Exchange
NY State of Health
State-based exchange
Medicaid Expansion
✅ Expanded
Adults up to 138% FPL eligible
Avg. Benchmark Premium
$620/mo
Age 40, Silver plan
New York ACA Health Insurance Overview
New York operates NY State of Health, one of the most comprehensive state exchanges in the country. The state expanded Medicaid and also offers the Essential Plan — a $0-to-$20/month program for residents earning up to 200% FPL. Roughly 78% of marketplace enrollees receive premium tax credits, though the Essential Plan covers many who would otherwise need subsidized marketplace coverage.
New York Income Limits for ACA Subsidies (2026)
ACA subsidy eligibility is based on the Federal Poverty Level (FPL). The table below shows key income thresholds for an individual in New York. For a family, multiply by the household size factor (e.g., a family of 4 at 100% FPL ≈ $50,706/year).
| FPL Level | Annual Income (Individual) | Significance |
|---|---|---|
| 100% FPL | $15,650 | Minimum income for marketplace subsidies (below this → Medicaid) |
| 138% FPL | $21,597 | Medicaid expansion threshold — above this, use marketplace |
| 150% FPL | $23,475 | Below this threshold, $0-premium Silver plans are often available |
| 400% FPL | $62,600 | Traditional “subsidy cliff” — but the ARP extension through 2025 removed the cliff, capping premiums at 8.5% of income for all enrollees |
Based on 2025 Federal Poverty Guidelines used for the 2026 plan year. Alaska and Hawaii have higher FPL thresholds.
How ACA Subsidies Work in New York
New York's ACA subsidy landscape is unique because the Essential Plan absorbs many low-income residents who would otherwise use marketplace subsidies. For those above 200% FPL, premium tax credits work the same as other states — capping your contribution as a percentage of income and making Silver-level coverage affordable.
How to Enroll in New York
New York operates its own health insurance exchange: NY State of Health.
Visit your state's exchange website to browse plans, compare premiums, and enroll during Open Enrollment or a Special Enrollment Period. You may also find state-specific subsidies or programs not available on HealthCare.gov.
Medicaid in New York
New York has expanded Medicaid under the ACA.
Adults with household income up to 138% of the Federal Poverty Level may qualify for Medicaid coverage with little or no premium cost. If your income drops due to the subsidy cliff, Medicaid may be an option.
Calculate Your New York Premiums
See how the subsidy cliff affects your specific situation.
Open Calculator →See How the 2026 Subsidy Cliff Affects You
Enter your income and household size for a personalized premium comparison.
Calculate Your 2026 Premium Impact →Related Resources
⚠️ Disclaimer
This calculator provides estimates for educational purposes only. It is not a substitute for professional advice. Actual premiums, subsidies, and eligibility may vary based on your specific circumstances, location, and available plans. We are not licensed insurance agents or brokers. For official information, visit HealthCare.gov or contact a licensed insurance professional. This site is not affiliated with the U.S. government, CMS, or any insurance company.