Why county matters
An insurer is licensed to sell particular products in particular counties, and it builds a network for each. That produces three effects people run into without knowing why.
A plan can be unavailable to you even though it is heavily advertised in the city.
The same plan name can carry different networks in different counties.
Moving within New York State can break your coverage arrangement, even a short move, if it crosses a county line into an area where your product is not sold. Moving is a qualifying life event for exactly this reason.
The two state tools, and what each answers
NY State of Health, plans by county. The marketplace publishes lists of the qualified health plans and Essential Plan options available in each county, updated for the plan year. Start here to learn what exists for your address before you compare anything.
The Provider and Health Plan Look-Up Tool, run by the state health department at pndslookup.health.ny.gov. This one runs the other direction: it associates providers with the plans they participate in, using data plans are required to submit to the state.
Neither replaces the last step, which is a call to the practice. What they do is stop you comparing plans that are not sold to you, and give you a state-sourced starting list instead of a carrier-sourced one.
What the tools cannot tell you
Whether a practice is accepting new patients. Participation and an open panel are two different facts, and only the practice knows the second.
Whether the site bills a facility fee. A practice owned by a hospital system bills the same consultation differently. What that is.
Whether every clinician at an address participates. Networks attach to individual providers as well as practices, which is how an in-network office produces an out-of-network bill.
How adequate the network actually is. A directory can be technically complete and practically unreachable. If yours is, that is a network adequacy problem with a complaint route, not bad luck.
If you are choosing rather than checking
The county list tells you the menu. Choosing from it is a different job, and the order that matters is: the people and medications you already rely on, then cost sharing, then premium. Sorting by premium first is the most common expensive mistake, particularly for anyone eligible for a cost-sharing reduction, which only attaches to silver plans.
And before comparing marketplace plans at all: below 200% of the federal poverty level, the relevant program in New York is usually the Essential Plan, which has no premium, no deductible and no enrollment season. The full comparison method.
Questions people ask
How do I find which plans are sold where I live?
NY State of Health publishes plans-by-county lists for each plan year. That is the authoritative answer for your address.
Is there an official way to check which plans a doctor takes?
The state health department runs a Provider and Health Plan Look-Up Tool at pndslookup.health.ny.gov, built on data plans must submit. Confirm by phone afterward.
Why is a plan available in one borough and not another?
Insurers are licensed to sell particular products in particular counties and build a network for each.
I am moving within New York. Does my plan follow me?
Not necessarily, if the move crosses into a county where your product is not sold. Moving is a qualifying life event, which opens a window to change.
The directory says my doctor takes the plan but the office says no. Who is right?
The office. Directories have a known error rate, which is why the phone call is the last step and not the first.
What should I check besides the doctor?
The formulary for your medications, whether the office bills a facility fee, and which hospital it would refer you to.
Sources
- NY State of Health — plans by county (checked 2026-09-13)
- NYS Provider and Health Plan Look-Up Tool (checked 2026-09-13)
- NY State of Health — insurers (checked 2026-09-13)
More in Health Insurance Companies in New York: Who They Are and How They Differ
- How to Verify a Provider Takes Your Plan — Directories are wrong often enough that the industry has a name for it. The two-question call that settles it, the log that turns a bad directory into a complaint, and the four things nobody checks.
- Fidelis Care: What to Know Before You Pick It — Fidelis Care is one of the largest Essential Plan and Medicaid carriers in New York State. What its statewide reach means for your network, and the questions to ask first.
- EmblemHealth and MetroPlus: New York's Two Local Plans — MetroPlus belongs to the city's public hospital system; EmblemHealth is the old GHI and HIP. What each one is good for, and who should look at which.
This page explains how the system works. It is not medical advice. More.