What Changed in New York Health Coverage This Summer

Four things moved this year that change what New Yorkers pay for coverage. Here they are in the order they’ll affect you.

The Essential Plan’s upper tier is gone. As of July 1, the program’s income ceiling returned to 200% of the federal poverty level after the federal funding arrangement covering the 200–250% band ended. Roughly 360,000 people were moved onto marketplace plans with tax credits. If your income is at or below 200% FPL — about $31,920 a year for one person — nothing changed for you: still $0 premium, still no deductible. If you were in the upper band, you now have a monthly premium, and the size of it depends on the plan you were placed in. Worth checking whether a different metal tier costs you less. What the Essential Plan covers now.

The 2026 poverty thresholds took effect in January, and every program threshold on this site is derived from them: $15,960 for a household of one, plus $5,680 for each additional person. That’s the arithmetic behind Medicaid limits, Essential Plan eligibility, hospital financial assistance tiers and NYC Care’s sliding scale. If your income sits near a cutoff, the update may have moved you across it in either direction — it’s worth recalculating rather than assuming last year’s answer holds.

Two enrollment seasons open this fall, and they are not the same season. Medicare’s annual enrollment period runs October 15 to December 7. The NY State of Health open enrollment period for 2027 marketplace coverage runs November 1 to January 31, with December 15 as the cutoff for coverage that starts January 1. Neither of these applies to Medicaid, the Essential Plan or Child Health Plus, which accept applications every month of the year — a distinction that costs people coverage every single year when they’re told they “missed the deadline.”

One thing that did not change: hospital financial assistance. Below 200% of the federal poverty level, a New York hospital still cannot charge an uninsured patient out-of-pocket costs. Between 201% and 300%, it still cannot charge more than 10% of the Medicaid rate. Immigration status still cannot be considered, and you can still apply after a bill has gone to collections. If you got care during a coverage gap this summer, that’s the process to run. How to apply.