Most of what changed comes from the federal budget law signed in July 2025, often called the One Big Beautiful Bill Act, plus the expiration of the enhanced tax credits at the end of 2025. The law sets national dates; New York decides what it covers with its own money. Read separately, the notices make each change look isolated. Read in order, they show which households are hit more than once: a lawfully present immigrant on the Essential Plan, or an older adult with both Medicare and the Medicare Savings Program.
The timeline
- December 31, 2025 Enhanced premium tax credits expireMarketplace credits continue at the older, smaller formula, and the cap on repaying excess advance credit at tax time is gone. What changed for 2027 plans.
- July 1, 2026 The Essential Plan’s 200–250% income band endsAbout 450,000 New Yorkers were moved toward marketplace plans, most with tax credits. At or below 200% of the poverty level nothing changed. Your options now.
- September 4, 2026 New York sets 2027 premiumsIndividual-market rates rise an average of 6.0% (insurers asked for 20.6%); small-group rates rise 8.0% (asked for 23.7%).
- By September 30, 2026 Work-rule notices go outNY State of Health was due to tell Medicaid enrollees the work rule applies to them. No letter is not proof of an exemption. Check your status.
- October 1, 2026 Federal Medicaid money narrows for many non-citizensNew York keeps covering refugees, asylees and other lawfully present groups with state funds. The Medicare Savings Program ends for non-citizens outside the federal list, with no state replacement.
- October 15 – December 7, 2026 Medicare annual enrollment for 2027New York’s cheapest stand-alone Part D plan costs $37.30 a month in 2027, and every New Yorker in one can find a lower premium. The numbers.
- November 1, 2026 – January 31, 2027 Marketplace open enrollmentEnroll by December 15 for a January 1 start. Open enrollment 2027.
- January 1, 2027 Premium tax credits narrow for many immigrantsLimited to lawful permanent residents, certain Cuban and Haitian entrants and COFA citizens. The Essential Plan runs on the same federal money; read the notice NY State of Health sent.
- January 2027 Medicaid work rule beginsMany adults 19 to 64 must show 80 hours a month of work, school, training or service, or monthly income of at least $580, or an exemption.
- January 4, 2027 Medicare ends for non-citizens outside the federal listCitizens, green card holders, Cuban and Haitian entrants and COFA citizens keep it. What New York keeps.
- March 1, 2027 Work-rule checks start at renewalPeople already on Medicaid meet the rule at renewal; some adults will renew every six months instead of once a year.
Who is hit more than once
The dates matter most where they stack. The table shows the households the changes reach repeatedly, built from the rules on this site’s program pages.
| Household | Changes that reach it | First date | What to do now |
|---|---|---|---|
| Lawfully present immigrant (refugee, asylee, TPS) on the Essential Plan | Essential Plan federal funding and tax credit end January 1, 2027 | January 1, 2027 | Read the NY State of Health notice; call a navigator about a special enrollment period |
| Same person on Medicaid | Medicaid continues with state funds | October 1, 2026 | Nothing changes in coverage; keep renewals on time |
| Non-citizen outside the federal list with Medicare | Medicare Savings Program ended October 1, 2026; Medicare ends January 4, 2027 | October 1, 2026 | Ask about Medicaid and NYC Care before January |
| Adult 19 to 64 on Medicaid, not exempt | Work rule from January 2027; checks at renewal from March 1, 2027; some six-month renewals | January 2027 | Find out whether an exemption applies and keep records of hours or income |
| Adult who was between 200% and 250% of the poverty level | Moved off the Essential Plan July 1, 2026; smaller federal credits since January 2026 | July 1, 2026 | Check the plan you were placed in during open enrollment |
| Older adult on Medicare with drug costs | 2027 Part D cap rises to $2,400; NY’s cheapest stand-alone plan is $37.30 a month | January 1, 2027 | Compare plans by December 7; check EPIC and Extra Help |
What New York kept, and what it could not
Kept with state money: Medicaid for refugees, asylees, TPS holders and other lawfully present New Yorkers after October 1, 2026. Children and pregnant people keep federally funded coverage.
Never depended on status: NYC Care at the city’s public hospitals, Emergency Medicaid, Child Health Plus for children under 19, and hospital financial assistance up to 400% of the federal poverty level.
Could not replace: the Medicare Savings Program for non-citizens outside the federal list, which the state cannot pay for with its own money, and Medicare itself, which is federal.
What to do, in order
- Find your line in the table above. If more than one row fits, the earliest date is your deadline.
- Open every letter from NY State of Health, HRA and your plan this fall. The Essential Plan notice and the work-rule notice are the two most often missed.
- If you are losing a program, ask about the special enrollment period that opens when eligibility ends. Navigators are free: 1-855-355-5777.
- If you are on Medicaid and between 19 and 64, check the exemptions before January: pregnancy and 12 months after, caring for a child under 14 or a disabled person, disability, serious medical or mental health conditions, treatment, SNAP or TANF work rules, and recent release from jail or prison. Free help in NYC: 347-665-0214.
- If you have Medicare, compare plans before December 7, 2026, and call HIICAP at 1-800-701-0501 for free, unbiased help.
Methodology
This timeline compiles dates already verified on our program pages, each against the primary source listed above: New York State Department of Health guidance (GIS 26 MA/14 of September 29, 2026), NY State of Health’s notice to Essential Plan enrollees, the NYC Health Department’s Medicaid changes page, CMS’s interim final rule on the work requirement, the Department of Financial Services’ September 4, 2026 rate decision, and CMS’s 2027 Medicare fact sheets. When an agency updates a date, we update the program page and this timeline on the same day and change the date at the top.
Questions people ask
When do the Medicaid work requirements start in New York?
In January 2027, for many enrollees aged 19 to 64. People already on Medicaid meet the rule at renewal, starting with renewals from March 1, 2027, and some will renew every six months.
What changed for immigrants on October 1, 2026?
Federal Medicaid money narrowed to citizens, green card holders past or not subject to the five-year bar, Cuban and Haitian entrants and COFA citizens. New York keeps covering the other lawfully present groups with state funds, but the Medicare Savings Program ended for them.
Did the Essential Plan end?
No. Its 200% to 250% income band ended on July 1, 2026. At or below 200% of the poverty level the Essential Plan continues with a $0 premium. Some lawfully present immigrants lose its federal funding on January 1, 2027.
Why did my marketplace premium go up in 2026?
The enhanced federal premium tax credits expired on December 31, 2025. Credits continue at the older, smaller formula, and the cap on repaying excess credit at tax time is gone.
Who loses Medicare on January 4, 2027?
Non-citizens outside the federal list: Medicare stays available to citizens, green card holders, Cuban and Haitian entrants and citizens of the Compact of Free Association nations.
What still covers people regardless of immigration status in New York?
NYC Care, Emergency Medicaid, Child Health Plus for children under 19, and hospital financial assistance up to 400% of the federal poverty level.
Sources
- NYS Department of Health — GIS 26 MA/14, non-citizen coverage and the Medicare Savings Program (September 29, 2026) (checked 2026-09-30)
- NY State of Health — information for Essential Plan enrollees about changes due to federal rules (checked 2026-09-30)
- NYC Health Department — Medicaid coverage changes (checked 2026-09-30)
- CMS — Medicaid community engagement requirement, interim final rule (checked 2026-09-30)
- NYS Department of Health — federal approval to preserve health coverage (March 23, 2026) (checked 2026-09-30)
- Congressional Research Service — Enhanced premium tax credit and 2026 exchange premiums (R48290) (checked 2026-09-30)
- NYS Department of Financial Services — 2027 health insurance rate decision (September 4, 2026) (checked 2026-09-07)
- Greater New York Hospital Association — the One Big Beautiful Bill Act's Essential Plan restrictions (checked 2026-09-30)
- CMS — 2027 Medicare Advantage and Part D state fact sheets (September 28, 2026) (checked 2026-10-07)
More in Research and Data: New York Health Coverage and Costs, in Numbers
- New York Marketplace 2027: Approved Rate Changes by Insurer — Insurers asked New York for +20.6% on 2027 individual plans; the state approved +6.0%. Every insurer's requested and approved rate, with a CSV.
- Essential Plan Insurers in New York City for 2027: Quality Ratings, Complaints and What the Network Data Shows — The seven Essential Plan insurers rated in New York City, compared on the state's star ratings, member experience, enrollment and DFS complaint data, with a CSV.
- Medicaid in NYC Before the 2027 Work Requirement: Enrollment by Borough, 2024 to 2026 — NYC Medicaid fell by 341,901 people, or 8.7%, from August 2025 to August 2026, months before the work rule starts. Queens lost the most. State data, CSV.
This page explains how the system works. It is not medical advice. More.