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Family Health Agency

Frequently Asked Questions

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This plan has been endorsed and subsidized by the New York State government. As such, those eligible for the plan may receive health insurance (including dental and vision care) for free.

The plans cover the same mandatory services covered by other plans sold in New York. These services are known as Essential Health Benefits. In broad terms this includes:

  • Doctor visits, including specialists

  • Tests ordered by your doctor

  • Prescription drugs

  • Inpatient and outpatient care at hospital

  • Physical examination

  • Dental and vision care(Please refer to specific plan)

Unfortunately not. As the Essential Plan is subsidized by the New York State government, only New York State medical centers are included. When you are outside the service area (outside of New York State), you are only covered for emergency and urgent care.

The Essential Plan is a subsidized healthcare program, and is entirely free for eligible individuals.

If you are an international student:

- Must be 21+ years old

- Must have a New York residential address

- Must have income below $27,180 annually

Not an international student? Check our eligibility page:

www.familyhealthagency.com/eligibility 

Essential Plan 1 - Individuals with annual income greater than $19,320 and less than or equal to $25,760.

Essential Plan 2 - Individuals with income greater than $17,774 and less than or equal to $19,320.

Essential Plan 3 - Individuals with income equal to or greater than $12,880 and less than or equal to $17,774, and not eligible for Medicaid due to immigration status.

Essential Plan 4 - Individuals with income below $12,880, and not eligible for Medicaid due to immigration status.

No, enrollment in the Essential Plan will not affect your immigration status as this is not a federal benefit. As the plan is provided by the New York State government, enrollment in the Essential Plan will not be reported to the federal immigration bureaus. After you have submitted your application, we will provide a letter stating that your immigration status will not be impacted.

 

No, but without a social security number, additional steps may be needed to verify your identity.

Yes. Most OPT students qualify if they meet other eligibility requirements. These requirements include:

  • Being a New York resident
  • Having no active coverage by any employer
  • Having a legal immigration status
  • Meeting the income requirement

No, unfortunately you have to obtain your EAD card in order to apply.

 
 Part “A” is typically in place, and a paid-up benefit when you turn 65. Part “B” is not, unless you have enrolled in Social Security prior to age 65. If you have not filed to receive Social Security benefits, then you need to proactively enroll in Part “B” benefits and begin paying for them.
 
 Part “C” is another name for Medicare Advantage. Also named MA, MSA, or MA-PD (when prescriptions are included).

  Part “D” is the Prescription Drug plan Medicare introduced in 2006.

Yes. However, you will not have prescription coverage, and you will face unlimited exposure to those costs due to the gaps in Original Medicare.

 No. But some Advantage plans offer limited dental coverage.

You usually can. It’s important to be sure your doctor accepts Medicare. Some don’t.
Maybe. If the employer group has 20 eligible employees or more, and you’re going to continue to work, then yes it’s an option. But there are many things to consider.
Assuming you have met the work-related eligibility requirements, you may begin enrollment into Medicare 90 days in advance of the month you turn 65.
No.
Online at SSA.gov or in person at a local Social Security office.
This is a Medicare term that establishes previous coverage being at least as good as Medicare’s. Typically is in play for Part “D” to avoid penalty.
In addition to having a huge gap in coverage, you will likely face a penalty from Medicare. A Part “B” penalty can be 10% of your Part “B” premium for each 12-month period outside of Medicare, and up to 1% of the national average of a Part “D” plan for each month absent Part “D”
No, a retiree plan will typically wrap around Medicare primary benefits.
Yes, for up to 100 days, after a required three-day hospital stay.
Medicare does not have spousal or dependent coverage. Medicare is individual. If your spouse has reached age eligibility (65), then they can enroll in Medicare of their own accord 90 days in advance of the month they turn 65.
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