Getting Care in Ozone Park and Richmond Hill: Working for a Small Business

The number that changes the law

Most coverage advice is written for people at large employers, where HR has a benefits department and federal rules apply straightforwardly. A shop with twelve people is a different legal object.

Three thresholds decide almost everything:

Twenty employees — the line for federal COBRA and for the Medicare coordination rule.

Two employees — the floor for New York’s own continuation coverage, which exists precisely to cover the gap federal law leaves.

Fifty employees — the line above which an employer is generally required to offer coverage at all. Below it, offering coverage is a choice.

At 65, small size flips the rule

This is the trap that costs the most money in a neighborhood of small employers, and it works backwards from what people expect.

At 20 or more employees: the employer plan pays first and Medicare second, so Part B can be delayed without penalty while you keep working.

Below 20 employees: Medicare becomes the primary payer once you are eligible. The employer plan pays second — and pays as though you had Part B whether or not you enrolled. Skipping Part B does not save a premium here; it leaves the primary share of every claim unpaid.

One question to the employer, three months before the birthday: “Do we have 20 or more employees for Medicare coordination purposes, and does our plan pay primary or secondary once I turn 65?” Get it in writing if you can. The full Medicare timing.

If the job offers nothing

Below 50 employees there may simply be no plan, and that is lawful. What fills it:

The Essential Plan — $0 a month at or below 200% of the federal poverty level, no deductible, no enrollment season. This covers a very large share of people working full time in small businesses. What it covers.

Medicaid, at lower income, also year-round.

Child Health Plus for children, at income limits far above what parents expect. Child Health Plus.

A marketplace plan with a premium tax credit, priced on the income you actually expect this year. The 2026 limits by household size · The five-question check.

If you are the one running the business, the same three numbers decide what you owe and what you do not — and one obligation is not optional at any size. What a small employer owes.

Two things people assume disqualify them, and do not

Being paid in cash. It does not disqualify anyone from coverage or from a community health center’s sliding scale. Income can be self-declared where there are no pay stubs, and that is a normal documented process rather than an exception being made.

Immigration status. It does not affect a child’s eligibility, does not affect pregnancy coverage through Medicaid, may not be considered in hospital financial assistance, and is not asked at all by NYC Care. What status does and does not affect.

Before booking anywhere new

Two questions that decide the size of the bill more than the copay does:

“Is this billed as a doctor’s office or as a hospital outpatient department?” — the second adds a facility fee. What a facility fee is.

“Do you take [exact plan name], and are you accepting new patients with it?” — two separate facts. The two-question call.

Everything the federal registry lists here