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Why Are People in New York Paying $1,200+ a Month for Health Insurance?
Every January we hear the same thing from New Yorkers: "My premium is $1,200 and I never go to the doctor." Here's why that happens.
Reason 1: you're above the subsidy line
Marketplace plans are built around the premium tax credit. If you earn too much to get it, you're paying the sticker price designed to be subsidized. Nobody tells you that's what happened.
Reason 2: guaranteed issue has a cost
NY State of Health plans must accept everyone regardless of health, and can only price on age, location and tobacco. A healthy 45-year-old and a 45-year-old with multiple chronic conditions pay the same. The healthy person is subsidizing the pool.
Reason 3: New York's market
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. New York has no individual mandate penalty, but it has the strictest insurance rules in the country.
The option most people were never shown
Private shared-network plans — PPOs on the MagnaCare PPO networks — price on your health instead of your income. For a healthy person they are often $400–$700 a month less than full-price marketplace coverage, with a national network. They aren't for everyone: there's a health questionnaire, and serious pre-existing conditions can be declined. But if you're healthy and over the subsidy cliff, you're exactly who they were built for.
If you're paying $1,200 a month, you deserve to see the alternative. Check your options — it takes 60 seconds.