New Yorker and Family Coverage

A self-employed contractor in her late 30s lived in Manhattan with her teenage son. They were weathering the pandemic and looking forward to getting vaccinated and enjoying spring. She recently shared her family’s health insurance experience.

What were her family’s medical needs? She and her son were healthy. They had the occasional bad cold or broken arm, and they got their annual physicals, flu shots, and other preventive care.

How was she covered? Affordable Care Act (ACA). She enrolled in a plan through the New York’s federal marketplace (New York State of Health) for the first time in 2021.

How much did she spend? $400 per month. She made too much money to qualify for any financial assistance, so “it’s expensive, and the deductible makes it worse.”

How was she covered in the past? She wasn’t. She went without coverage because of the expense until this year when “the risk of COVID-19 made me get insured.”

How about her son? Father’s employer plan, which she described as “useless.” The individual deductible of $5,000 per year made if it difficult to pay her son’s out-of-pocket expenses in case of an accident or injury.

What about other New Yorkers? Nearly 95% are insured. The state has one of the lowest uninsured rates in the country thanks to its Medicaid expansion efforts and the marketplace’s communications campaign.

What else? Like many New Yorkers, the family had a cat. Unfortunately, it was not insured. The cat had asthma, so its owners spend lots of money on the vet and medications. “Who knew that I had to insure my pet?”

The Biden Administration has authorized a special open enrollment (HealthCare.Gov) to help uninsured Americans obtain coverage during the pandemic. New York has done the same on its state marketplace. While this family struggled with the cost of health insurance, it’s also Mastering Health Insurance.

Sources: KFF (2019 data); NY State of Health (Press Release: 2/20/21)

Photo: Chicago’s Lincoln Park (not NY’s Central Park)