Living in New York is a double edged sword when it comes to health insurance. We have the advantage of many mandated benefits – chiropractic care, maternity coverage, mental health coverage, portability of coverage, no medical underwriting etc. All these marvelous things come with a hefty price tag.
Along comes Healthy New York, a plan subsidized by the state meant to cover people who fall into the abyss of no health insurance. Individuals and Sole Proprietors with limited income who either don’t have or have lost coverage and businesses who haven’t provided (or contributed less than $50 per month) coverage for their employees can be eligible.
The coverage is a Health Maintenance Organization (HMO) plan design however, because it is a government plan many of the mandates don’t apply to these plans. Because it is an HMO the insured must chose a primary care physician and use providers only within the network of the company they have chosen to use. The plan design is identical from one company to the next and the purchaser can chose from any company which is marketing in the county of residence or business domicile.
Premiums for Healthy NY products are about 3/5 the cost of a non-subsidized equivalent plan. The plan has physician co-payments of $20 and hospital co-payments of $500 depending on the company used referrals may be required for specialist care. Prescriptions are covered however there is a $100 deductible per calendar year a $10 co-payment for generic drugs and brand-name drugs have a $20 co-payment plus the difference in cost between the brand-name drug and generic equivalent (if a generic exists).
The plan does have limitations however because Healthy NY has a streamlined benefits package, certain services are not covered such as; mental health services and prescriptions to treat such, alcohol and substance abuse treatment, chiropractic care, hospice care, home health care (unless post surgery), physical therapy (unless post surgery), and last but not least ambulance transportation.
Locally the last limitation, lack of ambulance transportation, has caused some serious difficulties. As most readers are aware our two local hospitals have merged, what some people are not aware of or have forgotten in the stress of the situation is that we now only have one emergency room and it is at the Kingston Hospital. If you are one of the unfortunate to have an emergent situation and go to the Benedictine Hospital they will send you by ambulance to the other location. They are bound by regulations to do this. That very short trip has a very large bill attached to it of around $1000. Although the emergency room would be covered for the Healthy NY patient with the very slight co-pay of $50 the ambulance trip would be declined by the insuring company.
Healthy New York is a wonderful program for those who qualify and like all plans the insured should be aware of its limitations as well as its benefits. For this and all employee benefit you can contact