Key Facts
Medicaid in New York
New York was an early adopter of Medicaid expansion, providing comprehensive coverage to low-income adults well before the ACA. NY Medicaid offers robust benefits and the state also created the unique Essential Plan for residents earning slightly more than Medicaid limits.
Who Qualifies for NY Medicaid?
- Adults ages 19-64 with income up to 138% FPL ($20,783/year for individuals)
- Pregnant women with income up to 223% FPL
- Children under 19 with income up to 405% FPL (Child Health Plus)
- Seniors and people with disabilities meeting income requirements
- Parents/caretakers meeting income requirements
NY Medicaid Benefits
- Preventive care and wellness visits
- Doctor visits and specialist care
- Hospital inpatient and outpatient services
- Prescription drug coverage
- Mental health and substance abuse treatment
- Dental services (comprehensive for adults)
- Vision care including eyeglasses
- Transportation to medical appointments
How to Apply
You can apply for NY Medicaid through:
- Online at nystateofhealth.ny.gov
- By phone: 1-855-355-5777
- In person at your local Department of Social Services
- Through a certified navigator or enrollment counselor
Health Insurance Marketplace
New York operates its own state-based marketplace, NY State of Health. This gives residents access to qualified health plans, the Essential Plan, Medicaid, and Child Health Plus all through one portal.
Available Plan Types
- Bronze: Lower premiums, higher out-of-pocket costs (60% coverage)
- Silver: Moderate premiums and costs (70% coverage) - best for subsidies
- Gold: Higher premiums, lower out-of-pocket costs (80% coverage)
- Platinum: Highest premiums, lowest out-of-pocket costs (90% coverage)
- Catastrophic: Available for under-30 or hardship exemption
Enrollment Periods
Open Enrollment: November 1, 2024 - January 31, 2025 (extended deadline)
Medicaid, Essential Plan, and Child Health Plus accept applications year-round. You can also qualify for a Special Enrollment Period if you have a qualifying life event.
Average Costs in New York
Health insurance costs in New York vary based on your age, location, plan type, and whether you qualify for the Essential Plan. New York premiums tend to be higher than national averages but subsidies help reduce costs significantly.
| Plan Type | Individual (Age 40) | Family of 4 |
|---|---|---|
| Bronze | $450 - $550 | $1,400 - $1,750 |
| Silver | $550 - $680 | $1,700 - $2,100 |
| Gold | $620 - $750 | $1,900 - $2,400 |
| Essential Plan | $0 - $20 | $0 - $20 per person |
| NY Medicaid | $0 | $0 |
Frequently Asked Questions
Has New York expanded Medicaid?
Yes, New York was an early Medicaid expansion state. Adults with household incomes up to 138% of the Federal Poverty Level qualify for Medicaid, and those up to 200% FPL may qualify for the Essential Plan.
What is NY State of Health?
NY State of Health is New York's official health insurance marketplace where residents can compare and enroll in Medicaid, the Essential Plan, Child Health Plus, and qualified health plans with potential subsidies.
What is the Essential Plan in New York?
The Essential Plan is a low-cost health insurance option unique to New York for residents earning up to 200% of the Federal Poverty Level who don't qualify for Medicaid. Premiums are $0-20/month with low or no copays.
When can I enroll in health insurance in New York?
NY State of Health has year-round enrollment for Medicaid, the Essential Plan, and Child Health Plus. Qualified health plans have open enrollment from November 1 through January 31, extended compared to other states.
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