Key Takeaways
- Starting July 1, 2026, New York’s Essential Plan income limit is expected to return to 200% of the federal poverty level (FPL) for most adults, ending the 200–250% FPL coverage that was allowed under a federal Section 1332 waiver.
- Roughly 450,000 New Yorkers in the 200–250% FPL range may need to move to Qualified Health Plans (QHPs) through NY State of Health, where premiums and cost-sharing are often higher than on the Essential Plan today.
- About 1.3 million people with income below 200% FPL are expected to keep Essential Plan coverage under standard Basic Health Program (BHP) rules, according to the New York State Department of Health.
- Notices and outreach are part of the state’s transition plan; use official channels (website, call center, certified assistors) for personalized answers.
- SJM Cares focuses heavily on Medicare and related products; for under-65 marketplace questions we still offer licensed guidance on our health insurance page—always confirm subsidy and plan details on NY State of Health or with a certified assistor.
- What Is Changing on the Essential Plan, and When?
- Why Is New York Making This Change?
- Who Keeps the Essential Plan vs. Who May Need a New Plan?
- What Are Qualified Health Plans, and How Might Costs Compare?
- Important Dates and Notices
- How NYC and NY Residents Can Get Help
- Frequently Asked Questions
- Take the Next Step
The short answer: New York intends to end the expanded Essential Plan that covers many people from 200% up to 250% FPL and return to the standard BHP limit of 200% FPL, with the shift tied to July 1, 2026, after federal approval to terminate the state’s Section 1332 State Innovation Waiver.
The Essential Plan is New York’s Basic Health Program for eligible 19–64 year-olds who are lawfully present, state residents, not eligible for Medicaid or Child Health Plus, and without other qualifying coverage. Today, many enrollees pay $0 premium and have no deductible, with low copays for many services—details are summarized on NY State of Health’s Essential Plan pages.
Under the 1332 waiver (approved in 2024), New York expanded eligibility up to 250% FPL for a large group—about 450,000 people, per the state. That expansion is what is winding down.
Eligibility rules are statewide. If you live in Brooklyn, the Bronx, Manhattan, Queens, Staten Island, or anywhere else in New York, the same income and program rules apply. Local ads or community groups may use “NYC,” but the official program is NY State of Health / Essential Plan, not a separate city-only plan.
The state points to federal policy and funding. In public statements, New York officials describe H.R. 1 (Public Law No. 119-21), enacted in July 2025, as a turning point because it changed premium tax credit rules for many lawfully present immigrants, which in turn reduced the federal pass-through funding that helped pay for the expanded Essential Plan. With that support no longer workable at prior scale, New York asked CMS to approve ending the 1332 waiver and returning to BHP-only authority up to 200% FPL. CMS approved the termination request in March 2026 (the state announced approval on March 23, 2026).
This section reflects official state framing and summarized federal context; final legal interpretations belong to government agencies and qualified benefit counselors.
People with household income under 200% FPL (who still meet all other Essential Plan rules) are the group state officials say will remain on the Essential Plan—about 1.3 million enrollees in public estimates.
People in the 200–250% FPL range are the group most likely to lose Essential Plan eligibility when the waiver ends and may become eligible for QHPs in the individual marketplace instead.
Income limits change with federal poverty guidelines each year. New York publishes a simple “most you can make” table for planning; for example, state materials have listed $39,125 for a household of one in recent guidance—always verify the current table on NY State of Health or Department of Health before making decisions.
| Situation (illustrative) | What officials describe |
|---|---|
| Income below 200% FPL + other Essential Plan rules | Generally stays on Essential Plan (BHP) |
| Income between 200% and 250% FPL | May need to move to a QHP (or other coverage if eligible) after July 1, 2026 |
Qualified Health Plans are ACA marketplace plans sold through NY State of Health. They can include monthly premiums and deductibles that are higher than what many Essential Plan members pay today, even when advance premium tax credits (APTC) apply.
Two affordability context points show up repeatedly in state communications:
- Enhanced premium tax credits tied to the American Rescue Plan Act were not extended in the same form past 2025, which can mean higher net premiums for some marketplace shoppers than in prior years.
- H.R. 1 limited premium tax credit eligibility for many lawfully present immigrants, which can affect who can receive subsidies and how much help they get.
New York has said it is working with insurers so that people who transition mid-year from Essential Plan to a QHP in 2026 may see deductibles reduced by half compared to what they would otherwise face—a state mitigation, not a guarantee of any specific plan design. Actual premiums, deductibles, and networks depend on the plan you choose.
Need help comparing coverage options? If you are shopping the individual or family marketplace in New York, our team can discuss how health insurance guidance works for Brooklyn and NYC residents. Call (347) 696-6757 for a free, no-obligation conversation with a licensed advisor. For official subsidies and plan selection, also use NY State of Health or a certified assistor.
- April 1, 2026 — State officials indicated impacted enrollees would begin to receive information about options and next steps (confirm timing on official mail or your NY State of Health account).
- July 1, 2026 — Described as the date the 1332 waiver termination takes effect and the 200–250% FPL Essential Plan expansion ends; transitions are planned around this date.
- 90-day advance notices — Referenced in state materials as part of helping people plan ahead before coverage changes.
Dates and processes can be updated; rely on letters, secure portal messages, and state announcements for your personal situation.
Start with official, free resources:
- Website: nystateofhealth.ny.gov
- Phone: 1-855-355-5777 (TTY: 1-800-662-1220)
- In-person help: Use the marketplace’s Certified Enrollment Assistor search (linked from NY State of Health) to find local help in your borough or county.
- Press and background: The New York State Department of Health posts updates and links to fact sheets on Essential Plan changes.
For Medicare, Medicaid–Medicare coordination, or D-SNP topics—which are common for readers helping parents or planning ahead—see our Medicare Advantage overview and Resource Hub.
No. It is a New York State program. NYC residents use the same NY State of Health rules as residents of other counties.
State officials have said about 1.3 million people under 200% FPL should keep Essential Plan coverage, assuming they still meet all other eligibility rules (immigration status, age, no other minimum essential coverage, etc.). Always confirm on NY State of Health or with an assistor.
No. You typically need to compare plans, pick coverage, and complete enrollment during the window the marketplace gives you. Certified assistors can help you see premiums after subsidies and cost-sharing.
No. The Essential Plan is for adults 19–64 outside Medicare. If you are 65+ or otherwise Medicare-eligible, different rules apply; start with Medicare.gov or our Medicare Advantage educational pages.
Use the NY State of Health 1332 waiver information section and health.ny.gov press materials. They cite CMS approval and federal legislation in their own terms.
Essential Plan enrollment runs through NY State of Health and certified assistors on that platform. We provide licensed help on many health and Medicare topics; call (347) 696-6757 or review health insurance to see how we can support marketplace-related questions in our service model.
If you are navigating a coverage change in 2026, the most important step is to read official notices, log in to NY State of Health, and talk with a certified assistor early—before July 1—so you can compare premiums, deductibles, and networks with less pressure.
Call (347) 696-6757 or schedule an appointment online if you want a licensed SJM Cares advisor to discuss health insurance or Medicare options that fit your household.
Written by Hamad Amir, licensed insurance agent and founder of SJM Insurance Services, LLC. Licensed in New York and New Jersey (License #LB-1024797). Specializing in Medicare Advantage and D-SNP plans for Brooklyn and NYC residents.
Disclaimer: This article is for educational and informational purposes only and does not constitute professional insurance, financial, or legal advice. For personalized guidance, call a licensed SJM Cares advisor at 917-373-0117.
We do not offer every plan available in your area. Currently we represent 10 organizations which offer Medicare Advantage HMO, PPO, PFFS, and PDP plans in your area. Please contact Medicare.gov, 1-800-MEDICARE (TTY: 1-877-486-2048), or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options.
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