Compare Plans

We offer a range of plans through New York’s health insurance marketplace as well as other coverage options for individuals and families.

Financial assistance: You may be eligible for tax credits to help with premiums and out-of-pocket costs when enrolling through NY State of Health (NYSOH).

Bronze

Silver

Gold

Platinum

Catastrophic

A smart choice if you want to pay less for premiums and don’t seek frequent medical care.

Monthly Premium:

In-Network Deductible:
High

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A good balance if you go to the doctor regularly but want a low premium.

Monthly Premium:

In-Network Deductible:
Moderate

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Consider this if you go to the doctor often and want a low deductible.

Monthly Premium:

In-Network Deductible:
Low

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An option if you receive frequent care and don’t want a deductible.

Monthly Premium:

In-Network Deductible:
$0

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For individuals who meet eligibility requirements.

Monthly Premium:

In-Network Deductible:
Highest

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Highlight Differences
Monthly Premium
LowestLowModerateHighLowest for those meeting eligibility requirements
Deductible
$4,125 individual/$8,250 family$2,450 individual/$4,900 family$775 individual/$1,550 family$0 individual/$0 family$10,600 individual/$21,200 family
Maximum Out-of-Pocket
$10,150 individual/$20,300 family$10,150 individual/$20,300 family$10,150 individual/$20,300 family$2,000 individual/$4,000 family$10,600 individual/$21,200 family
Summary of Benefits and Coverage
Marketplace Plans*
Off-Exchange Plans Marketplace Plans*
Off-Exchange Plans Marketplace Plans*
Off-Exchange Plans Marketplace Plans*
 Off-Exchange Plans* Marketplace Plans*
Off-Exchange Plans
Network
19 counties19 counties19 counties19 counties19 counties**
Referrals
Required for specialist visitsRequired for specialist visitsRequired for specialist visitsRequired for specialist visitsRequired for specialist visits
Out-of-Network Coverage
No coverage for nonemergency servicesNo coverage for nonemergency servicesNo coverage for nonemergency servicesNo coverage for nonemergency servicesNo coverage for nonemergency services
Preventive Care
Covered in full***Covered in full***Covered in full***Covered in full***Covered in full***
Primary Care Provider (PCP) Visits
$50 copay after deductible with up to three copay visits**** before deductible$30 copay after deductible with one copay visit**** before deductible$25 copay after deductible$15 copayThree no-cost PCP visits, then 0% coinsurance after deductible
Specialist Visits
$75 copay after deductible with up to three copay visits**** before deductible$65 copay after deductible with one copay visit**** before deductible$40 copay after deductible$35 copay0% coinsurance after deductible
Telemedicine
Covered in fullCovered in fullCovered in fullCovered in full0% coinsurance after deductible
Urgent Care
$75 copay after deductible$70 copay after deductible$60 copay after deductible$55 copay0% coinsurance after deductible
Emergency Room
$500 copay after deductible$500 copay after deductible$150 copay after deductible$100 copay0% coinsurance after deductible
Pharmacy
$10 copay for generic drugs after deductible$15 copay for generic drugs before deductible$10 copay for generic drugs before deductible$10 copay for generic drugs0% coinsurance after deductible
Gym Reimbursement
Reimbursement up to $400 per calendar year if qualifiedReimbursement up to $400 per calendar year if qualifiedReimbursement up to $400 per calendar year if qualifiedReimbursement up to $400 per calendar year if qualifiedReimbursement up to $400 per calendar year if qualified
Pediatric Dental and Vision
Coverage up to age 19Coverage up to age 19Coverage up to age 19Coverage up to age 19Coverage up to age 19
Health Savings Account (H.S.A) Compatible
YesNoNoNoYes

*Plans through NY State of Health (NYSOH).

**Catastrophic plan is available to individuals and families living in Montgomery, Otsego, and Schohaire counties who meet eligibility requirements.

***Preventive services are not subject to cost-sharing (copayments, deductibles, or coinsurance) when performed by a network provider and provided in accordance with the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA), or if the items or services have an “A” or “B” rating from the U.S. Preventive Services Task Force (USPSTF), or if the immunizations are recommended by the Advisory Committee on Immunization Practices (ACIP), or when required by state law.

****Predeductible visit(s) apply to any combination of PCP, specialist, allergy testing and treatment, chiropractic services, second opinions, applied behavioral analysis (ABA) treatment, or outpatient mental health/substance use disorder.