The Essential Plan in New York: Who Qualifies, What It Covers, What Changes in 2027

What the Essential Plan actually is

It is a state-run health plan, not a discount card and not a marketplace plan with a subsidy attached. New York built it under a provision of the Affordable Care Act that lets states cover people who earn slightly too much for Medicaid, and it has been the quietest success in the state’s coverage system: over a million enrollees, no monthly premium, and no deductible to burn through before coverage starts.

You pick a carrier, Healthfirst, Fidelis Care, MetroPlus, EmblemHealth and others offer it, and you get a card that works like any other insurance card. The plan pays. You don’t get a monthly bill.

Who qualifies in 2026

Four conditions have to be true at once.

Age 19 to 64. Under 19, the answer is Child Health Plus or Medicaid. At 65, it’s Medicare.

You live in New York State. Any county, including all five boroughs.

You don’t qualify for Medicaid. This matters more than people expect: if your income is low enough for Medicaid, that’s where you go, and Medicaid is broader. The Essential Plan sits in the band above it.

Your household income is at or below 200% of the federal poverty level.

Each additional person adds $5,680 to 100% FPL. Annual figures.

Those figures are annual, before taxes, for the 48 contiguous states in 2026. If your income moves around, gig work, seasonal hours, cash pay, use what you reasonably expect for the year and correct it later. Reporting a change is normal and does not put your coverage at risk by itself. What counts as income, and what to do if you’re just over.

Immigration status. Lawfully present immigrants qualify. New York also covers some immigrants through state-funded arrangements that federal rules would otherwise exclude, which is why an “I probably don’t qualify” assumption is wrong so often here. If you’re undocumented, the Essential Plan is not your door, but NYC Care and hospital financial assistance are, and neither asks about status. For the federal change that reaches some lawfully present enrollees in 2027, see below.

What it covers

The benefit package is comprehensive by design, not a stripped-down catastrophic plan:

There is no deductible. Depending on which income band you land in, you may see small copays for some services, and you may see none at all.

Essential Plan 1, 2, 3, 4: what the numbers mean

Carriers still print numbered versions on cards and websites, and people search for “Essential Plan 1 vs 2” every month. The numbers come from how the state historically ran the program: versions tied to income bands, with 1 for the highest band (150% to 200% of the poverty level), 2 for the band just above Medicaid (138% to 150%), and 3 and 4 for lawfully present immigrants below 138% who did not qualify for federally funded Medicaid.

The versions differed mainly in cost sharing, with the lower-numbered plans carrying modest copays and the higher-numbered ones none. The monthly premium that once applied to Essential Plan 1 was eliminated in 2021, so every version has been $0 a month since. Which version you receive is decided by the application from your income and status; you do not choose it, and the benefits are set by the state either way. “Is Essential Plan 4 Medicaid?” comes up too: no. It is the Essential Plan, run through the same carriers, for people whose immigration category keeps them out of federal Medicaid.

Essential Plan vs Medicaid

You don’t choose between them. If you qualify for Medicaid, the application puts you there, and that is the broader coverage. How Medicaid works in New York.

What changed on July 1, 2026

Until that date, the Essential Plan covered people earning up to 250% of the federal poverty level. The federal funding arrangement that paid for the 200% to 250% band ended, and New York did not replace it. NY Health Access put the number of people who lost eligibility at roughly 450,000. They were moved into Qualified Health Plans on the marketplace, most with tax credits that cut the monthly premium substantially, but “substantially cheaper” is not “$0,” and that band now pays something every month.

If your income is at or below 200% FPL, this change did not affect you. Your $0 premium coverage continues.

If you were in the 200% to 250% band, see what your options are now, and use this fall’s open enrollment to choose a plan deliberately rather than keep the one you were assigned.

What changes on January 1, 2027

The federal budget law of July 2025 narrowed which immigrants can receive the federal premium tax credits that fund much of the Essential Plan. From January 1, 2027, that funding is limited to lawful permanent residents, certain Cuban and Haitian entrants, and citizens of the Compact of Free Association nations. Refugees, asylees, people with Temporary Protected Status and other lawfully present categories are outside it.

State officials have estimated that more than 200,000 Essential Plan enrollees above 138% of the poverty level are in the affected categories, and have said they want to keep them covered where the state can. NY State of Health says it has notified affected enrollees directly, by letter, text or WhatsApp, about how the change affects their plan; if you are in one of those categories and have not seen it, call 1-855-355-5777. If you are in one of those categories: keep your NY State of Health contact information current, do not drop coverage on your own, and read the 2027 immigrant coverage page for the doors that never asked about status. Green card holders are not affected.

How to apply

You apply through NY State of Health, the state marketplace, and the same application screens you for Medicaid, the Essential Plan and Child Health Plus at once. You don’t pick the program; the application sorts you.

1. Apply online at nystateofhealth.ny.gov, by phone at 1-855-355-5777, or in person with a certified navigator. Navigators are free, and they are not brokers: they don’t earn commission on what you pick.
2. Have ready: proof of identity, proof of New York residence, and proof of income (pay stubs, a letter from an employer, tax return, or a self-attestation if you’re paid in cash).
3. Choose a carrier. This is the decision that matters most day to day, because it determines which doctors and which hospital systems are in network. How to check it in an hour.
4. Coverage typically starts the first of the following month.

What people get wrong

"$0 premium means it’s bad coverage." It’s the same regulated benefit package as marketplace plans, delivered by the same carriers. The difference is who pays the premium.

“I have a job, so I don’t qualify.” Most Essential Plan enrollees work. Income is what matters, not employment.

“Applying will affect my immigration case.” Enrolling in the Essential Plan is not a public charge consideration. Health coverage other than long-term institutional Medicaid was removed from that analysis, and New York does not report enrollment to immigration authorities. If you have a specific case pending, talk to an immigration attorney rather than guessing, but the default assumption that coverage is dangerous is doing real harm to families who qualify.