Home › Subsidy calculator › NY State of Health income limits 2026
What Are the NY State of Health Income Limits for 2026? Medicaid, Essential Plan, Child Health Plus, and Tax Credits by Family Size
Written and reviewed by Dick Tracy, licensed health insurance broker (NPN 20414610) · Published September 4, 2026
New York stacks four programs on one income ladder. For 2026: Medicaid for adults up to $22,025 (one person) or $45,540 (family of four); the Essential Plan at $0 a month up to $31,920 or $66,000, after the July 1, 2026 change trimmed its ceiling to 200% of poverty; Child Health Plus from free up to $73,260 for a family of four, then $15 to $60 per child up to $132,000; and federal premium tax credits from the Essential Plan line up to 400% of poverty, $62,600 for one person and $128,600 for four by the IRS measure. Every rung for households of one to eight is below, with the Buffalo-versus-NYC price difference and what to do above the top line. I educate, you decide.
Medicaid, Essential Plan, and Child Health Plus lines are from the NY State of Health 2026 income levels chart (2026 poverty guidelines). The federal credit ceiling is the IRS measure for 2026 coverage (2025 guidelines). Income means modified adjusted gross income for the whole household. Married couples must file jointly to claim the credit.
The full NY State of Health income chart for 2026
This is the state's own "2026 Income Levels for Medicaid, Child Health Plus and Essential Plan" chart, on the 2026 poverty guidelines ($15,960 for one person plus $5,680 for each additional person), with the Essential Plan column corrected for the July 1, 2026 change. The chart was printed before July 1 and still shows a 200% to 250% Essential Plan tier. That tier is gone.
| Household | Medicaid adults (138%) | Essential Plan (200%) | CHP free (222%) | CHP $15 (250%) | CHP $30 (300%) | CHP $45 (350%) | CHP $60 (400%) |
|---|---|---|---|---|---|---|---|
| 1 | $22,025 | $31,920 | $35,432 | $39,900 | $47,880 | $55,860 | $63,840 |
| 2 | $29,864 | $43,280 | $48,041 | $54,100 | $64,920 | $75,740 | $86,560 |
| 3 | $37,702 | $54,640 | $60,651 | $68,300 | $81,960 | $95,620 | $109,280 |
| 4 | $45,540 | $66,000 | $73,260 | $82,500 | $99,000 | $115,500 | $132,000 |
| 5 | $53,379 | $77,360 | $85,870 | $96,700 | $116,040 | $135,380 | $154,720 |
| 6 | $61,217 | $88,720 | $98,480 | $110,900 | $133,080 | $155,260 | $177,440 |
| 7 | $69,056 | $100,080 | $111,089 | $125,100 | $150,120 | $175,140 | $200,160 |
| 8 | $76,894 | $111,440 | $123,699 | $139,300 | $167,160 | $195,020 | $222,880 |
| Each additional | +$7,839 | +$11,360 | +$12,610 | +$14,200 | +$17,040 | +$19,880 | +$22,720 |
Sources: NY State of Health, 2026 Income Levels; NYS Department of Health, Child Health Plus eligibility and cost. Children 1 to 18 qualify for Medicaid up to 154% of poverty; pregnant women and infants up to 223%. Child Health Plus premiums are capped at three children per family. Above the $60 tier, Child Health Plus is still available at the full plan premium.
The Essential Plan after July 1, 2026
no deductible
since July 1, 2026
in the 200% to 250% tier
The Essential Plan is for New Yorkers ages 19 to 64 who earn too much for Medicaid and are not eligible for Medicaid, Child Health Plus, or a job plan. The premium is $0, there is no deductible, dental and vision are included, and you can enroll any month of the year. Cost sharing depends on which side of 150% of poverty you land on: $0 for care up to $23,940 for a single person ($49,500 for four); above that, small copays ($15 primary care, $25 specialist, $75 emergency room, $150 inpatient). In July 2025 the federal law known as H.R. 1 cut the funding that paid for the plan's expanded 200% to 250% tier. New York ended its section 1332 waiver with CMS approval, and on July 1, 2026 about 450,000 people between $31,920 and $39,900 (single) lost the Essential Plan. The roughly 1.3 million enrollees under 200% were not affected. Those who lost it were moved to marketplace plans with tax credits, where the state says the average silver plan runs about $220 a month after the credit, with deductibles cut in half for the rest of 2026. The no-gap enrollment window closed August 30, 2026. If that was you and you are still sorting it out, start here.
Sources: NY State of Health, Impact of H.R. 1 on the Essential Plan (April 2026); Essential Plan at a glance (revised July 2026); NYS Department of Health, March 23, 2026.
Why your age does not change the price in New York
Everywhere else I am licensed, a 60-year-old pays three times what a 21-year-old pays for the same plan. Not here. New York Insurance Law section 3231 requires community rating: the same premium for every person on a plan in a region, without regard to age, sex, health status, tobacco use, or occupation. Family premiums run on fixed tiers off the single rate: a couple pays 2.0 times, a parent with children 1.7 times, and a couple with children 2.85 times, no matter how many children. Two consequences follow. A healthy 28-year-old in New York pays the most-overpriced marketplace premium in the country relative to their risk, which is why the ERISA group door matters so much here. And the subsidy math is simpler: the benchmark premium does not move with your age, so the credit is set almost entirely by income and household size. The calculator uses New York's tiers instead of the federal age curve when you pick New York.
Sources: NY Insurance Law section 3231; family tier ratios from the NY State of Health second-lowest-cost silver rate table.
What a silver plan costs in 2026, Buffalo versus the rest of the state
| Region (2026, one adult, lowest-cost silver, before any credit) | Monthly premium |
|---|---|
| Erie, Niagara, Allegany, Cattaraugus, Chautauqua, Genesee, Orleans, Wyoming (Western New York) | $581.62 |
| Albany | $680.51 |
| Monroe (Rochester) | $730.00 |
| New York City boroughs and Westchester | $806.61 |
| Nassau and Suffolk (Long Island) | $855.44 |
| Tompkins (Ithaca), the highest in the state | $1,041.11 |
| Statewide benchmark used for the subsidy formula (KFF) | $817 |
Sources: NY State of Health, 2026 lowest-cost silver plan by county; KFF, 2026 benchmark premiums.
Western New York is the cheapest individual market in the state, and it is not close: a Buffalo family (couple with children, 2.85 times the single rate) pays about $1,658 a month for the lowest-cost silver before any credit, where the same family in Manhattan pays about $2,299. For 2026, the Department of Financial Services cut insurers' requested individual rates by 47.4%, saving $148.2 million and holding the approved statewide increase to roughly 7.1%, with the profit provision capped at 1%. It still landed hard. NY State of Health reports the average marketplace premium at $812, and $636 for people getting financial help, up 19.5% from 2025 once the enhanced federal credits expired.
Sources: NYS Department of Financial Services, August 29, 2025; NY State of Health 2026 Health Coverage Update. The approved-average figure is from published summaries of the DFS rate actions.
Who is on which program: the 2026 enrollment picture
As of January 31, 2026, NY State of Health carried 6,606,045 people: 4,129,132 in Medicaid through the marketplace (6.7 million counting county offices), 1,714,745 in the Essential Plan, 551,464 children in Child Health Plus, and only 210,704 in qualified health plans, the private marketplace plans, of whom 90,807 had financial help and 119,897 paid full price. One line in that report tells the whole 2026 story: the number of marketplace enrollees over 400% of poverty receiving a tax credit fell from 46,079 to zero. Those are the households the cliff hit, and most of them are self-employed or small business owners. New York has 1,985,320 businesses with no employees, and the state median household income of $85,974 puts the typical family of four under the line, but the typical two-earner professional household above it.
Sources: NY State of Health 2026 Health Coverage Update; Census Bureau QuickFacts, New York.
Open enrollment and special enrollment in New York
New York runs one of the longest open enrollment windows in the country. For 2026 coverage it ran November 1, 2025 through January 31, 2026, with December 15 the deadline for a January 1 start, and the state has not yet posted the 2027 dates; expect November 1, 2026 through January 31, 2027 and check my 2027 dates page, which I update the day it is announced. Medicaid, the Essential Plan, and Child Health Plus enroll year-round. For marketplace plans outside the window you need a qualifying event reported within 60 days: losing other coverage (not for nonpayment), a permanent move, marriage, divorce, birth or adoption, gaining or losing subsidy eligibility, or gaining lawful presence. New York adds one most states do not have: pregnancy is a qualifying event here.
Sources: NYS Department of Health, November 6, 2025; NY State of Health enrollment periods fact sheet.
Over the line in New York? Here is the door most people never hear about
New York bans short-term plans outright (Department of Financial Services Circular Letter 7 of 2018) and community rating bars medical underwriting of individual coverage, so the private plan a healthy Texan buys to beat an unsubsidized premium does not exist here. What does exist: healthy people and families can merge into pre-established ERISA group plans and get group rates, because ERISA is federal law and the state cannot block it. That is the door I open first for a Western New York self-employed household earning $130,000 that just watched its credit go to zero, and it is the reason I wrote the ERISA cheat code page. Layer a fixed indemnity plan underneath and the deductible stops landing on you all at once. Before any of that, one honest check: if you are within $10,000 of the line, a Solo 401(k) or SEP contribution run with your tax professional may put you back under it, and for 2026 there is no cap on repaying a credit you were not entitled to, so the income estimate has to be right.
Source: NYS DFS Insurance Circular Letter No. 7 (2018).
Common questions about NY State of Health income limits
What are the NY State of Health income limits for 2026?
Medicaid for adults to $22,025 (one person) or $45,540 (four); the Essential Plan to $31,920 or $66,000 at $0 a month; Child Health Plus free to $35,432 or $73,260, then $15, $30, $45, or $60 per child up to 400% of poverty. Federal premium tax credits run from the Essential Plan line to 400%, which the IRS measures at $62,600 for one person and $128,600 for four for 2026 coverage.
What is the Essential Plan income limit for 2026?
Since July 1, 2026: up to 200% of poverty, $31,920 for one, $43,280 for two, $54,640 for three, $66,000 for four, $77,360 for five, $88,720 for six, $100,080 for seven, $111,440 for eight. $0 premium, no deductible. The 200% to 250% tier ended June 30, 2026, moving about 450,000 people to marketplace plans with tax credits.
What is the Essential Plan income eligibility for a family of 4?
Up to $66,000 a year. Under $45,540 the adults are in Medicaid instead. Between $45,540 and $66,000 the adults get the Essential Plan at $0 a month; cost sharing is $0 up to $49,500 and small copays above that.
What are the Child Health Plus income limits for 2026?
There is no cutoff; income sets the premium. Family of four: free to $73,260, $15 per child to $82,500, $30 to $99,000, $45 to $115,500, $60 to $132,000, full premium above. Single parent with one child: free to $48,041, $15 to $54,100, $30 to $64,920, $45 to $75,740, $60 to $86,560. Capped at three children, no copays, year-round enrollment. Full details on the Child Health Plus page.
Does NY State of Health use the 2025 or 2026 poverty guidelines?
Its 2026 chart uses the 2026 guidelines ($15,960 plus $5,680 per person) for Medicaid, the Essential Plan, and Child Health Plus, and prints 400% at $63,840 for one and $132,000 for four. The IRS reconciles the federal credit for 2026 coverage on the 2025 guidelines, where 400% is $62,600 and $128,600. Treat the lower IRS figure as the safe line for the credit.
Why does age not matter for New York marketplace premiums?
Insurance Law section 3231 requires community rating: the same premium for everyone on a plan in a region regardless of age, sex, health, tobacco, or occupation. Families use fixed tiers: couple 2.0 times the single rate, parent with children 1.7, couple with children 2.85. A 25-year-old and a 60-year-old in Buffalo both pay $581.62 for the lowest-cost silver in 2026.
How much does a NY State of Health silver plan cost in 2026?
Lowest-cost silver for one adult, before credits: $581.62 in Western New York, $680.51 in Albany, $730.00 in Monroe County, $806.61 in New York City and Westchester, $855.44 on Long Island, $1,041.11 in Tompkins County. Statewide benchmark for the subsidy math: $817. Average marketplace premium: $812, or $636 with financial help.
What happens if I earn more than the limit?
Above 400% the federal credit is zero for 2026 and you pay full price, about $1,658 a month for a Western New York family on the lowest-cost silver. New York bans underwritten individual plans and short-term plans, so the door that stays open is a pre-established ERISA group plan at group rates. Marketplace enrollees over 400% with credits fell from 46,079 to zero this year; most of them had another option and did not know it.
Give me your county, your household, and an honest income figure and I will tell you which program you land in, what the actual credit is, and what the ERISA door costs next to it. Free, no hard sell, Buffalo based. I educate, you decide.
Grab a time right here
Pick a slot below and it lands on both our calendars. No phone tag, no hard sell. I educate, you decide.