Health insurance under 65 in New York
Between jobs, self-employed, retiring early, or simply never offered coverage at work: New York's marketplace is where individual health insurance is bought, and it works differently from the national one. The Essential Plan has no premium, the tax credits changed in 2026, and the plans on offer in the Capital Region come from a short list of carriers. I'm certified with NY State of Health and enrol people at no cost.
If you're under 65 without employer coverage in New York, your options are NY State of Health marketplace plans (with income-based premium tax credits), the Essential Plan ($0 premium for adults with income up to 200% of the federal poverty level, year-round enrollment), Medicaid, or COBRA from a former employer. Short-term plans are not sold in New York. Open enrollment runs November 1 to January 31; losing coverage, moving or a new child opens a 60-day special enrollment window. As a certified marketplace broker I enroll you at no fee.
Your options in New York
| Option | Who it's for | Premium | When to enrol |
|---|---|---|---|
| Medicaid | Lowest incomes; also many people 65+ or disabled | $0 | Year-round |
| Essential Plan | Adults 19 to 64, income up to 200% of poverty, not Medicaid-eligible | $0, no deductible | Year-round |
| Qualified Health Plan with tax credit | Income above Essential Plan, up to 400% of poverty | Reduced by the credit; varies with income and plan | Nov 1 to Jan 31, or a life event |
| Qualified Health Plan, full price | Income above 400% of poverty, or anyone who prefers off-marketplace | Full premium | Nov 1 to Jan 31, or a life event |
| COBRA | Anyone leaving a job with group coverage, for up to 18 months (36 in some cases) | Full group premium plus 2% | 60 days from the notice |
| Child Health Plus | Children under 19, any income, premium by income | $0 to modest | Year-round |
Choosing a marketplace plan
- Metal levels. Bronze has the lowest premium and highest deductible; Platinum the reverse. New York standardises the benefits at each level, so comparison is mostly about network and premium.
- Networks. Capital Region plans come from a handful of carriers, and each has a different relationship with Albany Med, St. Peter's, Ellis and Saratoga Hospital. Check your doctors first, then price.
- The credit. It's based on your estimate of this year's income and reconciled on your tax return. Estimate carefully; I'll walk through it with you, particularly if you're self-employed or retiring.
- Cost-sharing reductions are available on Silver plans for incomes up to 250% of poverty, and make Silver the best value in that band.
Recheck everything this year
With the enhanced subsidies gone and the Essential Plan back at 200% of poverty, a household that was comfortable in 2025 can face a very different bill in 2026. Anyone whose income is near an eligibility line should have the numbers re-run before renewing, and anyone who lost the Essential Plan in July should have been offered a Qualified Health Plan with a credit. If that didn't happen, call me.
Who I help most
- Self-employed and small-business owners, who also need to know when a small-group plan beats individual coverage; that's on the business insurance pages.
- People between jobs, deciding between COBRA and the marketplace inside the 60-day window.
- Early retirees bridging to Medicare.
- New arrivals and Turkish-speaking families navigating a system that is unfamiliar in any language. Eligibility rules for lawfully present immigrants differ by program, and I know them.
What I need to enrol you
- Household members, dates of birth and immigration status where relevant.
- A realistic estimate of this year's household income.
- Your doctors and prescriptions, for the network and formulary check.
- If you're losing coverage, the date it ends and the notice.
Request help choosing a plan. No fee.
- NY State of Health, the official health plan marketplace
- Essential Plan information (NY State of Health)
- New York health insurance marketplace guide 2026 (healthinsurance.org) — subsidy expiry, Essential Plan reversion to 200% FPL
- Short-term limited duration insurance, Circular Letter No. 7 (2018) (NY DFS)
Common questions
Short answers to what people ask before they call.
When can I enrol in a health plan in New York?
Open enrollment for marketplace Qualified Health Plans runs November 1 to January 31 each year, longer than the federal window. 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 enrol year-round.
What is the Essential Plan?
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.
Did the premium tax credits change for 2026?
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.
I'm retiring at 62. What do I do for coverage until Medicare?
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.
Can I buy a short-term plan to bridge a gap?
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.
Is there a fee for using a broker?
No. Certified brokers are paid by the carriers and your premium is identical whether you enrol through me, through the marketplace website or by phone with the state.
Let's talk it through
A phone call or a message is all it takes. The first conversation is just a conversation.