Essential Plan 200-250 Ending in New York: What to Do

About 500,000 New Yorkers are losing the version of the Essential Plan that covered people earning between 200% and 250% of the federal poverty level. Federal funding for that part of the program is no longer available, and New York has ended it. If you used the Essential Plan and your income was in that range, you will likely need to pick a new health plan through NY State of Health. This article explains what changed, who is affected, and the steps to keep your coverage.

What Is the Essential Plan?

The Essential Plan is a New York health insurance program for adults that don't qualify for Medicaid but who still need free or low-cost coverage. It was created under the Affordable Care Act through a program called the Basic Health Program. The federal government pays most of the cost, and New York runs the program through NY State of Health.

In 2024, New York expanded the Essential Plan so that more people could qualify. The new income limit went up to 250% of the federal poverty level. That expansion is what is now ending.

What Changed and Why

The expanded Essential Plan was paid for with extra federal funding. That extra funding is no longer available. Without it, New York cannot keep offering Essential Plan coverage to people in the 200% to 250% income range.

The Essential Plan is not going away for everyone. People with incomes at or below 200% of the federal poverty level can still qualify. The change only affects the higher-income tier that was added in 2024.

Who Is Affected?

You may be affected if all three of these are true:

• You live in New York State.
• You are an adult under age 65.
• Your household income is between 200% and 250% of the federal poverty level either now or last year.

The federal poverty level is updated each year by the U.S. Department of Health and Human Services. You can see the current numbers on the HHS poverty guidelines page. NY State of Health uses these numbers when it decides what programs you qualify for.

If you are affected, NY State of Health is mailing you a notice. The notice will explain when your current plan ends and what you can do next.

What Are Your New Options?

If you no longer qualify for the Essential Plan, you have other options through NY State of Health:

• Qualified Health Plans (QHPs). These are plans from private insurance companies sold on NY State of Health. You may qualify for federal tax credits that lower your monthly cost.
• Essential Plan at 200% or below. If your income is at or below 200% of the federal poverty level, you may still qualify for the Essential Plan.
• Medicaid. Adults with incomes up to 138% of the federal poverty level may qualify for New York Medicaid.
• Child Health Plus. If you have children under age 19, they may qualify for Child Health Plus even if you do not qualify for low-cost coverage yourself.

How to Get Help

A licensed New York health insurance broker can help you compare plans, check whether your doctors are in network, and apply through NY State of Health. Help from a broker is free to you. The NY State of Health marketplace lets you choose a broker from your account.

At Stan Steele Agency, our team includes Daren Forrest, Beth Ficarro, and Mathieu Steele. We are licensed in New York State and work with NY State of Health every day. To learn more about the steps for choosing us as your broker, visit our Essential Plan transition page.

Important Dates

• To ensure coverage is active on July 1, sign up by June 15.

Next Steps

1. Read any notice you receive from NY State of Health.
2. Gather basic information for the people in your household: dates of birth, Social Security numbers, and information about anticipated 2026 income.
3. Make a list of the doctors and prescriptions you want to keep.
4. Schedule an appointment with a Stan Steele Agency broker, or call 585-657-6101.

The change to the Essential Plan is a big shift, but you do not have to figure it out alone. Acting early gives you time to compare plans and avoid a gap in coverage.