You Can Shop For Health Insurance on The NY State of Health
Are Cost-Sharing Subsidies For Any Health
Plan?
Important: You can get these savings on
out-of-pocket costs only if you enroll in a
“Silver-Level” plan through the NY State of
Health.
When you qualify for a premium tax credit at
or below 250% of the Federal Poverty Level
(FPL) and enroll in a Silver Plan through the
NY State of Health, cost-sharing reductions
will automatically be applied to your coverage.
Financial Assistance Terms to Know
“Cost-sharing” is how much you pay towards the
health care you receive while insured. It includes
deductibles, copayments, and coinsurance. It
does not include premiums or the cost of services
not covered under your health plan.
Deductibles are what you must pay for most
types of care before your health plan begins to
pay. For example, if your deductible is $1,000,
your plan will not pay anything for most of the
care you receive until you have met the $1,000
deductible.
- Under the federal health care law, newly
purchased plans must cover certain
preventive care services fully – you will
not have to pay a deductible or other cost-
sharing amount when you receive these
services.
• Copayments are xed dollar amounts (for
example, $20) that you pay for covered health
care services. The copay can vary depending
on the type of covered health care service.
• Coinsurance is your share of the costs of a
covered health care service. It is a percentage
of the amount the insurer decides can be
charged for the service.
- For example, if your coinsurance is 20%,
an ofce visit is $100, and you have met
your deductible, your coinsurance payment
would be 20% of $100, or $20. Your health
insurance plan would pay the rest of bill;
80% or $80.
Copyright 2019, The City of New York Human Resources Administration/Department of Social Services. For permission to reproduce all or part of this material contact the New York City Human Resources
Administration.
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