Review the most frequently asked questions about the health care enrollment process.
Pre-Enrollment
Q: What documents are needed?
A: See Enrollment Documents for information you or your client should be prepared to share at appointment time.
Q: Would I qualify for coverage?
A: Anyone can apply during Open Enrollment. Certain circumstances qualify for a Special Enrollment Period (SEP). See the Special Enrollment Period Fact Sheet for details.
Q: How do I get insurance? Where do I go? Who do I call?
A: AHI can help – see Enrollment Services or call 1-866-872-3740. Or you can call NY State of Health (NYSOH) directly at 1-855-355-5777.
The Process
Q: Can I enroll myself by computer or do I need personal help?
A: Apply on the NYSOH website directly at https://nystateofhealth.ny.gov or call AHI for assistance, free of charge, at 1-866-872-3740.
Q: My income has changed, what do I do?
A: All income changes should be reported to NYSOH by calling 1-855-355-5777.
Q: Do I have to renew my coverage?
A: New York State will send a renewal notice directly to you. If nothing has changed, no action on your part is necessary and you will be renewed in the same plan you had last year.
Q: What does levels of insurance mean?
A: See Levels of Insurance for more information.
Q: How do I get assistance in signing up for coverage?
A: Request an appointment or call AHI at 1-866-872-3740.
Q: Does my doctor accept my insurance? How can we find doctors that take my insurance?
A: Each plan has its own unique network of doctors and providers. You can visit their website or call their customer service center to find out if your doctor or provider is a ‘participating’ provider with the Marketplace plans.
Q: Is health insurance affordable?
A: The State is working to make insurance affordable for all, by expanding the Medicaid guidelines, making tax credits and cost share reductions available, as well as creating a new Essential Health Plan, which will be available beginning 1/1/2016. For more information regarding the Essential Health Plan, please contact AHI at 1-866-872-3740.
Post-Enrollment
Q: I need help resolving billing issues.
A: The plans can be contacted directly to resolve billing issues. If additional help is needed, Community Health Advocates and the Southern Adirondack Independent Living Center (SAIL) are here to help. Contact Community Health Advocates (CHA) at 1-888-614-5400 or the Southern Adirondack Independent Living (SAIL) at 518-584-8202, or 518-792-3537.
Q: Who do I contact for customer service after the enrollment process?
A: Always start with your plan first. Their phone number is on your ID card and their customer service staff should be able to help. If you do not get the help you need from the plan, contact CHA at 1-888-614-5400, or SAIL at 1-518-584-8202, or 518-792-3537, and they will help you.
Q: How do I know the type of insurance I have?
A: The plan you have insurance with is clearly identified on your ID card, as well as the specific type of coverage (metal tiers: Platinum, Gold, Silver, Bronze), Medicaid, or Child Health Plus. When in doubt, call your insurance company’s customer service number and ask what type of coverage you have. They can also answer questions about what services are covered and what doctors participate.
Information Needed
Q: What if I fall into the Medicare coverage gap (a.k.a. the ‘donut’ hole)?
A: People with Medicare who get Extra Help paying Part D costs won’t enter the coverage gap. If you meet certain income and resource limits, you may qualify for Extra Help from Medicare to pay the costs of Medicare prescription drug coverage. In 2015, you may qualify if you have up to $17,655 in yearly income ($23,895 for a married couple) and up to $13,640 in resources ($27,250 for a married couple). If you don’t qualify for Extra Help, there may be programs that can help pay your prescription drug costs. Contact the State Health Insurance Assistance Program (SHIP) for more information. You can reapply for Extra Help at any time if your income and resources change.
Q: Do you have a resource list of providers with accepted insurances?
A: The list of participating providers changes periodically, so providing a list would prove unreliable. The best way to know for sure is to contact the insurance plan directly and ask if the provider you are looking for participates with the Marketplace plans.
Q: Do they have availability on nights or weekends?
A: Some provider offices are open nights and weekends. The best source of this information is the customer service department of the plan. They should be able to provide you with a list of providers and their hours.
Q: I have concerns about a tax penalty and how to fix it.
A: The best way to fix the tax penalty is to get insured as soon as possible. If you do not qualify for the Special Enrollment Period, the next Open Enrollment period begins on 11/1 and ends on 1/31. See the Special Enrollment Period document for more information.
Q: What are Special Enrollment Period (SEP) qualifiers?
A: See the Special Enrollment Period document for more information.
Q: How is insurance affordable? I don’t necessarily have money for copays and deductibles. I have a fear of penalty vs. cost of premium.
A: The new Essential Health Benefit plan may be a better option because is has low or no monthly premiums. You can explore your options by calling AHI at 1-866-872-3740 for an appointment to review this new plan. Sign up for coverage begins 11/1 for coverage starting 1/1.
Q: Should owners of small businesses choose to pay the penalty as it seems cheaper than purchasing insurance?
A: Employees of small businesses can apply for individual insurance in the Marketplace in order to get covered. However, the small business owner penalty for not offering insurance goes up every year – it may not be cost effective to avoid offering. The threshold for a small business goes up to 100 employees in 2016 from 50 employees in 2015.
Q: Do I have to wait for open enrollment to apply?
A: Yes, if you do not qualify for the Special Enrollment Period.
Q: Is there a need to change my physician if I join Child Health Plus (CHP) or Medicaid?
A: There is a possibility that your doctor does not participate with all plans. The best way to be sure is to call the doctor’s office or the insurance plan you are thinking of joining and ask if the doctor participates with CHP and/or Medicaid, or any other Marketplace plans.
Q: Can you pay my bill or cover my services?
A: We can’t pay your bill, but we can suggest that you work with your doctor or provider’s office to set up a payment plan, or ask if you qualify for a sliding fee arrangement.
Q: Can I get Child Health Plus if I have employer insurance?
A: Yes, you can enroll your children in Child Health Plus, even if you are offered employer-sponsored insurance. We encourage shopping for Child Health Plus for your kids as it is excellent coverage and is often a more affordable option for families. If your children are currently covered by employer insurance, you can check out Child Health Plus, as an alternative, during open enrollment.
Need assistance?
Receive guidance through the enrollment process. Request an Appointment for free help from an enrollment specialist.
