New York State  of Health  Exchange —

MEDICAID — Individuals eligible for Medicaid or Child Health Plus and American Indians/Alaskan Natives can enroll at any time during the year  on the New York State of Health website.   This is for people under age 65 who do not have Medicare (with some exceptions for Medicare beneficiaries who live with dependent children, grandchildren or certain other family).   They may qualify for “MAGI Medicaid” under the Affordable Care Act.   Contact a Navigator or Community Health Advocates for help. 

  •  People with Medicare  or who are age 65+ must apply for Medicaid at their local Medicaid office using a paper application. During the pandemic, NYC HRA is accepting applications by fax.   See more here (NYC)(outside NYC)

Qualified Health Plans — Open enrollment began Nov. 16, 2021 and goes through Dec. 31, 2021. See here

  • This is for people whose income is above the Medicaid level, but who may still be eligible for premium and co-insurance subsidies based on their income.  

  • Individuals and families can enroll in coverage  outside of this open enrollment period if they qualify for a “special enrollment period” (“SEP”). Click here to learn more. And see more info about the Special Enrollment Periods – FAQs, webinars, directives that allow some people to enroll in a Qualfied Health Plan and in premium and co-insurance subsidies any time during the year — here

  • Small Business Owners and Employees interested in the Small Business Marketplace — enrollment in the small business marketplace is available all year long.  

Background on the Affordable Care Act and the New York State Exchange.  New York is is one of a small group of states to establish its own health insurance Exchange.  Health reform consists of two laws. The first and larger of the two is the Patient Protection and Affordable Care Act (PPACA) signed on March 23, 2010, and the second is the Health Care & Education Reconciliation Act, signed on March 30, 2010. Federal health reform contains many provisions which affect both public health insurance programs, such as Medicaid and Medicare, and private health insurance including the health insurance many people either get through their employer or purchase directly. The provisions of the health reform laws go into effect on a staggered basis, with some provisions going into effect immediately, but most going into effect in 2014.

See links to information on MAGI Medicaid under the Affordable Care Act here and NYS directives here. 

Here are some suggested resources:

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Affordable Care Act –New York State Health Exchange Open Year-Round for Medicaid Applications and for Certain “Special Enrollment” categories