New York health insurance: Understand your coverage options (2024)

See your New York health insurance coverage options.

Find individual and family plans, small-group, short-term or Medicare plans through licensed agency partners.

To purchase health coverage through the New York Health Insurance Marketplace, you must:⁹

• Live in New York
• Be lawfully present in the United States
• Not be incarcerated
• Not be enrolled in Medicare¹⁰

Eligibility for financial assistance (premium subsidies and cost-sharing reductions) depends on your household income. In addition, to qualify for financial assistance with your New York Marketplace plan you must:

• Not have access to affordable employer-sponsored health coverage. If your employer offers coverage but you feel it’s too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace.
• Not be eligible for Medicaid, Child Health Plus, or The Essential Plan.
• Not be eligible for premium-free Medicare Part A.¹¹
• If married, file a joint tax return.¹²
• Not be able to be claimed by someone else as a tax dependent.¹²

In New York, the open enrollment period has both a start and end date that differ from the schedule used in most other states.Open enrollment in New York starts November 16, and normally continues through January 31¹³

For 2024 coverage, however, New York State of Health is keeping enrollment open through May 31, 2024, due to the “unwinding” of the pandemic-era continuous coverage rule for Medicaid. So enrollment in 2024 qualified health plans in New York continues through May 2024, without the need for a qualifying life event. After that, a qualifying event will be necessary to sign up for 2024 coverage.¹⁴

(For 2025 and future years, the federal government has proposed a rule change that would require all state-run exchanges to begin open enrollment on November 1, and end it no sooner than January 15.¹⁵ If that rule is finalized, New York would have to change its open enrollment start date.)

Enrollment in Medicaid, Child Health Plus, and the Essential Plan continues year-round for eligible people.

For qualified health plans (ie, not Medicaid, CHP, or the Essential Plan), enrollment outside of the annual open enrollment window is only possible if you qualify for a special enrollment period, which is typically triggered by a specific qualifying life event.

New York is one of several states where pregnancy counts as a qualifying event. In most states, it’s the birth that triggers a special enrollment period, but New York allows the expectant mother to sign up for health insurance due to the pregnancy.¹⁶

If you have questions about open enrollment, you can learn more in our comprehensive guide to open enrollment. We also have a comprehensive guide to special enrollment periods.

To enroll in an ACA Marketplace plan in New York, you can:

• Visit NY State of Health to access New York’s Marketplace, an online platform where you can compare plans, determine whether you’re eligible for financial assistance, and enroll in the plan that best meets your needs.
• Purchase NY State of Health Marketplace health coverage with the help of an insurance agent or broker, a Navigator, or a certified application counselor.¹⁷

You can contact NY State of Health by phone at 1-855-355-5777 (TTY: 1-800-662-1220)

New York residents use NY State of Health to enroll in health coverage and obtain income-based subsidies.

In the New York exchange, about 60% of enrollees were receiving premium subsidies as of early 2023 with an average subsidy of $364/month. After applying subsidies, enrollee premiums averaged $279/month.¹⁸

In addition to the private qualified health plans available through the state exchange, almost 1.2 million people were enrolled in Basic Health Program coverage through New York’s Essential Plan as of January 2024. Essential Plan enrollment is completed via NY State of Health, just like qualified health plan enrollment. But BHP coverage in New York dwarfs qualified health plan enrollment.¹⁹

The Essential Plan has zero premiums and low cost-sharing. It has thus-far been available to adults with household incomes up to 200% of the poverty level. But the state has obtained federal permission to extend the eligibility limit to 250% of FPL, starting in April 2024.³ For a single adult in 2024, this will allow access to the Essential Plan with a household income up to $37,650.

(New York had previously paused the proposal to extend Essential Plan eligibility in the fall of 2023,²⁰ but subsequently asked the federal government to continue with the review and approval process,²¹ including an addition to ensure that DACA recipients can enroll in the Essential Plan — which was granted as part of the waiver approval.³)

Source: CMS.gov¹⁸

In addition to the ACA’s premium tax credits (subsidies), people with household incomes up to 250% of the federal poverty level also qualify for cost-sharing reductions (CSR) that reduce the out-of-pocket costs on Silver plans.

Because Essential Plan coverage extends to 200% of the poverty level in New York, relatively few enrollees (only those with income between 200% and 250% of FPL) are eligible for CSR benefits. This amounted to about 14% of the people who enrolled in private plans through NY State of Health during the open enrollment period for 2023 coverage.¹⁸

Starting in April 2024, there will no longer be anyone eligible for CSR benefits in New York, as Essential Plan coverage will extend to 250% of the poverty level.

A note about standardization of qualified health plans in New York: Insurers that offer plans through NY State of Health must offer one standard plan design in each metal level in every county where the insurer offers plans (here are the 2024 standardized plan details). Carriers can also offer up to two non-standard plan designs at each metal level.²²

Since 2021, New York has required state-regulated (non-self-insured) health plans, including Marketplace plans, to cap out-of-pocket costs for insulin at no more than $100 per month.²³ Legislation passed in the Senate in 2023 to lower that cap to $30, but did not advance in the Assembly.²⁴ In 2024, the Senate passed legislation to eliminate cost-sharing for insulin, but it had not been taken up by the Assembly as of early March.[/efn_note]”New York S504” BillTrack50. Accessed March 4, 2024.[/efn_note]

The overall weighted average rate change for 2024 qualified health plans in New York amounted to an increase of 13.5%, before any subsidies were applied.²⁵ As is typically the case in New York, the approved rates were quite a bit lower than the insurers had initially proposed, with significant modifications made during the rate review process.

Health insurance companies in New York have implemented the following rate changes for 2024, as approved by the New York State Department of Financial Services.²⁶

Source: New York State Department of Financial Services²⁶

It’s important to understand that net rate changes for people who receive premium subsidies can be quite different from the overall rate changes for that person’s plan, since it also depends on how the benchmark plan (second-lowest-cost silver plan) premium changes.

For perspective, here’s a summary of how average full-price (pre-subsidy) premiums for qualified health plans in New York’s individual/family market have changed over the years:

• 2015: Average increase of 5.7%.²⁷
• 2016: Average increase of 7.1%.²⁸
• 2017: Average increase of 16.6%.²⁹
• 2018: Average increase of 13.9%.³⁰
• 2019: Average increase of 8.6%.³¹
• 2020: Average increase of 6.8%.³²
• 2021: Average increase of 1.8%.³³
• 2022: Average increase of 3.7%.³⁴
• 2023: Average increase of 9.7%.³⁵

As of January 13, 2024, CMS reported that 279,879 people had enrolled in private qualified health plans through NY State of Health (this total does not include Essential Plan enrollments).³⁶

By February 1, 2024, NY State of Health reported that 288,647 people were enrolled in qualified health plans through the exchange.³⁷

Open enrollment continues through May 31, 2024 in New York (it normally ends January 31, but has been extended due to the “unwinding” of the Medicaid continuous coverage rule).¹⁴ But the enrollment total by early 2024 was the highest enrollment had been in New York’s Marketplace since 2015.

(See chart below; enrollment in QHPs dropped in 2016 when the Essential Plan debuted, because many people previously eligible for subsidized QHPs transitioned to the Essential Plan starting in 2016.)

The enrollment growth in 2024 was likely driven by a combination of the continued subsidy enhancements under the American Rescue Plan, as well as the Medicaid unwinding process that began in the spring of 2023. By early 2024, about 1.1 million people in New York had been disenrolled from Medicaid.³⁸

Some of them had transitioned to QHPs in the Marketplace, helping to drive 2024 enrollment. CMS reported that by November 2024, more than 48,000 New York residents had transitioned from Medicaid to a qualified health plan in the Marketplace (another 223,507 had transitioned to Essential Plan coverage).³⁹

The chart below shows QHP enrollment by year in New York. But it’s important to note that New York’s Basic Health Program (BHP) covers far more people than the QHPs in the state, with nearly 1.2 million people enrolled in New York’s BHP as of early 2024.³⁷

Source: 2014,⁴⁰2015,⁴¹ 2016,⁴²2017,⁴³2018,⁴⁴2019,⁴⁵2020,⁴⁶2021,⁴⁷2022,⁴⁸2023¹⁸

NY State of Health
855-355-5777

State Exchange Profile: New York
The Henry J. Kaiser Family Foundation overview of New York’s progress toward creating a state health insurance exchange.

Health Care For All New York (HCFANY)