Improving Affordability of Marketplace Plans: Key Wins from the 2025 NYSOH Plan Invitation

Posted May, 10 2024 by Mia Wagner

New York State of Health (NYSOH) has included several exciting new initiatives in its 2025 Plan Invitation. Though some of the initiatives are subject to federal approval, HCFANY is thrilled about the improvements to the quality and affordability of health insurance plans offered on the NYSOH marketplace. Here are some key wins for consumers:

  • Eliminating in-network cost-sharing for New Yorkers with diabetes in State-regulated plans. The program applies to medical care, prescription drugs, supplies, and diagnostics related to the primary diagnosis of diabetes.
  • Cost-sharing subsidies for low- and moderate-income New Yorkers on Qualified Health Plans (QHP) with incomes up to 400 percent of the Federal Poverty Level (FPL), or $125,000 for a family of four. If approved, NYSOH will use $315 million of federal waiver passthrough funding that was allocated for these subsidies in the 2024-25 State Budget.
  • Expanding maternal health cost-sharing initiatives to QHPs to allow pregnant and post-partum New Yorkers to access zero copay care for almost all diagnoses and services through 12 months postpartum.
  • Eliminating waiting periods for standalone dental plans offered through NYSOH for all adult dental services (exception for orthodontics), allowing New Yorkers to use the coverage they are paying for.