Your Insurance Detective › Essential Plan 2026 changes
The NY Essential Plan Changed July 1, 2026: Who Still Qualifies, Who Lost Coverage, and What To Do Now
Written and reviewed by Dick Tracy, licensed health insurance broker (NPN 20414610) · Published August 31, 2026
Here's the straight answer. The Essential Plan still exists, with $0 premiums and no deductible, for incomes up to 200% of the federal poverty level: $31,920 for a single person or $66,000 for a family of four in 2026. What ended on July 1, 2026 is the expanded tier for incomes between 200% and 250% of the poverty level ($31,920 to $39,900 single), cut under a July 2025 federal budget law. About 450,000 people lost that coverage and now shop the regular marketplace. The special no-gap enrollment window closed August 30, 2026. If you missed it, there can still be a path depending on your situation, so do not just wait for November. Call first.
I'm Dick Tracy, an independent health insurance broker in Buffalo, licensed in New York and 24 other states, working with 80+ carriers. My help costs you nothing. This page is not a sales pitch. If you're one of the 450,000, you lost a program you counted on through no fault of your own, and the letters from the state can read like a foreign language. So let's walk through what actually happened, who's still covered, and what your real options are right now.
200-250% tier July 1, 2026
for those still qualified
for a family of four
Sources: NYS Department of Health press release, March 23, 2026 and the NY State of Health fact sheet on the H.R. 1 changes (April 2026).
What is the Essential Plan, and who still qualifies in 2026?
The Essential Plan is New York's low-cost health program for people who earn too much for Medicaid but still don't earn a lot. It runs through NY State of Health, and for the roughly 1.3 million people still in it, nothing changed on July 1: $0 monthly premium, no deductible, dental and vision included, and you can enroll any month of the year, no open enrollment window required. Details are on the official Essential Plan page.
| Household size | 2026 income limit (200% FPL) | What you pay |
|---|---|---|
| 1 person | Up to $31,920 a year | $0 premium, no deductible |
| 4 people | Up to $66,000 a year | $0 premium, no deductible |
Cost sharing depends on which side of the income range you land on. The lower tier pays $0 for care. The upper tier pays small copays: about $15 for a primary care visit, $25 for a specialist, and $75 for the emergency room. Either way there is no deductible standing between you and your doctor, which is the part people miss most when they move to a marketplace plan.
What changed on July 1, 2026, and why?
In July 2025, a federal budget law known as H.R. 1 eliminated the premium tax credits for most lawfully present immigrants. That federal money is what funded New York's expanded Essential Plan, the tier that covered incomes between 200% and 250% of the poverty level. With the funding gone, New York terminated the section 1332 waiver that paid for the expansion, with approval from CMS, effective July 1, 2026. The state announced the plan in a March 23, 2026 press release, and NY State of Health published a plain-language fact sheet on what the law changed.
The result: about 450,000 people in the 200% to 250% tier lost the Essential Plan on July 1, 2026. To be just as clear about the other side of it, the roughly 1.3 million enrollees under 200% of the poverty level were not affected. If your income is under the limits in the table above, your Essential Plan continues, and if you're not enrolled yet you can still sign up year-round.
I lost my Essential Plan. What now?
On July 1 you became eligible for a Qualified Health Plan, the regular private coverage sold on NY State of Health. The state says the average silver plan costs about $220 per month after tax credits for people in your income range, and it arranged for deductibles to be cut in half for former Essential Plan members who moved mid-year, since you're starting a plan partway through 2026.
The state set up a special no-gap enrollment window so people could move without a break in coverage. That window closed August 30, 2026. If you enrolled in time, good. If you missed it, do not assume the door is bolted until November. Whether there's still a path onto coverage now depends on your income, your household, and what's happened in your life this year, and that is exactly the kind of thing to check with a licensed person before you decide anything. The November open enrollment period is the guaranteed backstop for a January 1 start. My review costs nothing, and the state's enrollment line is 1-855-355-5777.
One more thing, because I see it every week: do not go bare. A few uncovered months is exactly when the bad-luck bill shows up, and an unpaid hospital bill follows you a lot longer than a premium does.
Why will a marketplace plan feel different?
Two reasons, and it's better to hear them straight. First, marketplace plans come with premiums and deductibles. After years of $0 premiums and no deductible, even a well-priced silver plan feels like a demotion. The half-deductible arrangement for mid-year movers softens that for the rest of 2026, but it doesn't erase it.
Second, the enhanced federal subsidies that made marketplace plans cheaper for everyone expired at the end of 2025, so 2026 marketplace prices are higher across the board, not just for former Essential Plan members. This is the part of the job where a broker actually earns their keep: pricing plans side by side across carriers, checking that your doctors are in the network, and running your income against the 2026 subsidy cliff before you commit, all at no cost to you. The plan prices are the same whether you use a broker or click through alone; the only difference is whether someone who does this every day is checking your work. I wrote up the full comparison in NY State of Health vs. using a broker.
What about pregnancy, DACA, and other special cases?
A few groups follow different rules under the change, and these come straight from the state's own materials:
Pregnant enrollees stay covered continuously. If you were pregnant and enrolled, your coverage did not cut off on July 1.
DACA recipients at or under 138% of the poverty level were moved to Medicaid on July 1, 2026, so their coverage continued under a different program.
Higher-income DACA recipients who are not pregnant no longer qualify for NY State of Health programs under the federal rules. If that's your situation, there are still private options worth pricing outside the marketplace, and that conversation is worth having before you conclude you have none.
And if you have kids, know that Child Health Plus is its own program with its own rules. A parent losing the Essential Plan does not automatically mean the kids lose their coverage.
Common questions about the Essential Plan in 2026
Does the Essential Plan still exist in 2026?
Yes. New York's Essential Plan still exists for households earning up to 200% of the federal poverty level, which is $31,920 for a single person and $66,000 for a family of four in 2026. It still has a $0 monthly premium, no deductible, dental and vision included, and you can enroll year-round. The roughly 1.3 million enrollees under 200% of the poverty level were not affected by the July 1, 2026 change. What ended was the expanded tier for incomes between 200% and 250% of the poverty level.
What are the Essential Plan income limits for 2026?
For 2026, the Essential Plan covers incomes up to 200% of the federal poverty level: $31,920 a year for a household of one and $66,000 for a household of four. The former expanded tier for incomes between 200% and 250% of the poverty level, roughly $31,920 to $39,900 for a single person, ended on July 1, 2026. People in that income range now shop for a Qualified Health Plan on the NY State of Health marketplace instead.
Why did 450,000 people lose the Essential Plan?
A July 2025 federal budget law, H.R. 1, eliminated the premium tax credits for most lawfully present immigrants that funded New York's expanded Essential Plan. Without that federal funding, New York terminated the section 1332 waiver that paid for the expansion, with approval from CMS, effective July 1, 2026. That ended coverage for the roughly 450,000 enrollees in the 200% to 250% of poverty level tier. The core program for incomes up to 200% of the poverty level continues unchanged.
I lost my Essential Plan and missed the August 30 deadline. What do I do?
Call someone before you decide anything, because the answer depends on your situation. The special no-gap enrollment window New York set up for former Essential Plan members closed August 30, 2026, but depending on your income, household, and life events there can still be a path onto coverage before the November open enrollment period, which is the guaranteed backstop for a January 1 start. Do not just go without coverage until November without checking first. A licensed broker's help costs you nothing, and the state's enrollment line is 1-855-355-5777.
How much does a marketplace plan cost after the Essential Plan?
New York State says the average silver level Qualified Health Plan costs about $220 per month after premium tax credits for people moving off the expanded Essential Plan. The state also arranged for deductibles to be cut in half for former Essential Plan members who moved to a marketplace plan mid-year in 2026, since they are starting a plan partway through the year. Your actual price depends on your income, age, county, and the plan you pick, which is exactly what a broker prices out side by side at no cost to you.
Is the Essential Plan the same as Medicaid?
No. They are separate programs. Medicaid covers the lowest income levels and is run under its own federal and state rules. The Essential Plan sits one rung above Medicaid on the income ladder and is offered through NY State of Health for people who earn too much for Medicaid but not more than 200% of the federal poverty level. Both can look similar from the member's seat, with little or no premium, but the eligibility rules, funding, and plans behind them are different.
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