Are NY plans different from plans elsewhere?
Yes, in two ways beyond community rating. (1) NY mandated benefits require coverage for things federal ACA doesn't mandate: infertility and IVF on most plans, autism spectrum disorder treatment including ABA therapy, broader contraception coverage, telehealth parity, and stricter mental health parity enforcement. (2) Provider networks in NY are heavily concentrated around the major hospital systems (NYC: NewYork-Presbyterian, Mount Sinai, NYU, Northwell, Montefiore; upstate: each region has 2–3 dominant systems) — picking a plan is functionally picking a hospital network. We start the conversation with which doctors and hospitals you need to keep, then narrow to plans that contract with them.
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Related FAQs
Are LTC premiums tax-deductible?
Federal: yes, as itemized medical expenses, subject to age-based limits that increase in steps every decade of age (current figures published annually by the IRS). The deduction phases in based on whether your total medical expenses exceed a percentage of AGI. NY allows a state income tax credit equal to a portion of LTC premiums paid (subject to caps). Self-employed individuals can deduct LTC premiums above-the-line up to the federal age-based limits. Confirm current dollar limits with a tax advisor…
Read answerCan I see specific doctors / hospitals on the plan I'm considering?
This is the most important question and the most-overlooked one at enrollment. Marketplace plan summaries don't tell you network depth. The right move: get the list of every provider you currently see (PCP, specialists, dentist, mental health), call each one, ask "do you take [Plan Name from Carrier X for the current plan year]?" — and confirm the *specific plan*, not the carrier. Carriers offer many plans on different networks (e.g., HMO, EPO, PPO, narrow network) and a doctor accepting…
Read answerDo I need a medical exam?
For most term policies above $500K, yes — a paramedical exam (height, weight, blood pressure, blood draw, urine sample) at home or in an office. **No-exam (simplified or accelerated) underwriting** is increasingly available for healthy applicants under age 50–55 buying $500K–$2M of term, often with an answer in 1–7 days. **Guaranteed-issue** policies (no health questions, no exam) exist for older applicants but cap face value at $25K–$50K and are expensive per dollar of coverage. We pre-screen the underwriting category at…
Read answerDoesn't Medicare cover long-term care?
No, and this is the single most-misunderstood point in retirement planning. Medicare covers up to 100 days of **skilled nursing care** following a qualifying hospital stay (with cost-sharing after day 20). It does **not** cover custodial care — the day-in-day-out help with ADLs that constitutes the vast majority of long-term care needs. Medicaid covers long-term care, but only after you've spent down most of your assets. This is why people who want to control where and how they receive care,…
Read answerHow are disability benefits taxed?
It depends on who paid the premium with what kind of dollars. **Post-tax premium = tax-free benefits.** **Pre-tax premium (employer-paid, or employee-paid through pre-tax payroll) = taxable benefits.** This matters enormously: a $10K/month benefit at 35% effective tax is $6,500/month after tax — a big drop. Many high-income professionals deliberately pay LTD premiums with after-tax dollars even when their employer offers a pre-tax plan, specifically to capture the tax-free benefit on the back end. We model the tax treatment when…
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