Essential Plan Income Eligibility 2026

The New York State Essential Plan offers $0 monthly premiums for residents earning up to $39,125 annually in 2026.

This expanded program now covers individuals making up to 250% of the Federal Poverty Level, providing comprehensive health coverage, including dental and vision benefits at no cost.

Quick Summary:

Income limit increased to $39,125 for single individuals (250% FPL)
$0 monthly premium for all qualifying members
Free dental and vision coverage included
Available to NY residents aged 19–64
Essential Plan 5 ending July 1, 2026
Low or $0 copays depending on income tier

2026 Income Eligibility Limits

The Essential Plan expanded access in 2026. More New Yorkers now qualify for free coverage.

Previously, the income limit was 200% FPL. Now it reaches 250% FPL. This change helps middle-income families afford healthcare.

Income Chart by Household Size

Household Size	Maximum Annual Income
1 Person	$39,125
2 People	$52,875
3 People	$66,625
4 People	$80,375
5 People	$94,125
6 People	$107,875

Example: A family of three earning $65,000 annually qualifies for the Essential Plan.

What the Essential Plan Covers

All Essential Plan members receive comprehensive benefits at no monthly cost.

Core Benefits

Monthly Premium: $0
Annual Deductible: $0
Dental Coverage: Included (cleanings, exams)
Vision Coverage: Included (eye exams, glasses)
Preventive Care: Free checkups and screenings
Gym Reimbursement: Up to $400-$600 yearly

Cost Sharing Based on Income

Your copays depend on your income level.

Lower Income ($0 – $23,475):

Doctor visits: $0
Specialist visits: $0
Hospital stays: $0
Prescriptions: $1-$3

Higher Income ($23,476 – $39,125):

Doctor visits: $15
Specialist visits: $25
Hospital stays: $150 per admission
Prescriptions: $6-$30

Five Essential Plan Types

New York offers five Essential Plan variations. Your assignment depends on income and immigration status.

Standard Plans (Citizens & Eligible Immigrants)

Essential Plan 2

Income: $21,597 – $23,475 (138% – 150% FPL)
Medical copays: $0 for all services
Prescription copays: $1 / $3 / $3 per tier

Essential Plan 1

Income: $23,476 – $31,300 (150% – 200% FPL)
Doctor visit: $15 copay
Specialist visit: $25 copay
Hospital: $150 per admission
Prescriptions: $6 / $15 / $30 per tier

Essential Plan 200-250

Income: $31,301 – $39,125 (200% – 250% FPL)
Same copays as Essential Plan 1
Newly expanded tier for 2026

Immigrant Eligibility Plans

Some lawfully present immigrants qualify for special plans.

Essential Plan 4

Income: Below $15,650 (under 100% FPL)
All services: $0 copay
Maximum benefits included

Essential Plan 3

Income: $15,650 – $21,597 (100% – 138% FPL)
Medical services: $0 copay
Small prescription copays: $1-$3

Who Qualifies for the Essential Plan?

You must meet these requirements to enroll:

Basic Eligibility

Age: 19 to 64 years old
Residency: Live in New York State
Income: Earn up to 250% of the Federal Poverty Level
Immigration Status: U.S. citizen or lawfully present immigrant

Who Cannot Enroll

You are not eligible if you:

Qualify for Medicaid or Child Health Plus
Have affordable employer coverage
Are eligible for Medicare
Live outside New York State

Note: Undocumented individuals aged 65+ may qualify for Medicaid. Others should check state-funded programs.

Critical 2026 Update: Essential Plan 5 Ending

Essential Plan 5 will end on July 1, 2026.

This plan served lawfully present immigrants earning 200-250% FPL. Federal funding cuts caused this change.

If you’re enrolled in Essential Plan 5:

You’ll receive a notice from NY State of Health
Coverage ends July 1, 2026
Explore alternative coverage options immediately
Contact NY State of Health for guidance

How to Apply

Applying for the Essential Plan is simple and free.

Application Steps

Visit NY State of Health: Go to nystateofhealth.ny.gov
Create an account or log in
Complete the application with household and income information
Submit required documents (proof of income, residency, identity)
Receive your eligibility determination within days
Choose your health plan from available carriers

Required Documents

Proof of income (pay stubs, tax returns)
Proof of residency (utility bill, lease)
Social Security Number or immigration documents
Photo ID

Need help? Call 1-855-355-5777 for free application assistance.

Why Choose the Essential Plan?

The Essential Plan offers unmatched value for eligible New Yorkers.

Key Advantages

No monthly premium saves hundreds of dollars yearly
Comprehensive coverage includes medical, dental, and vision
Low copays make healthcare affordable
No deductible means coverage starts immediately
Quality care from top New York providers
Preventive services at zero cost

Thousands of New Yorkers rely on the Essential Plan for affordable, quality healthcare.

Frequently Asked Questions

1. What is the income limit for the Essential Plan 2026?

Single individuals can earn up to $39,125 annually. Families of four qualify with incomes up to $80,375. These limits reflect 250% of the Federal Poverty Level for 2026.

2. Does the Essential Plan include dental and vision?

Yes. All Essential Plan members receive free dental cleanings, exams, and vision coverage including eye exams and glasses. No additional premium required.

3. What happens if I get a raise during the year?

Report income changes to NY State of Health within 30 days. You may move to a different Essential Plan tier or qualify for Qualified Health Plans with subsidies.

4. Can undocumented immigrants apply for Essential Plan?

Undocumented individuals aged 65+ may qualify for Medicaid. Others should explore Emergency Medicaid or state-funded programs. Contact NY State of Health for options.

5. When does Essential Plan 5 coverage end?

Essential Plan 5 ends July 1, 2026 due to federal funding changes. Affected members will receive official notices with alternative coverage options before the deadline.

6. How is Essential Plan different from Medicaid?

Essential Plan serves individuals earning too much for Medicaid (above 138% FPL) but still needing affordable coverage. It has $0 premiums but may include small copays.