Your Health Coverage May Change July 1. Here's What East New York Residents Need to Do Right Now.

What Is Changing

New York State's Essential Plan has provided free or near-free health coverage to working New Yorkers with incomes between 138% and 250% of the federal poverty level. Starting July 1, 2026, federal funding cuts under H.R. 1 are forcing the state to drop the upper eligibility limit from 250% back down to 200% of the federal poverty level. The state cannot make up for the lost federal funding.

The result: approximately 450,000 New Yorkers who currently pay $0 in monthly premiums under the Essential Plan will be moved to Qualified Health Plans, which can carry monthly premiums, deductibles, and higher out-of-pocket costs. Coverage under the Essential Plan ends June 30, 2026.

Does This Affect You

You are affected if your household income falls between 200% and 250% of the federal poverty level. Here is what that looks like in actual dollar amounts:

Household Size	Monthly Income (affected range)	Annual Income (affected range)
Single person	$2,661 – $3,325	$31,920 – $39,900
Couple (2 people)	$3,608 – $4,509	$43,300 – $54,100
Family of 3	$4,554 – $5,691	$54,650 – $68,300
Family of 4	$5,501 – $6,876	$66,000 – $82,500

If your income is below these ranges, you remain on the Essential Plan and nothing changes. If your income is above these ranges, you were already on a different plan. This affects the people in the middle — working households earning too much for Medicaid but not enough to easily absorb higher insurance costs.

What Happens If You Do Nothing

Your Essential Plan coverage ends June 30. You will not automatically be enrolled in a new plan. Starting July 1, you will have no health insurance until you enroll in something else. That means any doctor visit, prescription, or emergency room trip after July 1 is paid out of pocket.

NY State of Health will give you a 60-day Special Enrollment Period to pick a new plan without penalty. But the clock starts July 1, and going even a week without coverage can disrupt prescriptions, mental health appointments, and ongoing care.

What Your New Options Are

Depending on your income and household size, you may qualify for one of the following:

• A lower-cost Essential Plan — if your income drops below 200% FPL, you may still qualify
• A Qualified Health Plan (QHP) — Bronze, Silver, Gold, or Platinum. Federal tax credits may reduce the monthly premium significantly depending on your income
• Medicaid — if your income has dropped recently, you may now qualify
• Special circumstance coverage — if you are pregnant, recently gave birth, or had a major income change, additional options may be available

The state has also negotiated with insurers to cut deductibles in half for anyone moving from the Essential Plan to a QHP mid-year. That is a direct protection for people making this switch.

Where to Get Help in East New York

What to Bring When You Call or Visit

• Your Social Security number
• Proof of income — a recent pay stub, tax return, or employer letter works
• Your current Essential Plan member ID card
• A list of any doctors, medications, or specialists you currently use — so a navigator can find a plan that keeps your existing providers

The Bigger Picture

This change is a direct result of federal cuts under H.R. 1, the same legislation driving proposed Medicaid work requirements set to begin in 2027. New York State pushed back as hard as it legally could — it preserved coverage for the 1.3 million New Yorkers below 200% FPL and negotiated the mid-year deductible reduction — but it could not replace the lost federal funding entirely.

For East New York residents, this lands hardest on households with fluctuating work hours, multiple part-time jobs, or gig work — people whose income moves in and out of the affected range month to month. If you are not sure whether you are affected, call 311 or the NY State of Health hotline today. The call is free and takes about 20 minutes.

Do not wait. Coverage ends June 30. The enrollment deadline to avoid a gap is today, June 15.