Helping you get enrolled

clayton & candra got you covered

The health insurance enrollment process can be overwhelming. Take a look at these entertaining videos on health insurance literacy for navigators, assistors, and consumers brought to you by Cover Missouri, a project of the Missouri Foundation for Health (MFH). They touch upon major issues and questions that you may encounter during the application process such as what questions to ask when you are on the phone with your carrier, common misconceptions of the Affordable Care Act, and how to find a primary care provider.

Check them out on YouTube:

Helping consumers talk with their insurance company

Myths and misconceptions of the ACA

Helping consumers find a primary care provider

Helping consumers understand the importance of preventive care

How to calculate Modified Adjusted Gross Income (MAGI)

uncle sam

The time to enroll or renew your coverage on the NY State of Health (NYSOH) Marketplace is just a few days away! Nearly 2.6 million people have enrolled in the Marketplace since its launch in 2013. We can continue to make progress by making sure more New Yorkers get enrolled and those who are covered maintain their coverage.

How it works and what you can do:

  • Visit the Marketplace and look at available options – even if you are satisfied with your current coverage. The Marketplace continues to change, and this year you may find a plan that better suits your needs.
  • See if you qualify for the new Essential plan for low- and moderate- income New Yorkers. You could get comprehensive coverage for yourself and your family for $0 or $20 per person per month!
  • There are options to make the process of enrollment or renewal easier. You may go online and search through the Marketplace, call the Community Health Advocates helpline at 1-888-614-5400, or visit an in-person assistor in your community.

A few important dates for new enrollees:

  • The Third Open Enrollment Period begins on November 1, 2015, and continues through January 31, 2016.
  • To get coverage that begins January 1, 2015 you must enroll by December 15, 2015.
  • For coverage starting February 1, 2016 you must enroll between December 16, 2015 and January 15, 2016.
  • For coverage starting March 1, 2016 you must enroll between January 16, 2016 and January 31, 2016.

For returning consumers, the re-certification period begins on November 15, 2015:

  • To make sure you do not have a gap in coverage, you must renew your coverage between November 15, 2015 and December 15, 2015 for coverage that begins on January 1, 2016.

If you miss the re-certification deadline, your coverage stop after December 31, 2015 and you will not be insured for a certain time period:

  • For coverage that begins on February 1, 2016 you must renew your coverage between December 16, 2015 and January 15, 2015 (coverage gap is 1 month).
  • If you renew your coverage between January 15, 2016 and January 31, 2016, your coverage will begin on March 1, 2016 (coverage gap is 2 months).

Make sure to get coverage to stay healthy and avoid the increasing tax penalty. Remember, the penalty for not being covered is rising to the greater of $695 per person ($347.50 per child under 18) or 2.5% of your family yearly taxable income in 2016!

Guest post: Bob Cohen, Policy Director, Citizen Action of New York


Close to 70 health insurance Navigators and representatives of hospitals, unions, health plans and community groups from the Capital District, the upper Hudson Valley and the North Country assembled on October 8th for the area’s third annual Outreach and Enrollment Summit. They shared best practices and worked in partnership to better coordinate activities in the region to get New Yorkers covered.

Like the others in the summit series sponsored by the Healthcare Education Project, HCFANY and other organizations, the Capital Region Summit was designed to build on the success of the New York Marketplace in enrolling over 2.5 million New Yorkers so far. The summit was kicked off by two outstanding Marketplace representatives – Executive Director Donna Frescatore and Chief Marketing and Outreach Officer Margo Janack – who detailed the agency’s outreach plans for the third year of Open Enrollment, which begins on November 1. The NY State of Health plans to expand the number of New Yorkers with health coverage through a variety of tactics, including: e-mails targeting the uninsured, stepped-up social media, outreach at cultural heritage events, networking with faith-based organizations, and partnering with community businesses like pharmacies and grocery stores.

An engaging panel of local advocates led participants in brainstorming innovative ideas to sign up area residents, and these discussions continued in the breakouts that followed. The panel included Navigator Veronica Fitzpatrick of Public Policy and Education Fund, which serves the Capital District and the Hudson Valley; Navigator Susan White of Nathan Littauer Hospital, which serves Fulton and Montgomery Counties; and Laden Alomar, Executive Director, Centro Civico, which serves Latinos in Albany and Montgomery Counties. Among the many suggestions were going into jails to enroll incarcerated individuals and working with refugee groups.

But the excitement didn’t stop with the Enrollment Summit! On October 19, Citizen Action of New York, 1199SEIU and HCFANY held a press conference to publicize the start of Open Enrollment in the Capital Region. It featured speakers from the NY State of Health, the mayors of Albany and Troy, the Albany City Treasurer, Congressman Paul Tonko (20th C.D.), and a local consumer who spoke about of the value of having a Navigator to help him to enroll smoothly. Four area television stations and the area public radio station covered the event. (See this example of the coverage: Follow-up groups convened during the Summit also plan to work on a menu of activities, including social media, tabling and conference



Today the New York State of Health Marketplace announced which health insurance carriers will be offering plans on the Marketplace for 2016. This encompasses Qualified Health Plans for both individuals and small businesses, the new Essential Plan, and stand-alone dental plans.

The 200,000 individuals who hold policies with Health Republic will have to go shopping for new plans when Open Enrollment begins on November 1st. The CO-OP is winding down operations and no longer issuing renewals. The good news is that sixteen carriers will offer individual QHPs in 2016, and eight for the Small Business Marketplace (SHOP). The definition of a small business is new for 2016: firms with 100 or fewer full time equivalent employees can use SHOP – up from 50 employees in 2015.

While insurers and consumers alike are new to the Essential Plan, there is a strong show of support with 13 carriers offering plans for 2016. Consumers can use this interactive map to see which plans are offered in their county. Some counties, like the Bronx, have eight plans on offer, while New Yorkers in other counties, like Putnam and Schoharie, will only have one plan option if they qualify for the Essential Plan.

The stand-alone dental market is largely the same as 2015, with 11 carriers offering plans, 3 of which offer plans in every county in the state. The maps for dental, individual, and small business plans are available here.