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New York runs a different individual market from most states: everyone in a region pays the same premium for a plan regardless of age or health, short-term plans aren’t allowed, and the Essential Plan changed in 2026. Here is how it works.
New York’s individual market is community rated: a plan costs the same for everyone in a rating region, whatever their age or health. Most people buy through NY State of Health, the state marketplace, or directly from a carrier.
Short-term plans are prohibited in New York, so the medically underwritten and short-term plans available in many other states aren’t part of the New York market. Lower-income New Yorkers may qualify for the Essential Plan or Medicaid, and the Essential Plan’s upper income band ended on July 1, 2026.
| Lane | Who it fits | What to know |
|---|---|---|
| Qualified Health Plans | Most individuals, families and the self-employed | Bought through NY State of Health or directly from a carrier; financial help depends on income |
| Essential Plan | Lower-income New Yorkers who qualify | Since July 1, 2026, for incomes below 200% of the federal poverty level |
| Medicaid and Child Health Plus | Lower-income households and children | Applied for through NY State of Health |
| Employer coverage | Business owners with employees | Small group plans for 1 to 100 employees, or an ICHRA; see the New York group guide |
Premiums for a plan don’t vary by age or health within a region. A 60-year-old and a 25-year-old pay the same price for the same plan.
New York prohibits short-term limited-duration plans in the individual and group markets, regardless of their length.
Coverage for incomes between 200% and 250% of the federal poverty level ended July 1, 2026. Those households may qualify for a Qualified Health Plan with financial assistance.
New York’s small group market runs to 100 employees, and level funding generally isn’t available at that size. See group health insurance in New York, or every state we serve.
No. New York prohibits short-term limited-duration plans in both the individual and group markets, regardless of how long the plan lasts.
No. New York’s individual market is community rated, so a plan’s premium in your region does not vary by age, sex or health. What changes your cost is the plan you pick, where you live, and whether you qualify for financial help.
Coverage for people with incomes between 200% and 250% of the federal poverty level ended on July 1, 2026, after New York ended the federal waiver that funded it. Those households may qualify for a Qualified Health Plan with financial assistance. People below 200% of the poverty level stay in the Essential Plan.
Usually a Qualified Health Plan through NY State of Health or directly from a carrier, with financial help if your income qualifies. If you have employees, a small group plan or an ICHRA may also fit. We walk through it with you.
Sources: New York DFS: Insurance Circular Letter No. 7 (2018), short-term plans; NY State of Health: Essential Plan changes; NY State of Health.
Call our licensed team. We explain your New York options in plain English and point you to the right place to enroll.