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Some important changes to New York’s Essential Plan health coverage are now in effect. These changes resulted from federal funding and eligibility changes that ended New York’s expansion of Essential Plan coverage to individuals with incomes between 200% and 250% of the Federal Poverty Level (FPL). As of July 1, 2026, many people previously covered under that expansion are no longer eligible for the Essential Plan and have been transitioned to other coverage options.
Your current health coverage depends on factors such as:
Many individuals have already received eligibility determinations and notices from NY State of Health regarding their health coverage options.
As of July 1, 2026, individuals in this income range are generally no longer eligible for the Essential Plan. New York has returned to the Basic Health Program eligibility rules, which limit Essential Plan eligibility to lower income levels.
You may have been:
Pregnant and postpartum individuals continue to have important coverage protections. Depending on your circumstances, you may remain enrolled in health coverage through the Essential Plan or Medicaid. Coverage should continue throughout pregnancy and the postpartum protection period.
Report any changes in pregnancy status, address, household size, or income, and carefully review any notices regarding your health insurance coverage.
Changes in income, employment, or household composition can affect eligibility for:
Report changes as soon as possible through NY State of Health to ensure you receive the correct coverage and avoid interruptions.
Losing Essential Plan eligibility does not necessarily mean you will lose access to health insurance. Many former Essential Plan members now qualify for Qualified Health Plans through NY State of Health, although premiums and cost-sharing may be higher than under the Essential Plan.
Individuals who do not qualify for marketplace coverage may still have access to other programs, including safety-net health services and hospital financial assistance programs.
If you have questions about your eligibility or coverage options:
The information in this document has been prepared by The Legal Aid Society for informational purposes only and is not legal advice. This information is not intended to create, and receipt of it does not constitute, an attorney-client relationship. You should not act upon any information without retaining professional legal counsel.