Ny Health Care

What Ny Health Care does

NY State of Health is a government public benefit corporation operating under the New York State Department of Health, established by Executive Order on April 12, 2012, and officially launched on October 1, 2013, as the official health plan marketplace for the state of New York under the Affordable Care Act. The platform enables individuals, families, and small businesses to compare, determine eligibility for, and enroll in health coverage programs including Medicaid, Child Health Plus, the Essential Plan, and Qualified Health Plans offered in four metal tiers (Bronze, Silver, Gold, Platinum) by 16 qualified insurers, as well as a separate Small Business Marketplace (SHOP) for employers with 50 or fewer employees.

The underlying technology is a state-based health insurance exchange platform providing eligibility determination, plan comparison, tax credit calculation, and enrollment functionality. It integrates with federal systems for ACA premium tax credit and cost-sharing reduction calculations and coordinates with state agencies for Medicaid eligibility verification. Supporting tools include an online self-service portal at nystateofhealth.ny.gov, a Tax Credit and Premium Estimator, a Provider and Health Plan Look-Up tool, Live Chat, and a toll-free Customer Service Center. Distribution is delivered through over 5,000 certified assistors and navigators across all 62 counties in 48 languages, supplemented by licensed brokers and partnerships with retail pharmacies, universities, museums, farmers markets, food pantries, state parks, and ridesharing platforms.

The business model relies on federal exchange establishment grants (cumulative approximately $213.8 million, including a $27M Early Innovator Grant, $1M Planning Grant, and $185.8M Level Two Establishment Grant) transitioning to self-sustaining operations funded through assessments on participating insurers and administrative fees, as required by ACA provisions for state-based exchanges. The entity is governed by a Board of Directors with ex officio representation from the Superintendent of Insurance, Commissioner of Health, and State Medicaid Director, and led by Executive Director Donna Frescatore. As of December 2018, record enrollment exceeded 4.7 million New Yorkers.

Name

Ny Health Care

Legal name

NY State of Health

Website

https://nystateofhealth.ny.gov

Company type

Public

Founded year

2013

Operating status

Operating

Headcount range

11–50 employees

Short description

NY State of Health is New York's official ACA health plan marketplace, enabling individuals, families, and small businesses across all 62 counties to compare and enroll in Medicaid, Child Health Plus, Essential Plan, and Qualified Health Plans from multiple insurers.

Ownership category

akta.pro rank

Product category

Health Insurance Marketplace

NAICS

Direct Health and Medical Insurance Carriers (524114), Health Care and Social Assistance (62)

SIC

Hospital & Medical Service Plans (6324), Services-Health Services (8000)

akta.pro primary industry

ACA Marketplace (On-Exchange) Individual Plans (FSAIAEAA)

akta.pro secondary industries

Healthcare-Linked Social Benefits Administration (e.g., Medicaid/Means-Tested Health Coverage) (BPAIAKAH), State/Provincial/Regional Health Departments (HLAJAAAA)

Keywords

• Health insurance marketplace
• Medicaid enrollment
• Qualified Health Plans
• Health plan comparison
• Small business health insurance

Headquarters

HQ city

Albany

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B and B2C

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure, Others

Revenue model

1. Exchange Operations Funding: NY State of Health is established as a public benefit corporation under the New York State Department of Health. The exchange was initially funded through federal exchange establishment grants (including a $27 million Early Innovator Grant and $1 million Exchange Planning Grant) and operates as a self-sustaining entity. Revenue generation mechanisms include assessments on participating insurers and administrative fees, consistent with ACA requirements for state-based exchanges to become self-sustaining by 2015.

Pricing tiers

Go-to-market motion1 record

Distribution channels5 records

Marketing channels8 records

Core offering

NY State of Health operates the official New York State health plan marketplace, a public benefit corporation under the NYS Department of Health. It provides a unified portal where individuals, families, and small businesses can compare and enroll in Medicaid, Child Health Plus, the Essential Plan, and Qualified Health Plans, while determining eligibility for federal premium tax credits and cost-sharing reductions. The marketplace supports enrollment through online self-service, a phone customer service center, and an in-person assistor network across all 62 counties.

Product overview

NY State of Health is a unified health plan marketplace platform operated by the New York State Department of Health. The platform serves as a centralized hub where individuals, families, and small businesses can access and enroll in multiple health coverage programs including Medicaid, Child Health Plus, the Essential Plan, and Qualified Health Plans (QHPs) offered in four metal tiers. The ecosystem also includes support services through certified Navigators, Assistors, and Brokers, along with self-service tools like the Tax Credit and Premium Estimator and Provider Look-Up. The Small Business Marketplace (SHOP) enables employers with 50 or fewer employees to access coverage with potential tax credits. All programs integrate with a customer service center offering phone and chat support.

Differentiator

Problem solved

Functional benefit

Products and services

• NY State of Health Marketplace The official New York State health plan marketplace platform that allows individuals, families, and small businesses to shop for, compare, and enroll in health insurance plans including Medicaid, Child Health Plus, Essential Plan, and Qualified Health Plans.
• Medicaid Government health insurance program for low-income adults, children, pregnant women, elderly adults, and people with disabilities, available year-round through the NY State of Health marketplace.
• Child Health Plus New York State health insurance program for children under 19 who do not qualify for Medicaid, providing comprehensive coverage with low or no-cost premiums.
• Essential Plan Low-cost health plan available to New Yorkers who do not qualify for Medicaid or Child Health Plus, offering comprehensive benefits with premiums starting at $0.
• Qualified Health Plans (QHPs) Health insurance plans certified as meeting ACA requirements, available in four metal tiers (Platinum, Gold, Silver, Bronze) offered by qualified insurers participating in the NY State of Health marketplace.
• Small Business Marketplace (SHOP) Marketplace for small businesses with 50 or fewer employees to offer high quality, affordable health insurance coverage to employees directly from NY State of Health certified insurers, with access to the Small Business Health Care Tax Credit.

Quantifiable outcome

• 53% reduction in health insurance premium rates compared to previous year individual rates (2013)
• +4 more outcomes

Named customers7 records

Segments6 records

Ideal customer profiles6 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Partnerships

13 partnerships are on record, tiered minor and core.

• SUNY (State University of New York)minorGTM or Marketing Partner · 3 December 2018Partnership with SUNY colleges to host more than 20 informational and enrollment events at campuses statewide. Certified enrollment assistors present to work directly with college students and graduates about affordable health coverage options.
• LyftminorGTM or Marketing Partner · 9 November 2018Ridesharing partnership to reach independent contractor drivers with health coverage enrollment information. Includes information sessions, distribution of educational materials, email and text campaigns, and promotion through online driver portals. Partnership ran through January 31, 2019 open enrollment period.
• UberminorGTM or Marketing Partner · 9 November 2018Ridesharing partnership to reach independent contractor drivers with health coverage enrollment information. Outreach includes in-app messages, emails, and in-person information sessions.
• Independent Drivers GuildminorGTM or Marketing Partner · 9 November 2018Partnership with this non-profit organization that helps drivers get access to benefits. Collaboration to reach drivers who do not have health coverage, as most drivers and their families qualify for free or low-cost health insurance through the marketplace.
• EquinoxminorGTM or Marketing Partner · 24 November 2015Partnership to spread the message of affordable health coverage through delivery of 10,000 Thanksgiving dinners. Includes enrollment outreach and awareness activities.
• CVS/PharmacyminorGTM or Marketing Partner · 9 December 2014Partnership for grassroots outreach campaign encouraging all New Yorkers to get health insurance. CVS locations serve as enrollment assistance sites during open enrollment periods.
• Retail Pharmacy ChainsminorGTM or Marketing PartnerPartnerships with top retail pharmacy chains to provide on-site enrollment opportunities and health coverage information at pharmacy locations statewide.
• New York State ParksminorGTM or Marketing PartnerPartnership to share health coverage information at learn-to-swim programs at state parks, helping families learn about affordable health plan options while enjoying recreational activities.
• Food Pantries StatewideminorGTM or Marketing PartnerPartnership with food pantries across New York State to provide enrollment opportunities and information about affordable health coverage to families utilizing food assistance programs.
• MuseumsminorGTM or Marketing PartnerPartnership with museums statewide to promote affordable health coverage information and enrollment opportunities to museum visitors during open enrollment periods.
• Shopping MallsminorGTM or Marketing PartnerStatewide mall tour offering on-site enrollment opportunities at each stop, providing convenient access to enrollment assistance in high-traffic retail locations.
• Farmers MarketsminorGTM or Marketing PartnerPartnership with farmers markets statewide to provide health coverage information and enrollment assistance to market visitors during summer and winter market seasons.
• Community NavigatorscoreChannel Partner/ Reseller/ DistributorNearly 500 trained in-person assistors/navigators providing high-quality enrollment assistance in all 62 counties of the state, in a total of 48 languages.

Scale indicators11 records

Recent moves8 records

Expansion highlights6 records

Direct peers

• Pennie: Pennsylvania's state-based ACA marketplace, transitioned from the federal exchange in 2020. Operates the same QHP/metal-tier model with state-level customer service and broker networks, making it a direct functional peer.
• Covered California: California's state-based ACA marketplace, the only other state-based exchange with multi-million enrollment volumes. Operates the same four-metal-tier QHP model with subsidies, navigators, and a similar unified eligibility platform, making it the closest functional peer to NY State of Health.
• Washington Healthplanfinder: Washington state's ACA marketplace, operating an integrated exchange for QHPs and Medicaid (Washington Apple Health). Comparable scale, state-agency structure, and unified eligibility platform model.
• BeWellnm: New Mexico's state-based ACA marketplace, smaller in scale but structurally identical — administering QHPs, Medicaid, and subsidies with state-licensed navigator and broker channels.
• Massachusetts Health Connector: The original state-based exchange predating the ACA, now operating under the ACA framework with QHPs, ConnectorCare, and MassHealth integration. Directly comparable governance model as a quasi-public state agency and similar multi-program eligibility integration.
• DC Health Link: Washington D.C.'s state-based ACA marketplace, offering individual, small-business, and DC government-employee coverage on a unified platform. Comparable small-state state-agency operating model with navigators and broker support.
• Connecticut Health Insurance Exchange (Access Health CT): A regional state-based exchange serving Connecticut with the same QHP/metal-tier and subsidy-distribution model. Comparable scale, navigator network, and small-business marketplace functionality.
• Maryland Health Connection: Maryland's state-based ACA marketplace, with similar navigator-based enrollment, QHP offerings, and Medicaid integration. Comparable state-agency operating model and small-business (SHOP) functionality.
• MNsure: Minnesota's state-based ACA marketplace, providing a comparable one-stop enrollment platform for QHPs and Medicaid with navigators and brokers. Comparable governance structure as a state-administered exchange.

Broad incumbents

• HealthCare.gov (CMS): The federal ACA marketplace operated by the Centers for Medicare & Medicaid Services, serving the majority of U.S. states. Functions as a broader incumbent alternative — same core product (QHP enrollment with subsidies) but federally operated rather than state-based.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/NYSDOHMEDICAID
• Facebookfacebook.com/NYSDOHMEDICAID
• Instagraminstagram.com/nysdohmedicaid
• LinkedInlinkedin.com/company/nyhalthcare

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Ny Health Care