Starting Today, Residents Earning Up to $37,650 Now Qualify for NY State of Health Essential Plan Coverage

Offers High-Quality Coverage With $0 Monthly Premium and Low Cost Sharing

The New York State Department of Health and NY State of Health today announced the highly anticipated expansion of the state's Essential Plan public health insurance program takes effect today, April 1.  The program now includes residents with incomes up to $37,650, 250 percent of the Federal Poverty Line, bringing high-quality premium-free health insurance to an additional 100,000 New Yorkers, saving them an average of $4,700 per year.

"The State's Essential Plan, offered through NY State of Health, has always served as a vital source of health coverage for those who need it," State Health Commissioner Dr. James McDonald said.  "With the launch of this expansion today we are now able to reach even more New Yorkers as we continue our mission to eliminate health disparities and deliver high-quality, affordable insurance statewide and this expansion will reach almost 100,000 individuals, saving them thousands of dollars a year, and giving peace of mind that their health needs will be met."

"This is a first of its kind 1332 waiver that moves New York's Basic Health Program to a State Innovation Waiver that permits New York to expand eligibility to consumers with annual income up to $37,650, including the Deferred Action for Childhood Arrival (DACA) population," NY State of Health Executive Director Danielle Holahan said.  "Through this expansion of $0 Essential Plan coverage, we hope to hold steady and even increase the gains in health insurance coverage we saw during the public health emergency."

The expansion follows federal approval of New York's section 1332 State Innovation Waiver application.  This waiver authority allows states to pursue innovative strategies for providing residents with access to high-quality, affordable health insurance.  New York's waiver was approved for five years, from 2024 through 2028.  This expansion of coverage is estimated to save New Yorkers an average of $4,700 per year, compared to what they would have spent on health coverage through Qualified Health Plans.  Starting today, an individual earning $37,650 annual income is eligible for the Essential Plan, making the high-quality, affordable program with a zero cost monthly premium available to an additional 100,000 New Yorkers, including Deferred Action for Childhood Arrival (DACA) recipients.  This is an increase from the prior limit of roughly $30,000 annual income for an individual.  New Yorkers who completed a NY State of Health application during 2024 Open Enrollment but did not enroll in coverage and now meet the expanded Essential Plan eligibility will receive e-mails, texts, and outreach from their enrollment assistors that they are eligible for the Essential Plan expansion and must select and enroll in a health plan.  Starting today, first-time applicants of the NY State of Health who meet the Essential Plan expansion eligibility criteria can enroll in the program.  Information about Section 1332 State Innovation Waivers, including a fact sheet on New York's waiver, can be found on CMS' website.