New York health insurance Marketplace guide

To purchase health coverage through the New York Health Insurance Marketplace, you must:¹¹

• Live in New York
• Be lawfully present in the United States
• Not be incarcerated
• Not be enrolled in Medicare¹²

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.¹³
• If married, file a joint tax return.¹⁴
• Not be able to be claimed by someone else as a tax dependent.¹⁴

In New York, the open enrollment period typically runs from November 1 through January 31.¹⁵

Starting in the fall of 2026, however, the open enrollment period will be shorter. A federal rule change, finalized in 2025, will require state-run exchanges to end open enrollment no later than December 31.

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, during the open enrollment period for 2025 coverage, 63% of the people who enrolled in private health plans qualified for premium subsidies. The average subsidy amount was $440/month. After the subsidies were applied, subsidy-eligible enrollees’ net premiums averaged $340/month.¹⁸

Source: CMS.gov¹⁸

In addition to the private qualified health plans available through the state exchange, almost 1.7 million people were enrolled in New York’s zero-premium Essential Plan coverage as of August 2025.¹⁹ Essential Plan enrollment is completed via NY State of Health, just like qualified health plan enrollment.

The Essential Plan has zero premiums and low cost-sharing. It was previously available to adults with household incomes up to 200% of the poverty level. But the state obtained federal permission to extend the eligibility limit to 250% of FPL, starting in April 2024.⁵

For a single adult in 2025, this allows access to the Essential Plan with a household income of up to $39,125.²⁰ But starting in July 2026, New York plans to reduce the Essential Plan eligibility limit to 200% of FPL.⁶ At that point, people with income between 200% and 250% of FPL will need to transition to qualified health plan coverage in the Marketplace instead.

Marketplace enrollees with household incomes up to 250% of the federal poverty level also qualify for the ACA’s cost-sharing reductions (CSR) that reduce the out-of-pocket costs on Silver plans. Almost a quarter of the people who enrolled in qualified health plans during open enrollment for 2024 — when Essential Plan eligibility still ended at 200% of FPL — were eligible for CSR benefits.²¹

Because Essential Plan coverage now extends to 250% of the poverty level in New York, federal cost-sharing reductions are no longer available for new enrollees in the Marketplace, as they’re eligible for the Essential Plan instead (as noted above, this will no longer be the case as of mid-2026, when the income limit for Essential Plan coverage will drop to 200% of FPL). But New York has started offering state-funded cost-sharing reductions that extend to higher income levels.

In 2024, New York received federal permission to modify the 1332 waiver that allowed for the extension of the Essential Plan. Under the terms of the modification, New York is allowed to use pass-through funding to provide cost-sharing reductions to Marketplace enrollees with income up to 400% of the federal poverty level, as well as cost-sharing reductions for diabetes treatment and pregnancy and postpartum services.²²

The state received approval to begin offering these additional benefits as of the 2025 plan year,⁷ and New York officials confirmed that the additional cost-sharing reductions would be available for plans effective beginning January 1, 2025.²² New York’s additional CSR benefit will continue to be available in 2026.⁸

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 2025 standardized plan details). Carriers can also offer up to two non-standard plan designs at each metal level.²³

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.²⁴ Legislation passed in the Senate in 2023 to lower that cap to $30, but did not advance in the Assembly.²⁵ In 2024, the Senate passed legislation to eliminate cost-sharing for insulin, but it had not been taken up by the Assembly as of mid-2024.²⁶

Twelve insurers will offer qualified health plans through New York’s Marketplace for 2026,³ all of which also offered coverage for 2025.²⁷

See the next FAQ for details about approved premium changes for 2026 for each insurer.

For 2026, the insurers that offer Marketplace health plans in New York will implement the following average rate increases, which amount to an overall weighted average rate increase of 7.1%.³

Source: New York State Department of Financial Services³

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.

Unless Congress extends the federal subsidy enhancements that have been in effect since 2021, subsidies will be smaller and available to fewer people in 2026. New York Governor Kathy Hochul has signed onto a joint letter from 18 states, urging Congress to take immediate action to extend the subsidy enhancements. Without that action, coverage will become much less affordable in 2026.²⁸

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%.²⁹
• 2016: Average increase of 7.1%.³⁰
• 2017: Average increase of 16.6%.³¹
• 2018: Average increase of 13.9%.³²
• 2019: Average increase of 8.6%.³³
• 2020: Average increase of 6.8%.³⁴
• 2021: Average increase of 1.8%.³⁵
• 2022: Average increase of 3.7%.³⁶
• 2023: Average increase of 9.7%.³⁷
• 2024: Average increase of 13.5%.³⁸
• 2025: Average increase of 12.7%.²⁷ 

CMS reported that 221,534 people enrolled in private qualified health plans through NY State of Health during the open enrollment period for 2025 coverage (this total does not include Essential Plan enrollments).[/efn_note] 2025³⁹

Although nationwide Marketplace enrollment has reached record highs in recent years, that hasn’t been the case in New York (see graph below). This is because of the expansion of Essential Plan eligibility starting in April 2024, when people with household income between 200% and 250% of FPL became eligible for the Essential Plan and were able to transition from QHPs to the Essential Plan (as noted above, eligibility for the Essential Plan will once again be capped at 200% of FPL starting in July 2026).⁶

The chart below shows QHP enrollment by year in New York. But it’s important to note that the Essential Plan covers far more people than the QHPs in the state. As of August 2025, there were 222,589 QHP enrollees through NY State of Health, while Essential Plan enrollment stood at 1,695,913.¹⁹ 

Source: 2014,⁴⁰ 2015,⁴¹ 2016,⁴² 2017,⁴³ 2018,⁴⁴ 2019,⁴⁵ 2020,⁴⁶ 2021,⁴⁷ 2022,⁴⁸ 2023,⁴⁹ 2024,⁵⁰ 2025³⁹

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 same thing happened in 2024 and 2025, with the expansion of the Essential Plan.

But earlier in 2024, QHP enrollment was higher than it had been in several years. 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 June 2024, more than 2 million people in New York had been disenrolled from Medicaid.⁵¹

Some of them had transitioned to QHPs in the Marketplace, helping to drive 2024 enrollment. CMS reported that by April 2024, nearly 84,000 New York residents had transitioned from Medicaid to a qualified health plan in the Marketplace, and more than 416,000 had transitioned to Essential Plan coverage.⁵²

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)