC and Long Island.
Use our Find a Doctor tool to check for doctors that participate in the plan you have or are interested in. It's also a good idea to call doctors to confirm they participate.