Which program your income reaches
New York sorts applicants by household income as a percentage of the federal poverty level, and each program has its own line. The estimator applies these lines for adults 19 to 64, children under 19 and people 65 and older.
| Income, % of poverty level | Adults 19 to 64 | Premium |
|---|---|---|
| Up to 138% | Medicaid | None |
| Over 138% and under 200% | Essential Plan | $0 |
| 200% to 400% | Marketplace plan (Qualified Health Plan) with premium tax credit | Up to 6.78% to 10.22% of income for the benchmark plan |
| Above 400% | Marketplace plan without a credit | Full price |
The 138% Medicaid line comes from the state’s 2026 income standards: $22,025 a year for one person, $45,540 for a family of four. The Essential Plan has covered only people under 200% of the poverty level since July 1, 2026, when about 450,000 New Yorkers between 200% and 250% moved to marketplace plans. What happened to the 200–250% tier · Essential Plan income limits.
How the 2027 tax credit is calculated
The premium tax credit is the gap between the price of the benchmark plan, the second-lowest-cost silver plan where you live, and an amount the law says your household should pay. That amount is a percentage of income from the IRS table for the year.
| Household income, % of poverty level | Share of income you pay for the benchmark plan, 2027 |
|---|---|
| 200% to under 250% | 6.78% rising to 8.66% |
| 250% to under 300% | 8.66% rising to 10.22% |
| 300% to 400% | 10.22% |
| Above 400% | No credit |
Within each band the percentage rises in a straight line, which is what the estimator computes. A single adult earning $45,000 is at about 282% of the poverty level, pays about 9.66% of income, roughly $362 a month, for the benchmark plan, and gets a credit for everything above that. A bronze plan costs less after the same credit; a gold plan costs more. The credit, mechanically.
The IRS sets the table each summer. Rev. Proc. 2026-26 published the 2027 figures and set the top at 10.22%, up from 9.96% for 2026.
Why the estimator uses 2026 poverty figures for 2027 plans
Federal rules measure the credit against the poverty guidelines in effect on the first day of open enrollment for that coverage year. Open enrollment for 2027 started on November 1, 2026, when the 2026 guidelines were current, so a 2027 marketplace plan is priced against $15,960 for one person plus $5,680 per extra person even after the 2027 guidelines come out in January.
Medicaid, the Essential Plan and Child Health Plus work differently: they switch to new guidelines once the state adopts them, usually in the first months of the year. That is why the line between the Essential Plan and a marketplace plan can move slightly between November and spring. A household close to 200% should check its eligibility again after the state publishes its 2027 figures. 2026 income limits by household size.
How to get a real number from NY State of Health
- Estimate income for 2027, not last year. Use modified adjusted gross income for your tax household: you, a spouse you file with, and the dependents you claim. Pre-tax retirement and HSA contributions lower it. What MAGI counts.
- Open the plan comparison on NY State of Health and enter your county, household and ages. Note the premium of the second-lowest silver plan: that is the benchmark to type into the estimator.
- Apply. The application calculates your credit and tells you which program you qualify for. Call 1-855-355-5777 (TTY 1-800-662-1220) or use a free certified assistor; the state counts more than 9,000 of them.
- Enroll by December 15 for coverage that starts January 1, 2027. The window closes January 31.
- Report income changes to NY State of Health when they happen once you are enrolled, so the advance credit follows your real income.
If you are unsure what to type, the eligibility navigator asks the questions in plain language first.
Where this estimate is wrong
The estimator does not know your county, your household’s ages or the 2027 plan prices. Premiums vary by county and plan, so the credit for the same income can differ between the Bronx and Buffalo. That is why the benchmark field exists: with the real benchmark premium the arithmetic is close; without it you see only the most you would pay for the benchmark plan.
It also assumes everyone in the household is eligible for the same program. In New York eligibility is decided per person: children are measured against Child Health Plus and children’s Medicaid lines, pregnant people against a higher Medicaid line of 223%, and immigration status can change what an adult qualifies for. An offer of affordable job-based coverage generally rules out the credit. Treat a result close to any line as a reason to apply, not a verdict. Coverage changes for immigrants in 2027.
Questions people ask
How much will health insurance cost me in New York in 2027?
It depends on income first. Adults 19 to 64 up to 138% of the poverty level get Medicaid with no premium; under 200%, the Essential Plan at $0; from 200% to 400%, a marketplace plan where you pay at most 6.78% to 10.22% of income for the benchmark silver plan; above 400%, the full price.
What is the income limit for the Essential Plan in 2027?
Under 200% of the federal poverty level for adults 19 to 64. With the 2026 guidelines that is $31,920 a year for one person and $66,000 for a family of four. The 200% to 250% tier ended on July 1, 2026.
Is there a premium tax credit above 400% of the poverty level in 2027?
No. For 2027 plans the IRS table stops at 400%, and households above that line pay the plan’s full price.
Which poverty guidelines apply to 2027 marketplace plans?
The 2026 guidelines, because federal rules use the guidelines in effect when open enrollment begins, and open enrollment for 2027 started on November 1, 2026.
Does this estimator replace the NY State of Health application?
No. It shows the arithmetic with published figures. NY State of Health determines eligibility and the exact credit for your county, ages and household when you apply.
Sources
- IRS — Rev. Proc. 2026-26: applicable percentage table and required contribution percentage for 2027 (checked 2026-11-03)
- 26 CFR 1.36B-1(h): federal poverty line used for the premium tax credit (Cornell LII) (checked 2026-11-03)
- NYS Department of Health — GIS 26 MA/05, Attachment I: 2026 Medicaid income standards (MAGI) (checked 2026-11-03)
- NYS Department of Health — Federal approval to preserve health coverage, Essential Plan changes (March 23, 2026) (checked 2026-11-03)
- NYS Department of Health — Open Enrollment for 2027 coverage (October 28, 2026) (checked 2026-11-03)
- NYS Department of Health — Child Health Plus eligibility and cost, 2026 (checked 2026-11-03)
- HHS ASPE — 2026 poverty guidelines (checked 2026-11-03)
More in Open Enrollment in New York: 2027 Dates, Deadlines and What Changed
- What Changed for 2027 Coverage in New York: Rates, Credits, Eligibility — What changed for 2027 coverage in New York: approved rates, expired tax credits, the Essential Plan cutback, immigrant limits and Medicaid work rules.
- The 20-Minute Renewal Checklist for NY State of Health — Is your marketplace plan about to auto-renew? This 20-minute NY State of Health renewal checklist covers premium, tax credit, doctors, drugs and deadlines.
- The Premium Tax Credit in 2027: How It Is Calculated, What Changed, How Not to Owe It Back — The premium tax credit in New York for 2027: enhanced credits are gone, the credit generally ends at 400% of the poverty level, and repayment has no cap.
This page explains how the system works. It is not medical advice. More.