Home › Blog › Same Person, Same New York ZIP, Two Very Different Health Insurance Prices
Same Person, Same New York ZIP, Two Very Different Health Insurance Prices
Here's a real pattern we see every week in New York. Same person, same ZIP code, same month — and two quotes that are hundreds of dollars apart. Here's why.
The person
A 50-year-old self-employed consultant in New York City. Healthy, no medications, earns about $110,000. No subsidy.
Quote one: NY State of Health
Full-price Silver PPO-style plan from one of Fidelis Care, Healthfirst, Anthem (Empire), EmblemHealth, MVP, and Oscar: around $900 a month in 2026, $5,000 deductible, network concentrated around New York City. The price has nothing to do with his health — guaranteed-issue plans can't ask.
Quote two: private shared-network
A PPO on the MagnaCare PPO network: around $450 a month, $2,500 deductible, national network. The price has everything to do with his health — he answered a questionnaire and qualified.
Why both prices are "right"
They're answering different questions. The marketplace asks "what does it cost to insure everyone?" and spreads it evenly. The private plan asks "what does it cost to insure you?" For a healthy person, the second question has a lower answer. For someone with a serious condition, it wouldn't — and the marketplace would be the better deal.
What it means for you in New York
New York uses pure community rating — a 25-year-old and a 64-year-old pay the same marketplace premium — and the state restricts most non-ACA plans. Private options in New York are narrower than in other states, so the honest answer here is usually a careful comparison, not a promise of savings. If you're healthy and above the subsidy line, you should see both numbers before you renew. Check your options.