If you have NYC health coverage through the Essential Plan, a change taking effect on July 1, 2026 could affect you — and the deadline to understand your options is now. New York’s public insurance programs (Medicaid, Child Health Plus, and the Essential Plan) cover most low- and moderate-income New Yorkers at $0 or very low cost, and you can enroll in all three year-round through one application at NY State of Health. This guide walks you through who qualifies in 2026, what the July 1 Essential Plan change means, how to apply, and exactly where to get free in-person help. We’re here to help you navigate this.
Who this helps: Uninsured New Yorkers, families with children, anyone who lost job-based coverage, low-wage workers, immigrants (including the undocumented), and current Essential Plan members who need to know about the July 1, 2026 change. If you live in the five boroughs and aren’t sure how to get covered, start here.
This is general health information, not medical advice. Contact your healthcare provider for medical guidance. Eligibility numbers and program rules can change — verify your specific situation with NY State of Health before making decisions.
The big 2026 change: Essential Plan eligibility shrinks on July 1
The most important news for current enrollees: starting July 1, 2026, eligibility for New York’s Essential Plan drops from 250% of the Federal Poverty Level down to 200% FPL. According to the New York State Department of Health, this means about 450,000 New Yorkers who earn between 200% and 250% of the poverty level will become ineligible for the Essential Plan that day. They will instead be eligible for Qualified Health Plans (QHPs) in the individual marketplace, which may come with monthly premiums and deductibles that the Essential Plan does not have.
The roughly 1.3 million New Yorkers with incomes below 200% FPL keep their Essential Plan coverage — their eligibility is protected under the Basic Health Program. The State says it began notifying affected enrollees on April 1, 2026, with 90-day advance notices, and is working with insurers so that anyone moving from the Essential Plan to a Qualified Health Plan mid-year will see their deductible cut in half for the rest of the year.
If you currently have the Essential Plan, the single most useful thing you can do right now is confirm where your income falls and find out which plan you’ll be in after July 1. Call NY State of Health at 1-855-355-5777 or sit down with a free Certified Enrollment Assistor (details below). Do not wait until coverage changes to make a plan.
The four public coverage programs, and where you fit
New York runs four main coverage paths through one marketplace, NY State of Health. A single application screens you for all of them, and the system places you in the one you qualify for based on your income, age, and household size.
1. Medicaid — comprehensive coverage at $0
New York’s Medicaid program covers more than 7.5 million New Yorkers and pays for a wide range of services using your Medicaid card or a managed care plan, per the New York State Department of Health. Some services may carry small co-payments, which can be waived if you can’t afford them. To check whether your income qualifies, use the income tool on the NY State of Health site or call the NYS Medicaid Helpline at 1-800-541-2831 (Monday–Friday 8:00 AM–8:00 PM, Saturday 9:00 AM–1:00 PM).
One change to put on your calendar: the Department of Health notes that starting January 1, 2027, some people with Medicaid will need to show they are working, in school, helping in the community, or in job training to keep their coverage. Details are at the State’s Stay Covered page. This does not affect 2026 coverage, but it’s worth knowing now.
2. Child Health Plus — coverage for kids under 19
If your children are under 19, are New York residents, and don’t already have insurance, they may qualify for Child Health Plus even if your income is too high for Medicaid. Per the New York State Department of Health, there is no monthly premium for families earning less than 2.2 times the poverty level, and there are no co-payments for services. Families with somewhat higher incomes pay a modest monthly premium of $15, $30, $45, or $60 per child (capped at three children per family). The 2026 income guidelines, effective for applications received on or after February 17, 2026, set the free-coverage line at roughly $2,953/month for a household of one and $6,105/month for a family of four, with premium tiers above that.
3. Essential Plan — for adults 19–64 just above Medicaid
The Essential Plan is for New York residents ages 19–64 who are lawfully present, not eligible for Medicaid or Child Health Plus, and within the income limits. Per NY State of Health, the plan has $0 monthly premiums, no deductible, and very low cost-sharing, and covers comprehensive benefits including dental and vision. It has continuous open enrollment, so you can apply any time. As noted above, the income ceiling for new and continuing eligibility tightens to 200% FPL on July 1, 2026.
4. Qualified Health Plans — with financial help for higher incomes
If your income is above the Essential Plan limit, you can buy a Qualified Health Plan through NY State of Health, often with financial assistance to lower the cost. This is where most of the 450,000 transitioning Essential Plan members will land after July 1. Compare plans and estimate your costs using the marketplace’s cost estimator.
No insurance and don’t qualify? NYC Care is your safety net
If you can’t get or afford any insurance plan — including if you are undocumented — NYC Care connects you to care through the NYC Health + Hospitals system. Per ACCESS NYC, NYC Care gives you your own primary care doctor and services at little or no cost, regardless of immigration status or ability to pay. Discounted fees are based on family size and income and start at $0, with no membership fees or premiums. You can usually get your first appointment within two weeks, and enrollment does not pose a risk under the “public charge” rule.
To join, call 646-NYC-CARE (646-692-2273). To be eligible you must live in one of the five boroughs, not qualify for any New York health insurance plan, and not be able to afford insurance under government guidelines. For more on the safety-net clinics that back this up, see our guide to Gotham Health neighborhood clinics.
How to Take Action
Step 1 — Gather your documents. For each person in your household, have ready: birth dates; Social Security numbers (or document numbers for lawfully present immigrants, if you have them); and information about employment, income, and any current health insurance.
Step 2 — Apply through NY State of Health. One application covers Medicaid, Child Health Plus, the Essential Plan, and Qualified Health Plans. Three ways to apply:
- Online: nystateofhealth.ny.gov
- By phone: 1-855-355-5777 (TTY: 1-800-662-1220), Monday–Friday 8:00 AM–8:00 PM, Saturday 9:00 AM–1:00 PM
- With free in-person help from a Certified Enrollment Assistor or Broker — find one at the marketplace assistor search
Step 3 — Apply for Medicaid directly if you prefer. In New York City you can also contact the Human Resources Administration (HRA) at (718) 557-1399, or call the NYS Medicaid Helpline at 1-800-541-2831.
Step 4 — If you have the Essential Plan, check your status before July 1, 2026. Call 1-855-355-5777 to confirm whether you stay on the Essential Plan or move to a Qualified Health Plan, and what your new costs will be. If you got a notice from the State, read it carefully — it explains your options and any action you need to take.
Step 5 — If nothing fits, call NYC Care. Dial 646-NYC-CARE (646-692-2273) to get connected to a doctor through NYC Health + Hospitals, regardless of status or ability to pay.
Not sure where to even start finding a provider once you’re covered? Our guide on how to find a doctor in NYC walks through in-network, uninsured, and sliding-scale options.
Frequently Asked Questions
When can I enroll in Medicaid, Child Health Plus, or the Essential Plan?
Year-round. Unlike Qualified Health Plans, which generally have an annual open enrollment period, Medicaid, Child Health Plus, and the Essential Plan all have continuous enrollment, so you can apply at any time through NY State of Health.
What is changing about the Essential Plan on July 1, 2026?
Eligibility drops from 250% of the Federal Poverty Level to 200% FPL. The New York State Department of Health estimates about 450,000 New Yorkers between those two income levels will lose Essential Plan eligibility and become eligible for Qualified Health Plans instead. The roughly 1.3 million enrollees below 200% FPL keep their coverage.
Can undocumented immigrants get coverage in New York City?
Undocumented adults generally cannot enroll in Medicaid or the Essential Plan, but NYC Care provides access to a primary care doctor and services through NYC Health + Hospitals regardless of immigration status or ability to pay. Call 646-NYC-CARE (646-692-2273). NYC Care does not collect documentation status, and enrollment does not affect the public charge rule.
How much does Child Health Plus cost?
For families earning less than 2.2 times the poverty level, it is free. Families with higher incomes pay a monthly premium of $15, $30, $45, or $60 per child depending on income and family size, capped at three children. There are no co-payments for covered services.
Where can I get free help applying?
Certified Enrollment Assistors and Brokers help for free. Find one through the NY State of Health assistor search, or call the marketplace at 1-855-355-5777. For Medicaid specifically in NYC, the HRA line is (718) 557-1399.
The bottom line
New York offers some of the most generous public coverage in the country, and you can apply for all of it year-round through one place. If you’re uninsured, apply through NY State of Health today. If you already have the Essential Plan, confirm your status before July 1, 2026. And if no insurance plan fits your situation, NYC Care will still connect you to a doctor. Free help is a phone call away — you don’t have to figure this out alone.
This is general health information, not medical advice. Contact your healthcare provider for medical guidance.
