Your Insurance Detective › NY State of Health vs. a broker
Straight answer from a Buffalo brokerNY State of Health vs. Using a Broker: Same Price, Different Outcome
By Dick Tracy · Published August 28, 2026
Is it cheaper to buy through NY State of Health or through a broker? Neither. It's the same price, by law. Every marketplace plan's premium is filed with New York State, and the carrier pays the broker, so you pay identical money whether you click through the website yourself or I enroll you in the same plan with the same subsidy. The difference is not the price. The difference is what you get to see before you pick, and who's on your side after. I educate, you decide.
I'm Dick Tracy, an independent health insurance broker in Buffalo. I'm certified with NY State of Health, so I can put you in a marketplace plan any day of the week. I'm also appointed with 80+ carriers, so I can show you what's outside the marketplace. That second part is the one the website can't do. No gag clause on me, so here are the tips, the tricks, and the traps.
What NY State of Health does well
Let's give credit. If your household income is under the subsidy line, the marketplace can knock hundreds off your monthly premium, and the Essential Plan is a genuinely good deal for people who qualify. Coverage is guaranteed no matter your health. And if you've had a serious diagnosis in the last few years, the marketplace is the right door for now. I'll say that plainly, and I'll enroll you there myself.
What the website doesn't show you
NY State of Health shows you marketplace plans. That's the whole menu. It does not show you a pre-established ERISA group plan that gives a healthy self-employed person group rates and a true PPO with a policy they own. It does not show you gap, accident, or critical-illness coverage that turns a $6,000 deductible into a manageable bad day. It does not check whether your doctor at Buffalo Medical Group or your specialist at Roswell Park is actually in the network of the plan you're about to click. And it does not tell you what happens at tax time if your income comes in higher than you guessed.
| NY State of Health on your own | With me (same plans, plus more) | |
|---|---|---|
| Premium | Filed rate | Same filed rate, no fee to you |
| Subsidy | Based on the income you type in | Same subsidy, planned around the cliff so you keep it |
| Plans you can see | Marketplace only | Marketplace, plus ERISA group merge, customized individual plans, gap and accident add-ons |
| Network check | You look it up per carrier | Done for every plan before you choose |
| Enrollment timing | Open enrollment or a life event | Some non-marketplace options start any time of year |
| When a claim gets denied | Call the carrier | I read the EOB, find the coding error, and fight it with you |
Why your 2026 premium jumped, and why the cliff matters now
Two things hit New Yorkers at once this year. The enhanced federal subsidies expired on December 31, 2025, so the subsidy cliff is back: earn one dollar over 400% of the federal poverty level and the entire credit disappears, and there's no cap on what you pay back. At the same time, Western New York carriers were approved for individual rate increases of about 20% for 2026. Independent Health: 20.8%. Univera: 20.7%. That's why so many people are saying the math doesn't math.
subsidized New Yorkers, 2026
on a marketplace plan
Source: Office of Governor Hochul, January 2, 2026. See where your household lands with my free 2026 subsidy cliff calculator.
Here's the trap for the self-employed especially: the marketplace subsidy is based on the income you project. Have a good year, and Uncle Sam comes back to collect. That's not a reason to avoid the marketplace. It's a reason to have someone plan the income estimate with you, and to know what the other doors look like before you commit.
Lost the Essential Plan this summer? Read this
On July 1, 2026, New York lowered the Essential Plan income limit from 250% to 200% of the federal poverty level, and a lot of Western New Yorkers got a letter. If that was you, you had a special window to move into a marketplace Silver plan with a subsidy, and for many people in Erie County that Silver plan came out close to the old Essential Plan cost once the credit applied. If you missed the window or the numbers don't work, call me. There may be a door the letter didn't mention.
So which one should you use?
Use both. Seriously. Let me enroll you in NY State of Health if that's your best move; you'll pay the same and you'll have a human on your side. But let me price the other doors first, because for a healthy self-employed person or a family that just fell off the cliff, the marketplace is one tool, not the default. Thirty minutes, no hard sell, real numbers side by side. Then you decide.
Common questions about NY State of Health and brokers
Is it cheaper to buy health insurance through NY State of Health or through a broker?
It's the same price. Every marketplace plan's premium is filed with New York State, and the carrier pays the broker, so you pay identical money whether you enroll yourself on NY State of Health or a broker enrolls you in the same plan. The broker costs you nothing. The only difference is what else you get to see, and who's on your side afterward.
Can a broker enroll me in NY State of Health and still get me the subsidy?
Yes. A certified broker enrolls you through NY State of Health with the exact same subsidy you'd get on your own. The subsidy is based on your household income and size, not on how you enrolled. A good broker also helps you estimate that income carefully, because the 2026 subsidy cliff means guessing wrong can cost you the whole credit at tax time.
Why did my NY State of Health premium jump so much in 2026?
Two hits at once. The enhanced federal subsidies from the pandemic years expired on December 31, 2025, so many New Yorkers saw their subsidy shrink or disappear. At the same time, Western New York carriers got approved individual rate increases of about 20% for 2026. Independent Health was approved for 20.8% and Univera for 20.7%. If your net premium roughly doubled, that's the combination.
Can I get health insurance outside open enrollment in New York?
Sometimes. Marketplace plans require a qualifying life event outside open enrollment, like losing other coverage, moving, marriage, or a new baby. But some options outside the marketplace, including pre-established ERISA group plans for the self-employed and certain private plans, can be started at other times of the year. That's one of the first things I check when someone calls me in March.
What is the income limit for the Essential Plan in 2026?
As of July 1, 2026, the Essential Plan is limited to households under 200% of the federal poverty level, down from 250%. Roughly half a million New Yorkers lost it in that change. If you were one of them, a marketplace Silver plan with a subsidy is the door the state points you to, and for many Erie County households the net cost lands near what the Essential Plan used to be. If the numbers don't work, there may be options outside the marketplace worth pricing. Self-employed? Start here.
Let me price the marketplace and everything outside it, side by side. No fee, no hard sell, thirty minutes.
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.