To buy health insurance in NY, you apply through NY State of Health, the state-run marketplace at nystateofhealth.ny.gov.1NY State of Health. Individuals and Families One application screens you for every program you might qualify for: Medicaid, Child Health Plus, the Essential Plan, and private qualified health plans sold with federal premium tax credits. New York runs its own exchange rather than using HealthCare.gov, so the rules, plan menu, and some deadlines are specific to the state.2New York State of Health. Health Plan Marketplace for Individual and Small Business Health Insurance
You qualify to use the marketplace if you live in New York and are a U.S. citizen or lawfully present. Lawful presence covers permanent residents, refugees, asylees, people with temporary protected status, and valid non-immigrant visa holders, though a medical visa does not qualify.3NY State of Health. Determining Citizenship or Immigration Status Desk Aid for NYSOH Assistors People who are incarcerated cannot enroll, and if you are eligible for Medicare you generally cannot buy a separate marketplace plan. Children under 19 are usually enrolled in Child Health Plus or Medicaid instead of a standard private plan.4New York State Department of Health. Child Health Plus – Eligibility and Cost
Where to Apply and What to Gather First
You can apply online through your NY State of Health account, by phone with the marketplace’s customer service line, or in person with a certified navigator. Navigators work in every county, their help is free, and they are prohibited from charging you.5NY State of Health. Assistors Licensed insurance brokers can also help at no cost; brokers are paid by the insurance company.
Before you start, pull together the following for everyone in your household who needs coverage:
- Full legal names, dates of birth, and Social Security numbers
- Your current New York home address, which also determines which plan networks are available to you
- Immigration document types and ID numbers for anyone who is lawfully present but not a citizen
- Income records: recent federal tax returns, W-2s, or several consecutive pay stubs showing gross income
- Policy numbers for any existing coverage you are moving from
Income documentation matters more than any other piece, because the marketplace uses your household income to decide whether you qualify for Medicaid, the Essential Plan, premium tax credits, or cost-sharing reductions.6Internal Revenue Service. Questions and Answers on the Premium Tax Credit The calculation runs off your modified adjusted gross income, so accurate numbers now prevent trouble at tax time. If the system cannot verify your identity electronically, you can upload a driver’s license, Social Security card, or birth certificate directly to your account.
When You Can Enroll
Open Enrollment for Private Plans
Private qualified health plans — the Bronze, Silver, Gold, and Platinum tiers — are only available during the annual Open Enrollment Period. For 2026 coverage, open enrollment ran from November 1, 2025 through January 31, 2026.7NY State of Health. New York State Department of Health Announces Open Enrollment for 2026 Coverage Enrolling by mid-December started coverage January 1; later enrollments typically took effect February 1 or March 1, depending on when you signed up and paid.
Special Enrollment Periods
Outside open enrollment, you can only sign up for a private plan if a qualifying life event opens a Special Enrollment Period. You have 60 days from the event to enroll. Common triggers include:
- Losing existing coverage, such as job loss, aging off a parent’s plan, COBRA expiring, or losing Medicaid eligibility
- Getting married, having or adopting a child, or getting divorced
- Permanently moving to New York from another state, or moving to a new county within the state
Expect to upload documentation — a marriage certificate, birth certificate, or a letter from a former employer, for example. Miss the 60-day window and you generally wait until the next open enrollment to buy a private plan.
Year-Round Enrollment for Medicaid, Essential Plan, and Child Health Plus
Three programs accept applications all year with no enrollment window: Medicaid, the Essential Plan, and Child Health Plus.8NY State of Health. Enrollment If your income qualifies you, you can apply any day of the year without a qualifying life event. The marketplace application automatically screens you for these programs from the income and household information you enter.
What You Can Buy
Metal-Tier Private Plans
Private plans are grouped into four tiers by how costs are split between you and the insurer. The percentage is the plan’s actuarial value, roughly the share of total medical costs the plan covers on average:9New York State Department of Financial Services. Model Notice for Small Group Policyholders Renewal 2024
- Bronze (60%): lowest premiums, highest out-of-pocket costs when you use care
- Silver (70%): moderate premiums and cost-sharing, and the only tier eligible for cost-sharing reductions if your income qualifies
- Gold (80%): higher premiums, lower costs at the doctor or hospital
- Platinum (90%): highest premiums, lowest out-of-pocket costs
Every tier covers the same essential health benefits, including hospitalization, prescription drugs, maternity care, mental health services, and preventive care. For the 2026 plan year, federal rules cap out-of-pocket spending at $10,600 for an individual and $21,200 for a family, so even a Bronze plan limits your worst-case annual exposure.10HealthCare.gov. Out-of-Pocket Maximum/Limit
The Essential Plan
The Essential Plan is a New York program with $0 monthly premiums and no annual deductible.11NY State of Health. Essential Plan Information It is open to lawfully present residents aged 19 to 64 who earn too much for Medicaid but fall within income limits. For 2026, income tiers tied to the federal poverty level (FPL) determine your cost-sharing:
- Essential Plan 4: below 100% FPL, $0 cost-sharing for nearly all services
- Essential Plan 3: 100–138% FPL, $0 cost-sharing for most services
- Essential Plan 2: 138–150% FPL, $0 premiums, minimal prescription copays
- Essential Plan 1: 150–200% FPL, $0 premiums, low copays for doctor visits
- Essential Plan 200–250: 200–250% FPL, $0 premiums, moderate copays
Coverage includes dental, vision, prescriptions, and mental health care, with little or no cost-sharing at lower incomes.12NY State of Health. Summary of Essential Plan Costs and Benefits Because this is a year-round program, you can enroll any time you become eligible.
Dental Coverage
Essential Plan members get dental and vision automatically. On metal-tier plans, dental may be built into some qualified health plans; otherwise you can buy a standalone dental plan with its own premium. Standalone dental plans can only be purchased on the marketplace if you are also enrolling in a qualified health plan at the same time.
What Lowers Your Costs
Premium Tax Credits
The premium tax credit is a federal subsidy that reduces your monthly premium. It is available to households earning between 100% and 400% of the federal poverty level who buy a marketplace plan and are not eligible for other qualifying coverage such as job-based insurance or Medicaid.13Internal Revenue Service. Eligibility for the Premium Tax Credit The lower your income, the larger the credit.
From 2021 through 2025, expanded rules under the American Rescue Plan and the Inflation Reduction Act removed the 400% FPL income cap, so higher-income households could still qualify. As of early 2026, the U.S. House had passed legislation to extend those expanded subsidies, but the Senate had not yet acted. If the extension does not become law, the 400% FPL cap applies for 2026 and households above it would receive no credit. Check NY State of Health for the current rule when you apply.
At enrollment, you can take the estimated credit in advance each month as a lower premium bill, wait and claim the full amount when you file your tax return, or split the two.14Internal Revenue Service. The Premium Tax Credit – The Basics The credit amount is calculated against the second-lowest-cost Silver plan in your area, but you can apply it to any metal tier.
Cost-Sharing Reductions
If your income is below 250% of the federal poverty level, you may also qualify for cost-sharing reductions, which lower your deductibles, copays, and out-of-pocket maximum. These are only available on Silver plans, which is why Silver is often the right pick at lower incomes. You do not apply separately; the marketplace applies the reductions automatically based on the income you report.
Finishing the Enrollment
Selecting a plan does not finalize your coverage. You have to pay your first premium directly to the insurance company, following that insurer’s payment instructions.15HealthCare.gov. Complete Your Enrollment and Pay Your First Premium No first payment, no coverage. Keep paying on time after that; missed premiums can lead the insurer to end your plan.
Once you are enrolled, report mid-year changes to NY State of Health promptly: income shifts, household size changes, or a new offer of job-based coverage. Keeping the account current narrows the gap between the advance credits you receive and what you actually qualify for, which means fewer surprises when you reconcile the credit on your tax return.
If You’re Denied or Disagree With a Decision
If the marketplace denies you financial assistance, puts you in the wrong program, or finds you ineligible, you have 60 days from the date on the notice to request an appeal.16NY State of Health. Questions About Appeals That window is shorter than the 90 days the federal marketplace allows. You can appeal by calling NY State of Health at 1-855-355-5777, mailing or faxing a written request, or uploading an appeal form through your account. A late request can still be submitted with an explanation, but approval is not guaranteed.
A separate process applies if your insurer denies a specific claim or refuses to cover a treatment. For denials involving medical judgment, such as whether a treatment is medically necessary or experimental, you can request an external review, and the reviewer’s decision is binding on the insurer.17HealthCare.gov. External Review You generally have four months from the denial notice to file.