NEW YORK 2016 Individual Plan Primer

GENERAL
If your income is below 200% of the Federal Poverty Level (FPL) you may qualify for the new Essential Plans.  We will quote them if that is an option.

SKINNY NETWORKS
It is imperative that you check with your physician before selecting a plan.  Carriers continue to shrink the size of their networks under ObamaCare.

United Healthcare/Oxford
IMPORTANT – they are using their new Metro Network ONLY.  This is a smaller network and does not include Lenox Hill, Lutheran Medical Center, NS-LIJ, NYU, or Northern Westchester/Phelps hospital networks.  While Stonybrook is in-network, their physicians group is not in network, it is imperative that you check with your physician before selecting a plan.

There will be no out of network coverage available from any carrier this year.

CVS drug stores are no longer part of the network.

OSCAR
Stonybrook hospital is not included
All plans have no charge for PCP and no coinsurance
SIMPLE Plans – you pay  full price for specialists and drugs
SIMPLE+ Plans – $50 for specialist and preferred drugs
CLASSIC – Full Price for Specialist
MARKET – Better Drug Card

EMPIRE
They have a small hospital network called the Pathway network, and a small physicians network.  We are not recommending their individual product at this time.

AETNA
They are no longer actively marketing.