Navigating health insurance in New York is already a headache, but a massive shakeup is about to hit hundreds of thousands of residents. Due to major shifts in federal funding from recent H.R.1 legislation, roughly 450,000 New Yorkers are set to lose their current health insurance coverage starting July 1, 2026.
The changes specifically target New York’s Essential Plan, a critical lifeline that currently provides affordable coverage to 1.7 million residents. While the state is scrambling to protect as many people as possible, nearly half a million people will be dropped from the plan and forced to find alternative coverage.
If you or your family rely on the Essential Plan, here’s exactly what’s happening, who’s affected, and what steps you need to take right now to avoid becoming uninsured.
What’s Changing and Why?
The federal funding cuts packed into the H.R.1 legislation dealt a heavy blow to New York’s health infrastructure. To mitigate the damage and save state costs, the NY State Department of Health had to terminate its “1332 State Innovation Waiver” and pivot back to its Basic Health Program.
While this move successfully protects about 1.3 million enrollees, it means anyone whose household income sits between 200% and 250% of the Federal Poverty Level (FPL) will no longer be eligible for the Essential Plan as of July 1.
Are You Affected? Here’s the Breakdown
Your eligibility moving forward depends entirely on your income, household size, and specific life situations.
1. By Income Level
- Under 200% FPL (Good News): Your coverage will automatically continue under the Basic Health Program. Your benefits will stay the exact same
- Between 200%–250% FPL (Action Needed): Your Essential Plan coverage ends June 30, 2026. You’ll need to transition to a Qualified Health Plan on the individual marketplace
To put the numbers into perspective, here’s what the 200% FPL limit looks like in 2026:
- 1 Person: $31,920 Annual Income Limit (200% FPL)
- 2 People: $43,280 Annual Income Limit (200% FPL)
- 3 People: $54,640 Annual Income Limit (200% FPL)
- 4 People: $66,000 Annual Income Limit (200% FPL)
2. DACA Recipients
If you are a DACA recipient and your family income is over 138% of the FPL ($22,024 for an individual), your Essential Plan will end on June 30 and you’ll no longer qualify for NY State of Health programs unless your situation changes.
3. If You Are Pregnant
There’s a massive exception here. If you’re pregnant or gave birth between August 2025 and June 2026:
- Due before Jan 1, 2027: You can keep your Essential Plan for the rest of your pregnancy plus a 12-month postpartum period
- Due on or after Jan 1, 2027 (or DACA recipient): Your Essential Plan ends June 30, but you will automatically be transitioned into Medicaid
How Much More Will You Have to Pay?
If you have to move to a Qualified Health Plan, your costs will vary based on your income and where you live. Luckily, federal premium tax credits are available to help soften the blow.
For example, a New York City resident earning $35,910 a year (225% FPL) will qualify for a $637/month tax credit, meaning a standard benchmark Silver plan will cost around $230 a month.
Tip: You can apply your tax credits to any “metal level” plan (Bronze, Silver, Gold) to find a price point that fits your budget.
Will You Be Able to Keep Your Doctor?
Most likely, yes.
The majority of healthcare providers who accept the Essential Plan also accept Qualified Health Plans from the same insurance company. However, you should absolutely call your doctor’s office to confirm before locking in a new plan, or utilize the online NYS Provider & Health Plan Look-Up tool.
Crucial Next Steps: What You Need to Do
Don’t panic–NY State of Health is already tracking this and will be reaching out to affected individuals.
- Check Your Mail/Email: NY State of Health sent out official notices outlining your new eligibility and required next steps
- Review Your Options: The state will automatically assess what other financial assistance or programs you qualify for
- The Deadline: If your coverage ends on July 1, you have until August 30, 2026 to officially enroll in a new health plan
If you have questions, need help navigating the marketplace, or haven’t received your notice, you can contact a certified enrollment assistor or call the NY State of Health Customer Service Center at 1-855-355-5777.
Here are some additional New York laws going into effect on July 1st, 2026 that you need to know about.
