A premium is the monthly cost of having a plan. You pay it whether or not you see a doctor, and it is separate from the deductible, copays and coinsurance you pay when you use care.
In New York this is where the programs split most visibly:
| Coverage | Monthly premium |
|---|---|
| Medicaid | $0 |
| Essential Plan | $0 |
| Child Health Plus | $0 to a small amount, by family income |
| Marketplace plan | varies, reduced by tax credits applied in advance |
The trap in comparing plans by premium. The cheapest premium usually carries the highest deductible, so the plan costs least for someone who never uses it and most for someone who does. If you take regular medication or see a specialist, compare the total: premium times twelve, plus the deductible, plus expected copays.
Premiums do not count toward the out-of-pocket maximum. That ceiling covers what you pay for care, not what you pay for the card.
In New York: the premium is $0 on Medicaid and the Essential Plan, and $0 on Child Health Plus for families up to 222% of the federal poverty level, then $15 to $60 per child per month up to 400%. On marketplace plans the state approved an average 6.0% increase for 2027, well below the 20.6% insurers requested. What moved more than the premium is the tax credit, which shrank when the enhanced federal credits expired at the end of 2025. What that means for a renewal.
Also called: monthly premium. Reference: Premium on Wikipedia — general definition, not New York specifics.
More in Glossary of health coverage and billing terms
- Charity care — Charity care is the everyday name for hospital financial assistance in New York. Who qualifies, the income tiers to 400% of poverty, and how to apply.
- EMTALA — The federal law requiring emergency rooms to screen and stabilize anyone, regardless of insurance or status.
- Special enrollment period — A window outside open enrollment when a life event lets you sign up for a marketplace plan.
This page explains how the system works. It is not medical advice. More.