ROCHESTER, N.Y. — Changes are coming to New York state’s essential health care plan. Federal cuts are expected to impact 450,000 New Yorkers, according to the state Department of Health.

“Anybody [that] is on the essential plan will get in the mail this coming month, actually in April. They should pay attention to that. You should call their broker or call their navigator when it’s ready for them to re-qualify for the essential plan,” Michael King, owner and founder of Century Benefits Group, said.

What You Need To Know

Notifications are expected to be sent to New Yorkers who no longer qualify for the essential health care plan this week
The plan’s threshold is increasing, which is expected to leave 450,000 New Yorkers making too much money to qualify
Changes will be implemented July 1, 2026
Century Benefits Group says if you’re notified, it’s best to update your annual income on the state’s health care marketplace website
Owner Michael King says many people will still qualify for subsidies, even if they don’t qualify for the essential plan

Medicaid servers individuals and families between 100%-150% above the federal poverty line. For a single person, that could be between $15,000-$23,000 annual income. Anything beyond that, up until July 1, someone would qualify for the essential plan.

“The reason it’s happened is: less money is coming from the federal government. The federal government subsidizes the essential plan in a great amount. They provide a lot of funds for the essential plan, and that’s going to be going away,” King added.

For years, the essential plan has served folks who make between 150%-200%, but federal cuts are moving that threshold back thousands of dollars. For example, with these changes, a single person with a $31,300-$39,125 salary will now be losing their essential plan.

“Basically, it’s those people of higher income between 200 and 250% of the federal poverty level. Those individuals are going to lose the essential plan. However, they still are going to be eligible for a subsidy. They still qualify for a subsidy, which will help pay for part of their insurance going forward,” King said.

Anybody making more than these essential plan thresholds will be subject to new subsidies in their new plans. That’s why it’s important to go to the state’s health insurance marketplace, after notifications are sent this week, and update your annual income so you have access. You can contact your insurance navigator, too, but new plans won’t be finalized for a few more weeks. The state still has to establish the new subsidies on its website.

“What you should do now is try to find out what your projected income will be for 2026. That’s the information they would like they need to know to determine your subsidy. What is your projected income? And that’s going to be important when you go to update your account,” he added.

These changes will not apply to everyone. People who already have procedures scheduled or are pregnant will have a grace period. Others will continue to qualify for the essential plan. However, some New Yorkers will need to adjust to new subsidies.

“The challenge is going to be for everybody on the essential plan, there’s no premium currently for the essential plan. So they’re not paying any premium for that plan. If they lose the essential plan, there will now be a premium. They’ll have to pay based on their income level,” he explained. “The essential plan, as we know today, has no deductible. All the other plans that gold, silver and bronze have a deductible to meet before the insurance kicks in. So that’s going to be a change also for many of these people.”

King estimates that the premium can be between $500-$700 per individual. Subsidies, premiums, and plans are all income-based. But there are other new options coming to the state, as well.

“Low-income people can qualify for Medicaid. Now, the basic health plan is brand new. That’s going to be put in. We haven’t seen a lot of details on it yet, but it is going to be coming down. The basic health plan,” King added.