Individuals & Families:
Lower Your Medical Costs
Cost-Sharing Reductions
Available in NY State of Health
Some individuals and families who buy insurance
in the state-run NY State of Health, the Ofcial
Health Plan Marketplace, will be able to get
cost-sharing reductions that will allow them to
pay less when they receive health care.
You can nd out if you qualify for free or lower
cost health insurance through the state-run NY
State of Health by visiting nystateofhealth.ny.gov
What Are Cost-Sharing Reductions and How Do They Work?
Cost-sharing reductions lower how much you pay when you receive health care services. They can lower
your deductibles, copayments, co-insurance, and total out-of-pocket spending – but only if you enroll in a
“silver” level plan in NY State of Health. You may also be eligible for savings on your monthly premiums,
called Premium Tax Credits. You must qualify for a premium tax credit in order to receive cost-sharing.
Learn more from our fact sheet Understanding Your Premium Tax Credit: Options for Individuals and
Families.
The amount of the cost-sharing reduction you may receive depends on your income. The lower your
income, the more help you may get.
• Individuals and families with incomes between 200% and 250% of the Federal Poverty Level (FPL) can
get help with their deductibles, copays and co-insurance, so they can pay less each time they go to the
doctor or need other health care services.
- For example, 200% - 250% of the FPL equals income between $24,980 - $31,225 for an individual,
and $51,500- $64,375 for adults in a family of four.
- Individuals with lower incomes (below 200% FPL) may qualify for Medicaid or the Essential Plan at
low-or no-cost.
To learn more about health care reform and see if you qualify
for cost-sharing reductions, visit the NY State of Health at
nystateofhealth.ny.gov, or call 1-855-355-5777.
HEALTH
INSURANCE
LINK
FLY-927 (E)
Rev. 11/19
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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