New York offers some of the most generous health coverage options in the country under the Affordable Care Act. Whether you are looking for free Medicaid coverage, zero-premium Essential Plan benefits, or subsidized marketplace insurance, understanding the income limits and eligibility rules for 2026 is the first step toward getting covered. This guide breaks down everything you need to know about ACA eligibility in New York this year, including important mid-year changes that could affect your coverage.
Use our free eligibility screener to check which programs you may qualify for in just a few minutes, or visit our New York Benefits Overview for a broader look at all available assistance programs in the state.
How ACA Coverage Works in New York
New York runs its own state-based health insurance marketplace called NY State of Health (nystateofhealth.ny.gov). Unlike states that use the federal HealthCare.gov platform, New York manages enrollment, plan options, and eligibility determinations through its own system.
Through NY State of Health, residents can access four main types of coverage:
- Medicaid for individuals and families with the lowest incomes
- Child Health Plus for children under 19 in households above Medicaid limits
- The Essential Plan for adults whose income falls between Medicaid and marketplace thresholds
- Qualified Health Plans (QHPs) with potential premium tax credits for those with higher incomes
New York expanded Medicaid under the ACA, meaning adults without dependent children can qualify for coverage. The state also operates the Essential Plan, a Basic Health Program (BHP) that provides low-cost or zero-premium coverage to residents in a specific income range.
2026 Income Limits for New York Health Programs
Eligibility for ACA-related programs in New York depends on your household size and Modified Adjusted Gross Income (MAGI). The following tables show the 2026 income limits based on the federal poverty level (FPL) guidelines published by HHS in January 2026.
Medicaid (138% FPL)
New York Medicaid covers adults, children, and pregnant women. For most adults, the income limit is 138% of the federal poverty level. Pregnant women and infants qualify at higher thresholds (up to approximately 223% FPL).
| Household Size | Monthly Income Limit | Annual Income Limit |
|---|---|---|
| 1 | $1,836 | $22,032 |
| 2 | $2,489 | $29,868 |
| 3 | $3,142 | $37,704 |
| 4 | $3,795 | $45,540 |
These limits apply to the MAGI Medicaid category, which includes most adults under 65 who are not on Medicare. There is no asset or resource limit for MAGI Medicaid in New York.
Essential Plan (Changing Mid-Year in 2026)
The Essential Plan is one of the biggest advantages of living in New York. It offers zero-premium or very low-cost coverage to adults who earn too much for Medicaid but not enough to comfortably afford marketplace plans.
Important change for 2026: Due to federal funding reductions enacted through legislation in 2025, New York plans to lower the Essential Plan income limit from 250% FPL back to 200% FPL starting July 1, 2026. This means some current Essential Plan members will need to transition to Qualified Health Plans.
January through June 2026 (250% FPL):
| Household Size | Monthly Income Limit | Annual Income Limit |
|---|---|---|
| 1 | $3,325 | $39,900 |
| 2 | $4,509 | $54,108 |
| 3 | $5,691 | $68,292 |
| 4 | $6,875 | $82,500 |
Starting July 1, 2026 (200% FPL):
| Household Size | Monthly Income Limit | Annual Income Limit |
|---|---|---|
| 1 | $2,660 | $31,920 |
| 2 | $3,607 | $43,284 |
| 3 | $4,554 | $54,648 |
| 4 | $5,500 | $66,000 |
If your income is between 200% and 250% FPL, you should plan for potential changes to your coverage after July 2026. NY State of Health is expected to notify affected members and help them transition to marketplace plans.
Marketplace Subsidies (Premium Tax Credits)
For New Yorkers with income above the Essential Plan limits, Qualified Health Plans are available through the marketplace with potential premium tax credits to reduce monthly costs.
The enhanced premium tax credits that were available from 2021 through 2025 under the American Rescue Plan expired at the end of 2025. As a result, in 2026:
- Premium tax credits are available for households with income between 100% and 400% FPL
- The "subsidy cliff" has returned, meaning households above 400% FPL no longer qualify for any premium assistance
- Subsidies may be smaller than what enrollees received in 2024 and 2025
| Household Size | 400% FPL (Max for Subsidies) |
|---|---|
| 1 | $63,840 |
| 2 | $86,560 |
| 3 | $109,280 |
| 4 | $132,000 |
If your income is at or below these amounts (and above Essential Plan thresholds), you likely qualify for some level of premium assistance. The exact subsidy amount depends on your income, age, location, and the cost of the benchmark Silver plan in your area.
How to Apply for ACA Coverage in New York
Step 1: Gather Your Information
Before starting your application, have the following ready:
- Social Security numbers for everyone in your household
- Immigration documents (if applicable)
- Employer and income information (pay stubs, tax returns, or W-2 forms)
- Information about any current health coverage
- Your household size and filing status
Step 2: Visit NY State of Health
Go to nystateofhealth.ny.gov and create an account or log in to an existing one. You can also call 1-855-355-5777 (TTY: 1-800-662-1220) for phone assistance.
Step 3: Complete the Application
The online application will ask about your household, income, and current coverage. Based on your answers, the system will determine which programs you qualify for, including Medicaid, the Essential Plan, or subsidized marketplace plans.
Step 4: Compare and Select a Plan
If you are eligible for a Qualified Health Plan, you will see available options with estimated costs after subsidies. Compare plans based on premiums, deductibles, copays, and provider networks. If you qualify for Medicaid or the Essential Plan, you may be automatically enrolled or prompted to choose a managed care plan.
Step 5: Enroll and Confirm Coverage
Complete your enrollment by selecting a plan and confirming your information. For marketplace plans, set up your premium payment. Medicaid and Essential Plan coverage typically starts the first of the month after approval.
Getting Help with Your Application
You do not have to navigate this process alone. Free help is available through:
- Navigators trained by NY State of Health to help with enrollment
- Certified Application Counselors at hospitals, community centers, and nonprofits
- Licensed insurance brokers who can guide you through plan selection at no cost to you
Visit the NY State of Health website or call 1-855-355-5777 to find local assistance.
Enrollment Periods and Deadlines
Open Enrollment for 2026 ran from November 1, 2025, through January 31, 2026. If you missed open enrollment, you can still get coverage through a Special Enrollment Period if you have a qualifying life event, such as:
- Losing other health coverage (job loss, aging off a parent's plan)
- Getting married or divorced
- Having a baby or adopting a child
- Moving to a new area
- Becoming pregnant (New York is one of the few states where pregnancy qualifies)
- Changes in household income that affect eligibility
Year-round enrollment is available for Medicaid, the Essential Plan, and Child Health Plus. You do not need to wait for open enrollment to apply for these programs.
Looking ahead: Starting with the enrollment period for 2027 coverage, a federal rule change will require state-based exchanges like NY State of Health to end open enrollment by December 31, making the window shorter than in previous years.
Key Changes Affecting New York ACA Coverage in 2026
Several significant changes are shaping health coverage options in New York this year:
1. Expiration of Enhanced Premium Tax Credits The expanded subsidies from the American Rescue Plan, which eliminated the 400% FPL income cap and reduced premium costs for millions, expired after December 31, 2025. This means higher premiums for many marketplace enrollees and the return of the subsidy cliff.
2. Essential Plan Income Limit Reduction Starting July 1, 2026, the Essential Plan eligibility threshold drops from 250% FPL to 200% FPL. Approximately hundreds of thousands of New Yorkers in the 200% to 250% FPL range may need to find new coverage options. If you are affected, NY State of Health should contact you about transitioning to a marketplace plan.
3. Additional Cost-Sharing Reductions via 1332 Waiver New York received federal approval to use 1332 waiver pass-through funding to provide extra cost-sharing reductions for some marketplace enrollees. This benefit continues in 2026 but may terminate after July 2026 if federal funding is insufficient.
4. Shorter Open Enrollment Coming for 2027 Federal rules will require state exchanges to end open enrollment by December 31 starting with the 2027 plan year, so plan accordingly when the next enrollment window opens.
Who Qualifies for What: A Quick Summary
Here is a simplified overview to help you figure out which program to explore first based on your income:
- Income up to 138% FPL: You likely qualify for Medicaid with no premiums and minimal cost sharing
- Income 138% to 250% FPL (through June 2026): You may be eligible for the Essential Plan with zero or very low premiums
- Income 138% to 200% FPL (starting July 2026): The Essential Plan will still be available at this income level
- Income 200% to 400% FPL: You can purchase a marketplace plan with premium tax credits
- Income above 400% FPL: You can buy a marketplace plan at full price (no subsidies in 2026)
Not sure where you fall? Our free eligibility screener can help you find out in minutes.
Frequently Asked Questions
Can I still sign up for health insurance in New York if I missed open enrollment?
Yes, but only under certain conditions. Medicaid, the Essential Plan, and Child Health Plus accept applications year-round. For marketplace Qualified Health Plans, you need a qualifying life event (such as job loss, marriage, birth of a child, or a move) to enroll outside of open enrollment.
What is the Essential Plan, and how is it different from Medicaid?
The Essential Plan is a New York-specific program for adults who earn too much for Medicaid but have income at or below 250% FPL (dropping to 200% FPL in July 2026). It offers zero-premium or very low-premium coverage with low cost sharing. Unlike Medicaid, the Essential Plan uses private insurance carriers and has a different network of providers.
Did ACA subsidies change for 2026?
Yes. The enhanced premium tax credits that were in place from 2021 through 2025 expired. In 2026, the subsidy cliff at 400% FPL is back, meaning households above that income level no longer receive any premium assistance. Households below 400% FPL may also see smaller subsidies than they received in recent years.
What happens to my Essential Plan coverage in July 2026?
If your income is between 200% and 250% FPL, you will likely be transitioned off the Essential Plan when the eligibility threshold decreases in July 2026. NY State of Health is expected to notify affected members and help them enroll in a Qualified Health Plan, which may come with premium tax credits depending on your income.
Is there an asset or resource limit for Medicaid in New York?
For MAGI Medicaid (most adults under 65 not on Medicare), there is no asset or resource limit. Eligibility is based solely on income. However, for non-MAGI categories (such as aged, blind, or disabled individuals), resource limits do apply. In 2026, the resource limit for non-MAGI Medicaid is $33,038 for an individual and $44,796 for a couple.
How do I know which health program I qualify for?
The fastest way to check is to use NY State of Health's online application or try our free eligibility screener, which checks multiple programs at once based on your income, household size, and situation.
Can undocumented immigrants get health coverage in New York?
Undocumented immigrants are not eligible for Medicaid, the Essential Plan, or marketplace coverage with subsidies. However, New York does offer some coverage options. Emergency Medicaid is available regardless of immigration status, and some community health centers provide care on a sliding fee scale. Children under 19 may qualify for Child Health Plus regardless of immigration status.
Where can I get free help applying?
You can get free enrollment help by calling NY State of Health at 1-855-355-5777, visiting a local Navigator or Certified Application Counselor, or working with a licensed insurance broker. These services are available at no cost to you.
Next Steps
If you are a New York resident looking for affordable health coverage in 2026, start by checking your eligibility. With Medicaid, the Essential Plan, and marketplace subsidies available, there is a good chance you qualify for some form of assistance.
Use our free eligibility screener to see which programs match your situation, or visit NY State of Health to apply directly. For a complete look at all benefits available in your state, check out our New York Benefits Overview.
Do not wait, especially if you may be affected by the Essential Plan changes coming in July 2026. The sooner you understand your options, the better prepared you will be to maintain continuous coverage throughout the year.
