Health Insurance That Fits Your Life

The annual federal Marketplace Open Enrollment Period generally runs from November 1 through January 15, though exact dates should be confirmed for the applicable plan year. New York's QHP Open Enrollment is announced annually through NY State of Health. Essential Plan, Medicaid, and CHIP generally allow year-round enrollment for eligible applicants. Outside these windows, a Special Enrollment Period may apply if you have a qualifying life event.

A Special Enrollment Period is a window outside annual Open Enrollment during which you may enroll in or change coverage after a qualifying life event, such as losing job-based coverage, marriage, birth, adoption, or certain moves. Not every life event qualifies. For the federal Marketplace, many qualifying events use a 60-day window before or after the event, though rules vary by event, so it's important to act promptly.

New York's Essential Plan provides low-cost or no-premium health coverage to eligible New York residents who meet applicable income, residency, immigration, and other program requirements. Enrollment is generally available year-round. Eligibility thresholds and program rules can change — current eligibility should be confirmed through NY State of Health.

Losing qualifying job-based health coverage generally creates a Special Enrollment Period for Marketplace coverage. The timing and eligibility rules depend on how and when the prior coverage ends. Marketplace coverage, COBRA continuation, Medicaid, or other state programs may be options depending on the circumstances. Marketplace coverage and COBRA can have very different premiums, provider networks, deductibles, and enrollment rules.

It depends on the plan's provider network. Do not assume that a doctor who accepts an insurance company participates in every plan offered by that company — network participation should be confirmed for the specific plan before you enroll.

Coverage depends on the plan's formulary, which places medications into different coverage tiers with different cost sharing and requirements such as prior authorization, step therapy, or quantity limits. A medication covered by one plan may be treated differently under another. We cannot guarantee that any specific medication is covered.

The deductible is the amount you may need to pay for certain covered services before the plan begins sharing more of the cost. The out-of-pocket maximum is the maximum amount a member may pay for covered in-network essential health benefits during the plan year, subject to plan terms and federal/state rules. For covered in-network services, deductibles, copays, and coinsurance may count toward the plan's out-of-pocket maximum depending on the plan and applicable rules. Not every expense counts toward the deductible or out-of-pocket maximum. Review the specific plan's Summary of Benefits and Coverage and policy documents.

These are Marketplace metal levels that describe how costs are generally shared between the member and the plan — they do not reflect the quality of doctors or hospitals. Bronze generally has lower premiums and higher cost sharing; Platinum generally has the highest premium and lowest cost sharing, where available. Cost-sharing reductions, when available, generally require enrollment in an eligible Silver Marketplace plan.

Eligible households enrolling in a Qualified Health Plan through the Marketplace may qualify for premium tax credits or other financial assistance, depending on household income, tax household information, employer coverage availability, and other factors set by current law. Marketplace financial assistance generally is not available for plans purchased outside the Marketplace.

ACA-compliant individual and small-group major-medical plans generally cannot deny enrollment or charge a higher premium solely because of a pre-existing condition. This protection applies to ACA-compliant major-medical plans and does not extend to non-ACA supplemental products, which may have their own underwriting or exclusions.

Whitestone Insurance Services LLC is currently licensed in New York, New Jersey, Connecticut, Pennsylvania, Ohio, Delaware, and South Carolina. Product availability, plan options, and Marketplace rules vary by state. Contact us to confirm what options are available where you live.