What the video says
In New York, health coverage is a staircase: four income lines decide what you pay. Up to 138%, then up to 200% of the poverty level, $22,024 and $31,920 a year for one person: Medicaid, then the Essential Plan, both with a $0 premium. One dollar over 200% and a monthly premium starts: since July 1, 2026, a marketplace plan with a premium and a deductible. Up to 400%, $63,840, hospital bills are capped by law. Find your step on the calculator.
A benefit cliff is the point where a small raise costs more than it pays, because a program ends at a fixed line instead of tapering off. New York’s health programs are written as percentages of the federal poverty level, so every household has the same four lines, scaled by its size. This page puts the lines in dollars, shows what changes at each one, and lets you check where your own income sits.
Find your step
For adults 19 to 64 who are not pregnant. Children, pregnancy and people 65 and older have their own rules, below. The math runs in your browser and nothing is stored. It is arithmetic, not a decision: the application decides.
The four edges, in dollars
Annual household income before taxes, 2026 federal poverty level: $15,960 for one person plus $5,680 for each additional person.
| People in household | 138%: Medicaid ends | 200%: Essential Plan ends | 300%: 10% hospital cap ends | 400%: credit and hospital caps end |
|---|---|---|---|---|
| 1 | $22,025 | $31,920 | $47,880 | $63,840 |
| 2 | $29,864 | $43,280 | $64,920 | $86,560 |
| 3 | $37,702 | $54,640 | $81,960 | $109,280 |
| 4 | $45,540 | $66,000 | $99,000 | $132,000 |
| 5 | $53,379 | $77,360 | $116,040 | $154,720 |
| 6 | $61,217 | $88,720 | $133,080 | $177,440 |
Full table for households of one to eight in the CSV. Same arithmetic as our 2026 income limits table.
What changes at each edge
| Edge | Below the line | One dollar above | How steep |
|---|---|---|---|
| 138% | Medicaid: no premium, no deductible, long-term care included | Essential Plan: still $0 premium, no deductible | Gentle |
| 200% | Essential Plan at $0; uninsured hospital patients pay nothing out of pocket | A marketplace plan with a tax credit: a monthly premium, a deductible, cost sharing; uninsured hospital bills capped at 10% of the Medicaid rate | Steep |
| 300% | Uninsured hospital bills capped at 10% of the Medicaid rate | Capped at 20% of the Medicaid rate | Moderate |
| 400% | Marketplace tax credit; hospital caps; no hospital lawsuits; NYC Care scale | For 2027 plans the credit generally ends; the hospital’s own policy decides | Steep |
200%: the cliff the state rebuilt in July
Until June 30, 2026, New York ran the Essential Plan up to 250% of the poverty level. The federal money that paid for the upper band ended, and on July 1 the ceiling went back to 200%. For one person that moved the edge from $39,900 down to $31,920. A worker in that band who had a $0 plan now pays a premium every month, with a tax credit that reduces it but does not erase it. What happened to the 200–250% tier.
400%: where the help stops at once
Three things end on the same line. For 2027 plans the marketplace premium tax credit generally stops at 400% now that the enhanced credits have expired. The state’s caps on what a hospital can charge an uninsured patient stop. And so does the ban on hospital lawsuits against patients under 400%. A household just above the line can see its premium and its hospital exposure change in the same month. How the hospital rules work.
Children and pregnancy run on a different ladder
Child Health Plus covers children under 19 at any immigration status, free up to 222% of the poverty level and then at $15, $30, $45 and $60 a month per child in tiers up to 400%, charged for at most three children. A family over the adult lines can still have fully covered children. Pregnant patients qualify for Medicaid at substantially higher incomes than other adults, so report a pregnancy on the application instead of reading the adult table. Child Health Plus costs.
How to stay on the right side of a line, legally
The programs measure projected income for the current year, before taxes, after certain pre-tax deductions. Retirement contributions, HSA contributions and deductible self-employment expenses lower the figure the programs count. That is the legitimate way a household close to 200% or 400% lands under the line. Report income changes within the deadline on your notice; a raise that crosses an edge moves you to the next step, it does not erase your coverage. What counts as income.
If an edge has already moved you, two things to check: that NY State of Health placed you in the right plan for your new income, and that a hospital bill from the months you were uninsured went through financial assistance, which you can apply for at any stage.
Methodology
We built the table on October 16, 2026 from the 2026 HHS poverty guidelines ($15,960 for one person, $5,680 for each additional person) and the program lines that NY State of Health, the state Department of Health and Public Health Law 2807-k publish as shares of the poverty level. Dollar figures are the guideline multiplied by the percentage and rounded down to the whole dollar, the same method as our income limits table. Programs decide eligibility on a real application, with rules for household composition that this table simplifies.
Download: ny-coverage-cliffs-2026.csv, free to reuse under CC BY 4.0. Credit: NYC Med News, “New York’s Health Coverage Cliffs, 2026,” October 16, 2026.
Questions people ask
How much can I make and still get the Essential Plan in New York in 2026?
Up to 200% of the federal poverty level: $31,920 a year for one person, $43,280 for two and $66,000 for a household of four. The 200% to 250% band ended on July 1, 2026.
What is the Medicaid income limit for adults in New York in 2026?
For most adults 19 to 64, 138% of the federal poverty level, about $22,025 a year for one person or $45,540 for a household of four. Children and pregnant patients qualify at higher incomes.
What happens if my income goes just over 200% of the poverty level?
You leave the $0 Essential Plan and move to a marketplace plan with a tax credit, which has a monthly premium and a deductible. Uninsured, a New York hospital can then charge you up to 10% of the Medicaid rate instead of nothing.
Is there a cliff at 400% of the poverty level?
Yes. For 2027 plans the marketplace tax credit generally ends at 400%, and the state’s caps on hospital bills for uninsured patients and the ban on hospital lawsuits stop at the same line.
Can I lower my counted income to stay under a limit?
The programs count income after certain pre-tax deductions, such as retirement and HSA contributions and deductible self-employment expenses. Those lower the figure legitimately. Income has to be reported truthfully and changes reported on time.
Sources
- HHS 2026 Poverty Guidelines (Federal Register, January 15, 2026) (checked 2026-09-07)
- NY State of Health — Essential Plan (checked 2026-09-07)
- NY Health Access — Essential Plan income limit reduced to 200% FPL on July 1, 2026 (checked 2026-10-07)
- New York State Attorney General — Hospital financial assistance (checked 2026-09-07)
- NYS Department of Health — Child Health Plus eligibility and cost (checked 2026-09-07)
More in Research and Data: New York Health Coverage and Costs, in Numbers
- Preventable Hospital Visits by NYC ZIP Code: Where the ER Stands In for a Doctor — Tremont's 10457 had 47.01 potentially preventable ER visits per 100 residents in 2023, near 11 times Battery Park City. State data for 173 NYC ZIP codes.
- Medicare Advantage in NYC 2027: Who Leads Each Borough and How Plans Rate — 71.25% of Bronx Medicare enrollees are in Advantage plans. Healthfirst leads four boroughs; its main contract fell to 3.5 stars for 2027. CMS data by borough.
- Medicare 2027 in New York, by the Numbers: How the State Compares With All 50 — New York's cheapest stand-alone Part D plan costs $37.30 a month in 2027, the highest floor of any state. CMS data on Advantage plans and Extra Help, compared.
This page explains how the system works. It is not medical advice. More.