In 2026, you can get New York’s Essential Plan if you are 19 to 64, live in New York, are lawfully present, cannot get Medicaid, Child Health Plus or job-based coverage, and your household earns no more than $31,920 a year for one person, $43,280 for two, $54,640 for three or $66,000 for four. That ceiling is 200% of the federal poverty level. It dropped from 250% on 1 July 2026 because of the federal law H.R.1. The plan has a $0 monthly premium and no deductible.
If you searched for the old 2023 income guidelines, or saw a limit near $39,000 for one person, those numbers no longer apply. This guide covers the 2026 limits, what changed and when, what the plan costs and covers, and how it differs from Medicaid. Everything comes from NY State of Health, the state Department of Health (DOH) and federal agencies.
What are the Essential Plan income limits for 2026?
NY State of Health lists the most a household can earn in 2026 and still qualify. Medicaid’s limit for adults 19 to 64 is lower, so people under the Medicaid line go to Medicaid instead.
| Household size | Medicaid, adults 19-64 (138% FPL) | Essential Plan maximum (200% FPL) | 2026 federal poverty guideline |
|---|---|---|---|
| 1 | $22,025 | $31,920 | $15,960 |
| 2 | $29,864 | $43,280 | $21,640 |
| 3 | $37,702 | $54,640 | $27,320 |
| 4 | $45,540 | $66,000 | $33,000 |
Sources: the Essential Plan column is from the NY State of Health Essential Plan page and its fact sheet dated July 2026. The Medicaid column is from the Medicaid At a Glance card (April 2026). The poverty guidelines are from HHS (ASPE). These are annual household incomes. The state has not published 2027 figures yet.
Income is not the only test. NY State of Health says you must also be:
- A New York State resident
- Lawfully present in the U.S.
- 19 to 64 years old
- Not eligible for Medicaid or Child Health Plus
- Not eligible for employer or other coverage
There is one exception to the income floor. A lawfully present immigrant who cannot get Medicaid because of their immigration status can get the Essential Plan with income anywhere below 200% of the poverty level, even below the Medicaid line.
Why did the Essential Plan income limit drop in July 2026?
From April 2024 to June 2026, New York ran an expanded Essential Plan under a federal “Section 1332” waiver. It covered people up to 250% of the poverty level. According to the state, H.R.1 (Public Law 119-21), signed in July 2025, ended premium tax credit eligibility for most lawfully present immigrants. That money funded the expansion. The state says half of the program’s funding was eliminated, so it ended the waiver and went back to the original program, called a Basic Health Program, which stops at 200%.
Each step below is final and in effect. None of it is still a proposal.
| Date | What happened |
|---|---|
| 1 March 2024 | Federal approval of the 1332 waiver that expanded the plan to 200-250% of the poverty level |
| July 2025 | H.R.1 signed into federal law |
| 10 September 2025 | New York announced it would end the waiver and return to a Basic Health Program |
| 27 February 2026 | CMS approved reinstating the Basic Health Program, effective 1 July 2026 |
| 20 March 2026 | CMS approved ending the 1332 waiver, effective 1 July 2026 |
| 1 April 2026 | Notices sent to enrollees whose coverage was ending |
| 30 June 2026 | Last day of Essential Plan coverage for incomes above 200% |
| 30 August 2026 | Deadline for affected people to pick new coverage without a gap |
| 1 October 2026 | New federal immigrant rules for Medicaid; some adults moved to the Essential Plan |
The full history and the federal letters are on the state’s 1332 waiver page. The state says about 1.3 million enrollees with income below 200% keep their coverage with the same benefits.
What is still open
Two things were not settled on the official pages we read on 11 November 2026. First, the 2027 income limits have not been published. Second, a federal rule says that from 1 January 2027, federal payments for this kind of program count only citizens and certain “eligible noncitizens,” mainly green card holders, Cuban and Haitian entrants and COFA migrants (see the CMS summary). We found no announcement from NY State of Health that this changes who can enroll in the Essential Plan. If it affects you, the state will send a notice, so open your mail.
I earn between $31,920 and $39,900. What happens to me now?
For one person, that range is 200% to 250% of the poverty level. You lost the Essential Plan on 30 June 2026. The state says about 450,000 people were in this group. Most can buy a Qualified Health Plan through NY State of Health with a federal tax credit that lowers the premium.
- The state’s April 2026 fact sheet says the average silver plan costs $220 a month after tax credits.
- Its example: a New York City resident earning $35,910 (225% of the poverty level) gets a $637 monthly tax credit, so the benchmark silver plan costs $230 a month.
- The state said it was working with insurers so that people moving mid-year would see their deductible cut in half. Ask your plan whether this applies to you.
The window to switch without a gap closed on 30 August 2026. By then, the state counted 256,159 people (59%) enrolled in other coverage. That number includes nearly 197,000 who still qualified for the Essential Plan or moved to Medicaid after an income change. If you did not pick a plan, call NY State of Health at 1-855-355-5777 and ask what you can enroll in now. If your income has dropped, report it, because you may qualify again.
Some groups were handled differently, per the state’s notice to enrollees:
- Pregnant enrollees with a due date before 1 January 2027 keep the Essential Plan through pregnancy and 12 months after. Those due later moved to Medicaid on 1 July 2026.
- DACA recipients who are not pregnant and earn over 138% of the poverty level ($22,024 for one person) no longer qualify for any NY State of Health program. DACA recipients at or below 138% moved to Medicaid.
How much does the Essential Plan cost?
The monthly premium is $0 for everyone who qualifies, and there is no deductible. Preventive care is free. Copays depend on income. These figures are from the state’s Essential Plan At a Glance card dated July 2026.
| Service | Income up to $23,940 (one person) | Income $23,941 to $31,920 (one person) |
|---|---|---|
| Monthly premium | $0 | $0 |
| Deductible | None | None |
| Primary care visit | $0 | $15 |
| Specialist visit | $0 | $25 |
| Hospital stay, per admission | $0 | $150 |
| Emergency room | $0 | $75 |
| Urgent care | $0 | $25 |
| Physical, speech or occupational therapy | $0 | $15 |
| Generic / preferred brand / non-preferred brand drug | $1 / $3 / $3 ($0 below $15,960) | $6 / $15 / $30 |
| Dental and vision | $0 | $0 |
The state’s 2025 benefit grid, the newest one we found, set the yearly out-of-pocket maximum at $360 for incomes from 150% to 200% of the poverty level, $200 from 100% to 150%, and $0 below 100%. Copays are waived during pregnancy and for one year after. The state told insurers that copays stay waived for pregnant and postpartum members and for members with diabetes who remain in the plan.
What does the Essential Plan cover, and what does it not?
The At a Glance card lists free preventive care, inpatient and outpatient care, maternity and newborn care, emergency services, lab and imaging, prescription drugs, rehabilitative and habilitative services, mental health and substance use care, wellness and chronic disease management, and vision and dental.
It does not cover long-term care. A DOH directive, 16 OHIP/ADM-01 (January 2016), says community-based long-term care is not in the Essential Plan’s benefits, and people who receive or need it are excluded from the plan. The directive lists, among others:
- Personal care services and the Consumer Directed Personal Assistance Program (CDPAP)
- Managed long-term care, at home or in a nursing home
- Certified home health care and nursing home care, other than short-term rehabilitation
- Adult day care, assisted living programs and private duty nursing
- Personal emergency response services
The plan’s benefit grid does list “home care” with a per-visit copay. In plain terms, short visits after an illness can be covered, but daily help from a home health aide over months or years cannot. That kind of care is a Medicaid benefit.
Medicaid vs Essential Plan: which one will you get?
You do not choose between them. NY State of Health checks your application and places you in the program you qualify for.
| Medicaid | Essential Plan | |
|---|---|---|
| Age | All ages | 19 to 64 only |
| Income, adults 19-64 (one person, 2026) | Up to $22,025 (138% FPL) | Above that, up to $31,920 (200% FPL). For immigrants who cannot get Medicaid because of status: anything up to $31,920 |
| Premium | $0 | $0 |
| Copays | Small copays on some services; the most you would pay in a year is $200 | $0 to $150 per service, by income (table above) |
| Dental care | Yes | Yes, with vision, at $0 cost-sharing |
| Long-term home care and nursing homes | Yes: care through home health agencies, personal care, nursing home care | No |
| Medicare at the same time | Possible (dual eligibility) | No |
| When to enroll | Any time | Any time |
Medicaid figures are from the Medicaid At a Glance card (April 2026). Medicaid rules also change in 2027. NY State of Health says that from 1 January 2027, some Medicaid adults 19 to 64 will face work requirements and renewals every six months. For a wider comparison of programs for older adults, see Medicare vs Medicaid for older New Yorkers.
Turning 65 or need help at home? Why the Essential Plan won’t cover it
The Essential Plan ends at 64, and the 2016 directive says people eligible for Medicare cannot enroll. If you or a parent is about to turn 65, plan the move to Medicare, and to Medicaid if income is low, before the Essential Plan ends.
If someone under 65 needs ongoing help at home, such as an aide for bathing, dressing and meals, the program to look at is Medicaid. Medicaid for long-term care has its own income and asset rules, which differ from the Essential Plan table above. Our guide on how Medicaid covers home care in New York walks through them, and the Medicaid spend-down guide explains what happens when income is above the limit.
For immigrants, this was confirmed in September 2026. The DOH notice GIS 26 MA/14 says lawfully present non-citizens under 65 who need long-term services such as nursing home care stay on Medicaid paid by the state, rather than moving to the Essential Plan. More on this is in our guide to Medicaid home care for immigrants.
Are you an immigrant? Who can get the Essential Plan now
You must be lawfully present. Since 1 October 2026, federal Medicaid funding for adults is limited to green card holders (after the five-year bar), Cuban and Haitian entrants and COFA migrants. NY State of Health says these groups may move from Medicaid to the Essential Plan:
- Refugees and asylees
- Parolees
- Survivors of domestic violence or human trafficking
The state says benefits do not change with the move. DOH’s notice puts the age range at 21 to 64. Coverage for children, pregnant people and people who recently gave birth did not change. Notices went out from 1 to 4 September 2026. Details are on the state’s Stay Covered page.
How do you apply for the Essential Plan in New York City or anywhere in the state?
The rules are the same statewide, and enrollment is open all year. Plan choices depend on your county.
- Check your income against the table above, using the household size you will report.
- Gather your information for each family member: birth dates, Social Security numbers (or immigration document numbers for lawfully present immigrants, if you have them), and employment, income and health insurance details.
- Apply online at nystateofhealth.ny.gov, by phone at 1-855-355-5777 (TTY 1-800-662-1220), or with a free certified enrollment assistor. Phone lines are open Monday to Friday 8am to 8pm and Saturday 9am to 1pm.
- Pick a plan. The state’s Compare Plans tool shows which Essential Plan insurers serve your county. The Provider and Health Plan Look-Up tool shows which ones work with your doctors.
- Answer every notice. NY State of Health may ask for proof of income or immigration status. Report changes in income, household size or status, and act on renewal letters.
Related guides
- Does Medicaid Cover Home Care in New York?
- Medicaid Home Care for Immigrants in New York
- Medicare vs Medicaid: Differences for Older New Yorkers
- Medicaid Spend-Down in New York
ProLife Home Care is a licensed home care agency serving Brooklyn and Queens (New York State DOH licence #2572L001). We are not an insurance company, a navigator or NY State of Health, and we do not file Essential Plan or Medicaid applications for people. For help enrolling, use NY State of Health or a certified enrollment assistor. If a family member needs care at home through Medicaid or private pay, call (718) 232-2777 or use our contact page.
The Essential Plan changed in July 2026 and federal rules keep shifting. Everything above was checked on 11 November 2026 against NY State of Health’s Essential Plan, 1332 waiver and Stay Covered pages, its 2026 fact sheets and At a Glance cards, CMS approval letters of 27 February and 20 March 2026, DOH directives 16 OHIP/ADM-01 and GIS 26 MA/14, the CMS 2027 payment rule summary and the HHS 2026 poverty guidelines. This is general information, not legal advice. Confirm your own situation with NY State of Health at 1-855-355-5777.
Frequently asked questions
What is the Essential Plan income limit for 2026?
$31,920 a year for one person, $43,280 for two, $54,640 for three and $66,000 for four. That is 200% of the federal poverty level, the limit in effect since 1 July 2026.
Is the Essential Plan the same as Medicaid?
No. Medicaid is for lower incomes (up to $22,025 for a single adult in 2026) and all ages, and it covers long-term care. The Essential Plan is for people 19 to 64 above the Medicaid line or barred from Medicaid by immigration status, up to 200% of the poverty level.
Does the Essential Plan still cost $0?
Yes. The monthly premium is $0 for everyone who qualifies and there is no deductible. Some services have copays of up to $150 if your income is above 150% of the poverty level.
Does the Essential Plan cover a home health aide?
Not for long-term care. A DOH directive excludes personal care, CDPAP, managed long-term care and similar services from the plan. Ongoing aide hours at home come through Medicaid.
Can I keep the Essential Plan after I turn 65?
No. The plan is for people 19 to 64, and people eligible for Medicare cannot enroll. Look at Medicare, and Medicaid if your income is low, before your 65th birthday.
Are the 2023 Essential Plan income guidelines still valid?
No. Use the 2026 figures from NY State of Health. The older limits, and the 250% limits used until 30 June 2026, no longer apply.
When can I apply for the Essential Plan?
Any time of year. Apply at nystateofhealth.ny.gov, call 1-855-355-5777, or meet a free certified enrollment assistor.
