What Changed for 2027 Coverage in New York: Rates, Credits, Eligibility

Premiums: what the state approved for 2027

Every summer New York’s insurers file the rates they want for the next year, and every summer the Department of Financial Services cuts them. This year the cut was large. On September 4, 2026 the department approved an average increase of 6.0% in the individual market against a requested 20.6%, and 8.0% in the small-group market against a requested 23.7%. The department put the combined savings at about $1.6 billion for roughly 860,000 people in those two markets.

Two cautions about that number. It is an average across carriers and plans, so your renewal notice can show a larger or smaller change. And it is the sticker price before any tax credit, which means the premium you pay moves with two things at once: the plan’s rate and the size of your credit. The second one moved more.

Tax credits: smaller than 2025, and repayment caps are gone

From 2021 through 2025, enhanced federal premium tax credits capped what marketplace enrollees paid at a percentage of income and extended help above 400% of the poverty level. Those enhancements expired on December 31, 2025. Congress had not restored them when 2026 plans took effect, and had not restored them as of the date on this page. Nationally, average marketplace premium payments rose sharply in 2026 as a result.

For 2027 the credit works on the older formula: a percentage of income that rises with income, and generally no credit at all above 400% of the poverty level. In 2026 dollars that line is $63,840 for one person and $132,000 for a family of four.

A second change is quieter and costs people more. Federal law passed in July 2025 removed the cap on how much excess advance credit a household must repay at tax time, starting with the 2026 tax year. If you underestimate your income, the entire overpayment comes back as a tax bill. How the credit is calculated, and how to protect yourself.

The Essential Plan: back to 200%

The Essential Plan covered New Yorkers up to 250% of the poverty level from April 2024 until June 30, 2026. The federal funding for the upper band ended, and on July 1, 2026 the ceiling returned to 200%. NY Health Access put the number of people who lost Essential Plan eligibility at roughly 450,000; termination notices went out around April 1, 2026.

Those households were offered marketplace plans with tax credits. For many the monthly cost went from $0 to a real premium. If that was you, this open enrollment is the first chance to pick a plan deliberately rather than accept the one you were placed in. Where to start.

Immigration status: a new line on January 1, 2027

The same July 2025 federal law narrowed who can receive premium tax credits. From January 1, 2026, lawfully present immigrants with income under 100% of the poverty level lost eligibility. From January 1, 2027, eligibility is limited to lawful permanent residents, certain Cuban and Haitian entrants, and citizens of the Compact of Free Association nations. Refugees, people granted asylum, people with Temporary Protected Status and other lawfully present categories lose the credit.

Because New York funds much of the Essential Plan with the same federal money, the change reaches that program too. State officials have said they intend to keep the affected immigrant enrollees covered where they can. NY State of Health says it has notified affected Essential Plan enrollees directly, by letter, text or WhatsApp, about how the change affects their plan; if you are in one of these categories and heard nothing, call 1-855-355-5777 before January. What is known, what is not, and what stays open regardless of status.

Medicaid: work and community engagement rules

Federal law now requires states to condition Medicaid for most adults aged 19 to 64 in the expansion group on 80 hours a month of work, school, training or community service, or monthly income of at least $580, or an exemption, from January 2027. The federal agency issued its implementing rule on June 1, 2026. NY State of Health has said about 2 million New York enrollees are expected to be subject to the requirement. It was due to notify the people it applies to by September 30, 2026, and people already enrolled meet the rule at renewal, starting with renewals from March 1, 2027. The same law moves renewals to every six months for some of that group.

What that means for a New York household in practice, who is exempt, and what to keep as proof is on its own page: Medicaid work requirements in 2027.

What did not change

• Open enrollment dates. November 1, 2026 to January 31, 2027, December 15 for a January 1 start. New York keeps a longer window than the federal marketplace.
• The year-round programs. Medicaid, the Essential Plan and Child Health Plus still take applications any month.
• NYC Care. No immigration status requirement, no income cutoff to join, 1-646-NYC-CARE.
• Hospital financial assistance. Free care below 200% of the poverty level, capped charges to 400%, no lawsuits under 400%. The full law, which most billing offices still describe in its pre-2024 form.