Calculator Use
The fidelis care cost calculator is designed to help New York residents estimate their monthly health insurance premiums and total annual healthcare expenses. Navigating health insurance through the New York State of Health (NYSOH) marketplace can be complex, and this tool simplifies the process by factoring in your household income and family size to determine eligibility for various programs.
Whether you are looking for Medicaid Managed Care, the Essential Plan, or a Qualified Health Plan (QHP), this calculator provides a data-driven estimate of what you might pay. Use this tool to plan your monthly budget and compare the financial impact of different care usage levels.
- Annual Household Income
- Your total gross income (before taxes) for all members of your household who file taxes together. This is the primary factor for subsidy eligibility.
- Household Size
- The number of individuals included on your tax return. This includes you, your spouse, and your dependents.
- Est. Monthly Out-of-Pocket
- The amount you expect to spend on copayments, prescriptions, and coinsurance each month, excluding the premium.
How It Works
The calculator uses the Federal Poverty Level (FPL) guidelines to categorize your income. In New York, Fidelis Care plans are tiered based on where your income falls relative to the FPL. The general logic follows these thresholds:
FPL % = (Annual Income / FPL Base for Family Size) × 100
- Under 138% FPL: Usually eligible for Medicaid Managed Care ($0 premiums).
- 138% to 250% FPL: Usually eligible for the Essential Plan ($0 to $15 premiums).
- Over 250% FPL: Eligible for Qualified Health Plans (QHPs), often with Advance Premium Tax Credits (APTC) to lower costs.
- Over 400% FPL: May still receive subsidies under the Inflation Reduction Act to cap premiums at 8.5% of income.
Calculation Example
Example: A single individual living in Queens, NY, earning $32,000 per year.
Step-by-step solution:
- Household Size: 1
- FPL for Size 1 (2024): Approximately $15,060
- Income Ratio: ($32,000 / $15,060) = 212% of FPL
- Eligibility: Since 212% is between 138% and 250%, the user qualifies for the Essential Plan.
- Cost: Under current NY guidelines, the premium is likely $0 – $15 per month.
- Total Annual Premium: $180 (if $15/mo).
Common Questions
Does Fidelis Care cover all of New York?
Fidelis Care provides coverage in all 62 counties of New York State. However, specific plan availability and provider networks can vary significantly between Western NY, Central NY, and the New York City metro area. Use the fidelis care cost calculator to see how your income affects costs statewide.
What is the difference between a Premium and Out-of-Pocket cost?
The premium is the fixed amount you pay every month to keep your insurance active, regardless of whether you see a doctor. Out-of-pocket costs include copays (fixed fees for visits), deductibles (what you pay before insurance kicks in), and coinsurance (percentage of costs). Our calculator allows you to estimate both to see your "Total Cost of Ownership" for healthcare.
How often do the FPL guidelines change?
FPL guidelines are updated annually by the Department of Health and Human Services (HHS) in January. The New York State of Health marketplace typically applies these new numbers to plan selections for the following coverage year or during special enrollment periods. If your income changes mid-year, you should recalculate your costs as your subsidy eligibility may shift.