Qualified Health Plans (QHP) are comprehensive, private health plans offered through the New York State of Health marketplace (NYSOH). These health plans have been certified by New York State and meet certain requirements, including providing you with care for essential health benefits and having enough doctors in your area.
Who may qualify to purchase a QHP?
You may qualify to purchase a QHP, if:
- You are a New York State resident
- You are a US/Naturalized Citizen
- You are a Lawful Permanent Resident “Green Card” holder, in the US for more than five years
- You are a Cuban/Haitian entrant
- You are from Compacts of Free Association states (COFA)—citizens of Micronesia, Palau and Marshall Islands
- You are not eligible for Medicaid, Essential Plan or Child Health Plus
Please note:- DACA individuals are no longer eligible to purchase QHP’s from the New York State of Health marketplace but can enroll directly with individual insurance companies.
- Other non-citizens may be eligible for QHP and tax subsidies until January 2027.
How much does a QHP cost?
The monthly premium you pay for a QHP will depend on the health plan you pick. You may be eligible to receive tax credits that can lower your monthly costs. Tax credits are calculated based on your income, household size, and where you live. Your cost-sharing, or the amount you pay when you receive health care services including co-pays, co-insurance, and deductibles, will depend on the health plan you pick. However, once you reach you maximum out-of-pocket (MOOP) cost, the plan will pay 100% of your medical cost.
What services will a QHP cover?
A QHP will cover essential health benefits (EHBs), including:
- Free preventive care
- Inpatient care
- Outpatient services
- Maternity and Newborn Care
- Mental Health and Substance Abuse Disorders
- Emergency services
- Lab and imaging
- Prescription drugs
- Rehabilitative and habilitative services
- Wellness and chronic disease management services
- Pediatric Services, including Oral and Vision Care
How do I enroll in a QHP?
You can enroll in person, online, or over the phone. If you need assistance enrolling into a QHP or want more information, please contact CHA at 888-614-5400.