ROCHESTER, N.Y. — Qualifications for the state’s Essential Plan health insurance are changing as of July 1.

New Yorkers who made between 200-250% of the federal poverty line did qualify for the plan, but that level is decreasing to 150-200%. That means, for example, a family of one making between $31,300-$39,125 would lose their coverage. Similarly, a family of four with an annual household income between $64,300-$80,375 no longer qualifies for the plan.

These changes come after federal cuts to the plan were passed in 2025. Now, some say health insurance is simply too far out of reach. Lauren Goetz says her monthly health insurance bill is easily half of her monthly income.

What You Need To Know

Federal cuts were passed in 2025 to the state’s Essential Plan health insurance
The qualifications are decreasing from households who make 250% of the federal poverty line to 200%
The state is offering a 60-day period for New Yorkers who are impacted to sign up for new coverage, and be able to be reimbursed

“I’m really frustrated. I have never felt such a sense of being unsettled in my whole life. Especially in my adult life. Being 58 years old, I had assumed, I guess wrongly, that everything would be stable,” Goetz explained, “Life is life. I anticipate changes, but being in the financial situation that we are at this point in our lives, it’s hard.”

Experts say Essential Plan 200-250 customers need to make sure their information is up to date on the New York State of Health’s website, because some New Yorkers will still be able to qualify for new or different subsidies, which act similarly to a discount on health insurance.

“The importance of having your information as current as possible is really anchored in making sure that when the state goes to determine what you qualify for, what your costs are going to be, whether that’s your tax credits or the programs you qualify for, all that information is used to determine what program you can be in, and that really directly translates to what your cost is going to be,” explained Megan Woodward from Fidelis Care. “It’s really important for folks to know if fear of cost has kept folks away from taking action, that taking the action, figuring out what exactly is my subsidy, what exactly is my cost going to look like, is really a powerful way to overcome that fear and understand what you’re working with. Most people are going to be able to continue to access high-quality, low-cost health care on the other side of this.”

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If you missed the June 15 deadline to apply for new coverage, the state has provided customers a 60-day grace period. They need to find new health insurance by Aug. 30 of this year in order to have any costs reimbursed.

“The Aug. 30 deadline is really important in order to get your coverage re-effectuated for July 1. And that’s quite unusual that you could take action late and have something reactivate for a date in the past. So that is really a special flexibility right now,” Woodward said. “After that date, our folks will either, depending on the circumstances of their income, be required to wait until open enrollment begins all the way in the fall and November for 2027 coverage, or if their income is otherwise below that threshold, they may qualify to sign up for another low-cost option, but it won’t activate for a date in the past.”

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Woodward, the vice president of member experience for Fidelis Care, says health insurance is important to have no matter what your physical state is.

“Health insurance doesn’t only help for those emergencies of the really unforeseen things that can come out of nowhere, that we have no control over, that all of a sudden result in tremendous medical costs. But health insurance is also really important to make sure people are able to access preventative care, to get their children the services they need when they’re all well. Well, to be able to keep themselves healthy, to care for their families,” she said.

Excellus BlueCross BlueShield is encouraging members to check if they are impacted, update their information, choose new coverage for later and pay attention to dates and deadlines. They are advising members to check their eligibility status on the New York State of Health’s website, where they can also update account information. Members can also visit Excellus’s website for more information.