What the answers are based on
Every threshold used here is public, and each one is on a page that shows its source:
| Rule | Where it comes from |
|---|---|
| 100% FPL = $15,960 + $5,680 per additional person | HHS poverty guidelines, effective January 2026 |
| Medicaid, most working-age adults: about 138% FPL | New York State Medicaid rules |
| Essential Plan: 200% FPL, ages 19–64, lawfully present | NY State of Health |
| Child Health Plus: under 19, no immigration requirement | New York State |
| NYC Care: no income cutoff, no status requirement | NYC Health + Hospitals |
| Hospital financial assistance: no out-of-pocket at ≤200% FPL | New York State law |
The full table of income limits by household size is on the 2026 income limits page.
What it deliberately does not do
It doesn’t ask for your name, email or anything identifying. There is no form to submit and no list to join. If a coverage tool asks you for contact details before showing an answer, that tool is a lead generator.
It doesn’t decide anything. Eligibility is determined by NY State of Health or by the program itself, on a real application with real documents. What this does is tell you which application is worth your afternoon.
It doesn’t cover every case. Disability-based Medicaid, long-term care, immigrants in specific state-funded categories, and people with employer coverage they can’t afford all have rules this tool doesn’t model. If your situation is unusual, a free certified navigator will get further than any web page — 1-855-355-5777.
What to do with the result
If it points to Medicaid, the Essential Plan or Child Health Plus: apply now. Those have no enrollment season and take applications every month of the year.
If it points to a marketplace plan: note the dates. Open enrollment runs November 1 to January 31, with December 15 as the cutoff for coverage starting January 1. Outside that window you need a qualifying life event.
If it points to NYC Care: call 1-646-NYC-CARE. There is no deadline and no income cutoff for membership.
If you’re holding a hospital bill regardless of any of the above: the financial assistance rules apply on their own timeline, and you can apply after the bill arrives — including after it goes to collections.
Questions people ask
Is this an application?
No. It’s a map of which applications are worth making. The application itself is free at nystateofhealth.ny.gov or 1-855-355-5777.
Why does it ask about immigration status?
Because it changes the answer, and pretending otherwise would send people to doors that are closed. Nothing you enter leaves your browser, and the programs that don’t ask about status — NYC Care, Emergency Medicaid, hospital financial assistance — are shown for exactly that reason.
What income should I enter?
Household income before taxes, projected for this year. Not last year’s if this year looks different.
I’m just over a threshold. Does that settle it?
No — pre-tax deductions and household size both legitimately change the number the programs measure. See what counts as income.
Can I embed this on my organization’s site?
Yes. The embed code is here, and it’s free to use.
Sources
- NY State of Health (checked 2026-08-12)
- NY State of Health — Essential Plan (checked 2026-08-12)
- HHS 2026 Poverty Guidelines (Federal Register, January 15, 2026) (checked 2026-08-12)
- NYC Care (checked 2026-08-12)
More in Coverage
- The 20-Minute Renewal Checklist for NY State of Health — A printable checklist for reviewing a marketplace plan before it auto-renews: premium, credit, doctors, drugs, deadlines, and the three phone calls that settle each one.
- Fidelis Care: What to Know Before You Pick It — Fidelis Care is one of the largest Essential Plan and Medicaid carriers in New York State. What its statewide reach means for your network, and the questions to ask first.
- NYC Care: Who Qualifies, What It Covers, What It Doesn't — NYC Care gives uninsured New Yorkers access to NYC Health + Hospitals regardless of immigration status or ability to pay. What it is, what it isn't, and how to join.
This page explains how the system works. It is not medical advice. More.