Eligibility Guidelines

Who’s eligible?

nystateofhealth_logoNY State of Health Marketplace Insurance

Every New York state resident is eligible to enroll through the NY State of Health Marketplace.

Visit the NY State of Health website to determine cost of plans by income.

Enrollment period: November 1 – January 31


Child Health Plus

childhealthplus_logoEvery child is eligible to apply, regardless of family income.

Visit the NY State of Health website to determine cost by income. After comparing costs and benefits to their employer plan, many select Child Health Plus.

Enrollment period: All Year


Medicaid

All adults aged 19-64, not eligible for Medicare, are eligible for Medicaid; pregnant women and infants; children aged 1-18; and parents and caretaker relatives
can apply for Medicaid.Medicaid Logo

Eligibility, determined by the NY State of Health Marketplace, is based on a family’s modified adjusted gross income as it relates to the federal poverty level.

Enrollment period: All Year

Visit enrollment services for program descriptions.


Essential Plan

Lower-income families who don’t qualify for Medicaid or Child Health Plus may qualify for the Essential Plan.Essential Plan Logo 2

Visit the NY State of Health website to determine cost by income.

Learn more.

Enrollment period: All Year


Missed the open enrollment deadline?

Special enrollment periods apply if you are eligible for a Qualifying Life Event. You must apply within 60 days from the qualifying event date.

Qualifying Events

  • Change in employment status
    • Examples: change from part-time to full-time, termination of employment, etc.
  • Change in legal marital status
    • Examples: marriage, separation or divorce, death of a spouse, etc.
  • Change in the number of dependents
    • Examples: Birth, adoption, child ceasing to meet age or student status, etc.
  • Change in place of residence
    • Examples: Moving to a state or county that doesn’t offer your current plan, green card, etc.
  • Change in employer-sponsored plan
    • Examples: Coverage change for spouse or dependent, etc.
  • Change in eligibility
    • Examples: Medicare or Medicaid eligibility, gaining or losing tax credit eligibility, etc.
  • Errors or Violations through NY State of Health
    • Examples: Product chosen does not meet minimum required coverage, etc.
  • Loss of coverage under a group health plan of a governmental or educational institution.
    • Examples: A state’s children’s health insurance program, etc.

Questions? Find out more about Enrollment Services or request an appointment. Call toll-free 1-866-872-3740.