ACA Health Insurance in New York: Marketplace Plans & Subsidies
Residents of New York can access affordable health insurance through NY State of Health. Thanks to the Affordable Care Act (ACA), most families qualify for subsidies that significantly lower monthly premiums.
đź“Ť New York Health Insurance Fast Facts
How Health Plans Work in New York
When you shop on NY State of Health, you'll see plans organized by "Metal Levels" (Bronze, Silver, Gold). In New York, specific options will vary by your zip code. For example, a Silver plan in New York City might be offered by Fidelis Care, while a similar plan in a rural county might be from a different provider.
Key takeaway for New York residents: Don't just look at the premium. Check the provider network to ensure your preferred doctors and local hospitals are covered.
🏥New York Medicaid (Medicaid)
New York Medicaid is one of the most generous in the nation, covering adults up to 138% FPL with comprehensive benefits including dental, vision, and long-term care. New York's Essential Plan bridges the gap between Medicaid and standard marketplace plans, offering near-zero premium coverage for those earning 138-200% FPL. The state also offers Medicaid Buy-In for Working People with Disabilities.
đź’ˇInsurance Shopping Tips for New York
- •The Essential Plan offers $0-$20/month premiums for individuals earning up to 200% FPL—check eligibility before buying standard marketplace plans
- •New York's community rating means age doesn't affect your premium—valuable for older adults, less so for younger ones
- •Fidelis Care and MetroPlus often have the most affordable options in New York City
- •NY State of Health allows enrollment year-round for the Essential Plan and Medicaid, not just during Open Enrollment
- •New York prohibits insurers from denying coverage or charging more for pre-existing conditions—this predates the ACA
🏛️Unique Healthcare Programs in New York
Essential Plan: $0-$20/month comprehensive coverage for individuals up to 200% FPL
Child Health Plus: Free or low-cost coverage for children up to 400% FPL
EPIC: State prescription drug program supplementing Medicare Part D for seniors
Family Health Plus (now integrated into Essential Plan): Historic coverage expansion program
NYC Care: Guarantees low or no-cost healthcare to all NYC residents, regardless of immigration status
Important note
Marketplace (ACA) eligibility and premium tax credits depend on your household size, income, ages, ZIP code, and the plan you choose. Rules and plan pricing can change over time.
Use this page to understand the basics for New York. For your exact eligibility and final monthly premium, confirm on the official marketplace.
Important Note for New York
NY State of Health is the state marketplace. Essential Plan available for lower incomes. Year-round enrollment for certain qualifying events.
Frequently Asked Questions
How do ACA subsidies work in New York?
Premium tax credits can reduce monthly premiums for Marketplace plans. Eligibility and amounts depend on household size, income, ages, ZIP code, and plan selection. Confirm specific results on the official marketplace.
Is "NY State of Health" the official site for New York?
Yes, for New York, you should use **NY State of Health** to apply for coverage and subsidies. Using third-party sites might result in extra fees or missing out on tax credits.
When is Open Enrollment?
In most states, Open Enrollment typically runs from Nov 1 to Jan 15. Some state marketplaces may have different deadlines.
What carriers offer plans in my area?
Major carriers in New York often include Fidelis Care, Empire BlueCross BlueShield, UnitedHealthcare. Availability varies by ZIP code, so residents in New York City might have different options than those in Buffalo.
Do ACA plans cover pre-existing conditions?
Yes. ACA-compliant plans cannot deny coverage or charge more due to pre-existing conditions like diabetes, cancer, or pregnancy.
Sources & Disclaimer
Last Updated: January 2026
Disclaimer: The information provided is for educational purposes only. Actual costs vary based on individual circumstances, location, age, plan selection, and other factors. Always verify current information with official sources or licensed professionals. This site does not sell insurance or provide medical advice and is not affiliated with any insurance company or healthcare provider.