Health insurance under 65 in New York

Open enrollment for marketplace Qualified Health Plans starts November 1. For 2027 it runs November 1, 2026 to January 31, 2027, two weeks longer than the federal HealthCare.gov window, which ends January 15, 2027. Outside that, a qualifying life event such as losing job-based coverage, moving into the state, marriage, or a new child opens a 60-day special enrollment period. The Essential Plan and Medicaid enroll year-round.

A New York-only program through NY State of Health for adults 19 to 64 with income up to 200% of the federal poverty level who don't qualify for Medicaid. It has a $0 monthly premium, no deductible, low copays, and includes dental and vision. The income limit was temporarily 250% of poverty from 2024 until June 2026 and reverted to 200% on July 1, 2026, so people who were told they qualified last year should recheck.

For 2026 the limit is 200% of the federal poverty level, which NY State of Health publishes as $31,920 a year for one person, $43,280 for two, $54,640 for three and $66,000 for four. The premium is $0 at every income in that range and there is no deductible. Copays are $0 for most services if a single person earns up to $23,940; above that there are small copays, for example $15 for a primary care visit and $75 for the emergency room. You also need to be 19 to 64, lawfully present, and not eligible for Medicaid, Child Health Plus or job-based coverage.

It depends on the plan and metal level you choose, where in the state you live, how many people are covered, and your household income, which sets the tax credit. Age, health and smoking don't change the price here: New York law requires individual plans to be community rated, so a 60-year-old pays the same premium as a 25-year-old for the same plan. The Essential Plan and Medicaid have $0 premiums. For 2027 the Department of Financial Services approved an average 6.0% increase for individual plans, down from the 20.6% insurers asked for. For your actual monthly figure, I run your county, household and income through the marketplace quote.

Adults 19 to 64 and parents qualify with household income up to 138% of the federal poverty level, which NY State of Health lists for 2026 as $22,025 a year for one person, $29,864 for two, $37,702 for three and $45,540 for four. The limits are higher for pregnant women and infants (223% of poverty) and children 1 to 18 (154%), and children above those go to Child Health Plus. You need to live in New York and be a citizen or in an eligible immigration status; there is no monthly premium and you can apply any time through NY State of Health. Federal law is changing some Medicaid rules for adults, so recheck at each renewal.

Losing job-based coverage is a qualifying event: you have 60 days to choose a marketplace plan, and you don't have to take COBRA first. COBRA keeps the same plan and doctors, but you pay the full group premium plus 2%; a marketplace plan is often cheaper when your income has dropped, because the tax credit follows this year's household income. Mind the timing: if you start COBRA and then cancel it yourself before it runs out, you wait for open enrollment to switch, while COBRA ending on its own opens a new 60-day window. I compare both side by side inside your 60 days.

Usually a marketplace plan through NY State of Health, with a tax credit based on your estimated net self-employment income for the year; if that income is low enough, the Essential Plan or Medicaid instead. Self-employed people can generally deduct the premiums on their federal return, and IRS Form 7206 works out the amount. If you have employees, compare a small-group plan too; that's on the business insurance pages. Estimate the income carefully, because the credit is reconciled on your tax return.

Usually yes. If you had a net profit from self-employment, or you're a partner or a more-than-2% S corporation shareholder, the self-employed health insurance deduction goes on Schedule 1 of Form 1040, and IRS Form 7206 works out the amount. Medical, dental, vision and qualified long-term care premiums for you, your spouse and your dependents count, and the IRS says Medicare premiums you voluntarily pay for coverage in your name can be used too, so it isn't only for people under 65. The deduction can't be more than the business's net earnings, and you can't count any month in which you were eligible for a subsidized employer plan, yours or your spouse's, even if you didn't join it. Your tax preparer makes the final call; I can give them your premium totals.

Form 1095-A goes to households that had a Bronze, Silver, Gold or Platinum plan through NY State of Health, one form per plan. If you got the advance premium tax credit, the IRS requires you to file Form 8962 with your federal return, using the 1095-A to settle the credit against your actual income; if you don't, the IRS says you won't get advance credits or cost-sharing reductions the following year. Form 1095-B is a record of coverage for people in Medicaid, Child Health Plus or the Essential Plan: NY State of Health posts it to your account inbox, or you can request it from the Department of Health, and no 1095-A is sent for those programs because they don't carry tax credits. If your 1095-A looks wrong, call NY State of Health before you file.

For 2027 the IRS limit is $4,500 for self-only coverage and $9,000 for family coverage. The plan has to be a high-deductible health plan with a deductible of at least $1,750 (self-only) or $3,500 (family) and out-of-pocket costs, not counting premiums, of no more than $8,700 or $17,400. Since January 2026 a direct primary care arrangement no longer disqualifies you from contributing, as long as its fees add up to no more than $150 a month for one person or $300 when it covers more than one. Once you're enrolled in any part of Medicare you can't contribute at all; the timing is in my working past 65 guide.

No. New York has no state requirement to carry health insurance, and the federal penalty has been $0 since 2019: the IRS reduced the shared responsibility payment to zero for months after December 31, 2018. The real cost of going uninsured is the medical bills, and without a qualifying event you wait for the next open enrollment to get a marketplace plan. The Essential Plan and Medicaid enroll year-round if your income qualifies.

Yes. Marketplace plans and the Essential Plan are open to New York residents who are lawfully present, not only citizens, and Medicaid covers many immigrants too, with rules that depend on the specific status. One change to know: under federal law, from January 1, 2027 marketplace tax credits for immigrants are limited to green card holders and two other narrow groups, so other lawfully present immigrants can still buy a plan but pay full price. I check status, income and program together before anything is filed.

Yes. The enhanced federal subsidies that applied from 2021 through 2025 expired at the end of 2025. For 2026 the tax credit is back on the original formula: it phases out at 400% of the poverty level and covers a smaller share of the premium. Many households saw significant increases in January 2026, which is exactly why plan selection and income estimation matter more now.

Usually a marketplace plan with a tax credit based on your projected income, which you can influence by how you draw retirement funds in those years. Sometimes COBRA for up to 18 months if the employer plan is strong and the credit is small. It's the same conversation as the turning-65 review, three years earlier, and the numbers can differ by thousands a year depending on how it's set up.

Not in New York. Short-term limited-duration plans aren't permitted to be sold here. The bridge options are COBRA, a marketplace plan through a special enrollment period, or the Essential Plan or Medicaid if income qualifies.

No. Certified brokers are paid by the carriers and your premium is identical whether you enroll through me, through the marketplace website or by phone with the state.