

The health plans that offer Healthy NY coverage have their own medical provider networks. This means that benefits are provided a network of medical providers. You must use the doctors and health care providers who participate in your insurance company’s network, except in an emergency. Contact your health plan directly to confirm whether your health care providers are in their network.
This is not intended to be a complete list of covered benefits. Please refer to your health plan coverage documents for a full description of covered benefits.
Please consult your health plan coverage documents for a more extensive description of your cost sharing responsibility. Some examples of copayments and coinsurance are included below.
Deductible |
$600 individual / $1,200 family |
Maximum out of pocket costs |
$4,000 individual / $8,000 family |
Primary Care Physician (PCP) visit |
$25 |
Specialist visit |
$40 |
Preventive Care |
No cost sharing |
Ambulance |
$150 |
Emergency Room visit |
$150 (waived if admitted) |
Urgent Care |
$60 |
Chemotherapy, radiation therapy |
$25 per visit |
Chiropractic care |
$40 |
Physical therapy, occupational therapy, speech therapy |
$30 |
Diagnostic and routine laboratory and pathology |
$40 |
Diagnostic and routine imaging |
$40 |
Surgical Services – inpatient, outpatient and surgicenters |
$100 |
DME / Medical supplies |
20% coinsurance |
Hearing aids |
20% coinsurance |
Inpatient Facility / Skilled Nursing / Hospice |
$1,000 per admission |
Mental Health & Substance Use Disorder Services |
$1,000 per admission (inpatient) |
Prescription drugs |
$10 generic |
Pediatric dental - office visit |
$25 |
Pediatric vision – eye exam visit |
$25 |
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