Obamacare New York 2026: NY State of Health Plans & Costs Guide

New York runs one of the most comprehensive state-based Marketplaces in the country. More than 6.7 million New Yorkers are enrolled through NY State of Health, including Medicaid, Child Health Plus, the Essential Plan, and Qualified Health Plans (QHPs). That makes New York one of the top states for affordable, accessible health insurance, especially for immigrant communities.

If you live in New York City, the Bronx, Queens, Brooklyn, Long Island, Westchester, the Capital District, or anywhere Upstate — this guide explains what programs are available, what they cost, and how to enroll, including the Essential Plan that is unique to New York.

How Obamacare works in New York

New York does not use HealthCare.gov. Instead, New Yorkers enroll through NY State of Health, the state’s own Marketplace platform. It is one of the few state-based exchanges that has consistently outperformed the federal Marketplace on enrollment per capita.

NY State of Health is unique in that it combines four programs under one application:

1. Medicaid — for low-income adults, children, pregnant women, and people with disabilities
2. Child Health Plus — New York’s CHIP program for children
3. Essential Plan: for people below 200% FPL who do not qualify for Medicaid
4. Qualified Health Plans (QHPs) — the metal-tier ACA plans (Bronze, Silver, Gold, Platinum)

You fill out one application, and the system routes you to the program you qualify for.

New York has the most generous coverage options in the country. Talk to a licensed New York agent — free, Spanish available.

The Essential Plan — a New York advantage

The Essential Plan is what makes New York different from most other states. It is a state-run program (with federal funding) that fills the gap between Medicaid (under 138% FPL) and Marketplace QHPs (over 200% FPL).

Key features:

• Premium: $0 per month
• Deductible: $0
• Copays: Low ($0 to $15 for primary care, $0 to $25 for specialists)
• Eligibility: Income below 200% FPL since July 1, 2026, about $31,920 single or $66,000 for a family of four under the 2026 guidelines
• Coverage: Same essential health benefits as Marketplace plans
• Open enrollment: Year-round — no waiting for an enrollment window

2026 change: Since July 1, 2026, the Essential Plan covers incomes below 200% FPL, and about 450,000 enrollees between 200% and 250% FPL moved to Qualified Health Plans. If your income is in that range, a licensed agent can help you compare Qualified Health Plans. Below 200% FPL, the Essential Plan continues as before.

This is still one of the most affordable health coverage options in the country. If your income keeps you in the eligibility range, the Essential Plan will almost always be a better deal than a Marketplace plan.

Hispanic enrollment in New York

New York has the third-largest Hispanic population of any state — about 19% of New Yorkers identify as Hispanic or Latino. The Puerto Rican, Dominican, Mexican, Ecuadorian, and Colombian communities are concentrated in:

• The Bronx (~56% Hispanic) — Puerto Rican, Dominican
• Manhattan / Washington Heights — Dominican, Puerto Rican
• Queens (~28% Hispanic) — diverse, including Ecuadorian, Colombian, Mexican
• Brooklyn (~19% Hispanic) — Puerto Rican, Mexican, Dominican
• Long Island / Nassau and Suffolk — Salvadoran, Honduran, Mexican
• Westchester / Yonkers — Mexican, Ecuadorian
• Rochester, Buffalo, Syracuse — growing Hispanic populations

Spanish-language enrollment assistance is widely available through NY State of Health Navigators, licensed agents, FQHCs, and community-based organizations like Make the Road New York and Hispanic Federation.

Insurers in New York (2027)

The insurers that the New York Department of Financial Services lists as offering plans on NY State of Health for 2027 are:

• Anthem (formerly Empire)
• CDPHP
• EmblemHealth (HIP)
• Excellus
• Fidelis Care
• Healthfirst
• Highmark (formerly HealthNow)
• Independent Health
• MetroPlus
• MVP Health Plan
• UnitedHealthcare

NYC has the widest selection.

How much does Obamacare cost in New York?

It depends on which program you land in:

• Medicaid: Free
• Essential Plan: $0 per month, no deductible
• Qualified Health Plans (QHPs): average $376 per month in 2026 for enrollees with the federal credit

QHP cost drivers:

1. Age. Older costs more.
2. County / region. NYC has higher gross premiums than Upstate, but subsidies offset most of the difference.
3. Household income. Lower income, bigger subsidy.

For real 2027 prices for your age, county and income, ask a licensed agent or check NY State of Health. At lower incomes, Medicaid or the Essential Plan may apply instead.

Get your real New York number. Free quote from a licensed agent.

The New York Medicaid situation

New York expanded Medicaid under the ACA, with very generous rules:

• Adults up to 138% FPL (~$22,025 single, ~$45,540 family of four in 2026) qualify with no asset test.
• Pregnant women qualify at higher incomes than other adults for pregnancy-related care; confirm the current limit with NY State of Health.
• Children qualify for Medicaid or Child Health Plus at higher incomes than adults; confirm the current limit with NY State of Health.
• Older adults and people with disabilities have additional eligibility pathways.
• Some undocumented residents qualify — children regardless of status, pregnant women, and people over 65.

Application is year-round through NY State of Health.

Federally Qualified Health Centers (FQHCs) in New York

Major New York FQHCs include:

• Urban Health Plan (Bronx) — large bilingual network
• Community Healthcare Network (NYC)
• The Floating Hospital (NYC)
• Charles B. Wang Community Health Center (Manhattan, Queens, Brooklyn)
• Open Door Family Medical Centers (Westchester)
• Hudson River HealthCare (Mid-Hudson Valley)
• Mosaic Health (Western NY)
• Whitney M. Young Jr. Health Services (Albany)

Search the HRSA Find a Health Center tool for FQHCs near your zip code.

Immigrant eligibility in New York

New York has the most expansive coverage options for immigrants of any state alongside California:

• Lawfully present immigrants can buy Marketplace QHPs, but starting January 1, 2027 only green card holders, Cuban or Haitian entrants and COFA migrants qualify for subsidies.
• Lawfully present immigrants can qualify for the Essential Plan below 200% FPL since July 1, 2026; the 200-250% FPL group moved to Qualified Health Plans.
• DACA recipients: check current Essential Plan eligibility directly with NY State of Health.
• Undocumented children under 19 qualify for Child Health Plus.
• Undocumented adults over 65 qualify for Medicaid-equivalent programs.
• Undocumented pregnant women qualify for prenatal Medicaid.
• Mixed-status families apply together — only eligible members are enrolled.

NY State of Health does not share immigration information with ICE. This is protected by federal and state law.

If you do not have a Social Security Number but are lawfully present, you can still apply using your immigration document numbers. Read our guide on applying without an SSN.

When to enroll in New York

NY State of Health has historically extended Open Enrollment beyond the federal calendar:

• QHP Open Enrollment 2027: confirm the dates with NY State of Health (for 2026 coverage it ran November 1, 2025 through January 31, 2026)
• Medicaid, Child Health Plus, Essential Plan: Year-round, no Open Enrollment window required
• Special Enrollment Periods for QHPs: available year-round for qualifying life events

Qualifying life events: loss of other coverage, marriage, birth or adoption, moving zip codes, US citizenship, significant income change.

How to apply for Obamacare in New York

Four routes:

1. NY State of Health directly — free, official, English/Spanish/Chinese/Korean and more
2. A licensed agent or broker — free to you, paid by the insurer, what Nexus Insurance provides
3. A state-certified Navigator — non-commercial, available in every county
4. In-person at a NY State of Health Assistor site — community health centers and CBOs

What you need:

• Names, dates of birth, and SSNs (or immigration document numbers) for everyone applying
• Estimated 2026 household income
• Information about any current insurance
• Employer information if anyone has a job offer of coverage

Ready to enroll? Get a free quote from a New York licensed agent. Spanish available.

Common New York-specific questions

“I work for tips at a restaurant — can I get the Essential Plan?” Yes. The Essential Plan uses estimated annual income. Restaurant workers, gig workers, and self-employed people all qualify if income is within range.

“My employer offers insurance but it is too expensive.” If your employer’s self-only plan would cost more than 9.96% of your household income in 2026 (10.22% for 2027 coverage), you may qualify for a subsidy on NY State of Health. The Essential Plan has its own affordability test.

“My family is mixed-status — what do we apply for?” Each person is evaluated separately. Some family members may end up in Medicaid, some in the Essential Plan, some in QHPs, depending on individual eligibility. NY State of Health handles this in one application.

“I have a pre-existing condition.” Cannot be used against you. Federal and New York state law since 2014.

Cross-references

• Obamacare: The Complete US Guide
• The Health Insurance Marketplace
• Who Qualifies for Obamacare
• Income Limits for Subsidies
• How to Apply for Obamacare
• Applying Without an SSN

Disclaimer: This page is for informational purposes only and does not constitute professional advice. Insurance products vary by state and individual circumstances. Always speak with a licensed insurance agent for guidance specific to your situation. Nexus Insurance partners with US-licensed agents serving New York residents in English and Spanish. Contact us for a free quote.