Health insurance in the United States – employer plans, NY State of Health and other options

• Premium: what you (and your employer) pay each month for the plan.
• Deductible: what you pay for covered care each year before the plan starts paying for most services.
• Copay and coinsurance: your share of each visit or bill after the deductible.
• Network: the doctors and hospitals that have a contract with your plan. Seeing an out-of-network provider usually costs much more.
• Out-of-pocket maximum: the most you pay in a year for covered in-network care.

Most employers offer a group plan and pay part of the premium, which is deducted from your salary. Your employer decides who is eligible, but once you are otherwise eligible, a waiting period may not exceed 90 days. Ask HR for the enrollment deadline, the plan documents and the provider network, and add your spouse and children when you first enroll; if you lose employer coverage later, you usually have 30 days to join another group plan.

If you leave a job at an employer with 20 or more employees, you can often keep the group plan for a limited time under COBRA, but you then pay the full premium yourself.

If you have no employer plan, you can buy a Qualified Health Plan on NY State of Health if you live in New York, are a US citizen or lawfully present, and do not qualify for Medicaid, the Essential Plan or Child Health Plus. Every plan covers preventive care and pre-existing conditions.

• Open enrollment is held once a year. For 2026 coverage it ended on 31 January 2026, you had to enroll by 15 December 2025 for coverage from 1 January, and existing enrollees could renew or change plans from 16 November 2025. Check NY State of Health for the 2027 dates.
• Outside open enrollment, moving and other life events usually give you 60 days to enroll (a Special Enrollment Period). Medicaid, the Essential Plan and Child Health Plus are open all year to those who qualify.
• Help: apply online, call 855-355-5777 (TTY 800-662-1220), or call 311 for free help from an enrollment counselor in your language.

Federal law H.R. 1 (signed in July 2025) changes who can get financial help:

• From 1 January 2027, premium tax credits (the federal subsidy that lowers marketplace premiums) are limited to lawful permanent residents, Cuban and Haitian entrants and COFA migrants. Holders of nonimmigrant visas such as H-1B or F-1 can still buy a marketplace plan, but without this subsidy.
• New York's Essential Plan was restructured: about 450,000 people with incomes between 200% and 250% of the federal poverty level lost eligibility from 1 July 2026 and were moved toward Qualified Health Plans, while about 1.3 million people below 200% kept coverage.

If you rely on a public program or a subsidy, check your eligibility with NY State of Health before you renew, and do not stop coverage or services without advice.

Child Health Plus covers children aged 18 and under who live in New York, have no other insurance and do not qualify for Medicaid, regardless of immigration status. Most families pay a premium of $0 to $60 a month depending on income, with no copays (2026). Apply through NY State of Health.

Many universities require students to buy the school health plan or show equivalent cover. J-1 exchange visitors and their J-2 dependents must have insurance for the whole program with at least $100,000 of medical benefits per accident or illness, $50,000 for medical evacuation, $25,000 for repatriation of remains and a deductible of no more than $500 per accident or illness. Ask your sponsor or school before you buy a separate plan.

NYC Care gives New Yorkers who do not qualify for or cannot afford health insurance access to low-cost and no-cost care at NYC Health + Hospitals, with a member card, a primary care doctor and affordable medicines. There are no premiums or monthly fees, fees are on a sliding scale from $0, and NYC Care does not ask about immigration status. Call 646-NYC-CARE (646-692-2273) to enroll.

In an emergency, call 911 or go to the nearest emergency department. Hospitals that take part in Medicare must give a medical screening exam and stabilizing treatment regardless of your ability to pay. The federal No Surprises Act protects insured patients from most surprise out-of-network bills for emergency care, and if you are uninsured or paying yourself, providers generally must give you a good faith estimate; you may be able to dispute a bill that is at least $400 above it. Questions: 1-800-985-3059.