Written by a parent, not a doctor. Nothing here is medical advice.

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New York program

Review coverage or an income change with NY State of Health

NY State of Health is New York's Marketplace for buying an individual health plan.

What it is

NY State of Health is New York's Marketplace for buying an individual health plan.

NY State of Health can review replacement coverage after a qualifying event. If you already have a Marketplace plan, a change in income can also change your assistance. An enrollment assister checks the deadline, treatment network and actual cost before you choose.

Eligibility rules
  • Coverage loss, a qualifying move, birth or another qualifying event can open special enrollment.
  • In 2026, premium tax credits generally apply within 100–400% of poverty, with other eligibility conditions. Expanded credits ended December 31, 2025.
  • Losing Medicaid or Child Health Plus may have specific enrollment and start-date rules. The NY State of Health assister can confirm your deadline from the loss notice and explain when the new plan would begin; the federal Marketplace’s rules should not be assumed to apply.
What you get
  • A health plan with a premium tax credit if your household qualifies.
  • Coverage that cannot exclude your child because of a pre-existing condition.
What the help includes
  • The plan sets its premium, deductible and other cost sharing. A tax credit reduces the premium rather than every treatment bill.
  • Above 400% of poverty, no premium tax credit is available in 2026.
If you decide to apply
  1. Ask a NY State of Health assister to compare a Marketplace plan with Medicaid, Child Health Plus or COBRA.
  2. Have the coverage-loss notice, income estimate and your child's treatment-team and pharmacy names ready.
  3. Check the exact plan's network and coverage start date before choosing it.

NY State of Health: 855-355-5777 · Official page ↗

After you ask
  • The enrollment confirmation gives the premium, credit and start date. Coverage depends on completing enrollment and any required first payment.
Good to know

The general window is 60 days after a qualifying event. You can also seek coverage up to 60 days before an expected insurance loss.

Other details
  • New York uses NY State of Health. The application and special-enrollment rules are not interchangeable with HealthCare.gov's.

Federal background: Marketplace special enrollment.

Official sources
Ask your social worker

“Could an income change affect our current plan or help paying for it? If coverage is ending, could you help us compare replacement plans and their start dates?”

Why I’m asking: We want the next plan ready without a gap in cancer treatment.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

Report the event and its date within 60 days (or up to 60 days before the loss), send documents when asked, and pay the first premium by the insurer's date.

Your social worker

Connects you to an enrollment assister and checks the exact plan against the hospital's contracts.

The care team

Records and letters when the application asks for them.

Who decides
NY State of Health decides the enrollment period and the tax credit; the insurer sets the start date.
Ask your social worker
“Does this NY State of Health plan cover our hospital and specialty pharmacy? Who can help us compare it with COBRA before we enroll?”

How to apply

First step: Go to nystateofhealth.ny.gov or call 855-355-5777 within 60 days of the coverage loss (or up to 60 days before it) and report the exact event and date.

  1. Identify the coverage-loss event and its date.
  2. Check the treating hospital and specialty pharmacy against the exact plan.
  3. Compare with COBRA before choosing.

Official application / program page ↗

Where it starts: nystateofhealth.ny.gov or 855-355-5777

What to gather

  • The coverage-loss notice with its date
  • An income estimate for the tax household
  • The names of the hospital, oncologists and specialty pharmacy to check against the plan

How long: Enrollment is immediate once verified. Coverage starts on the insurer's date after you pick a plan and pay.

Clock: Report the coverage loss to NY State of Health within 60 days (you can apply up to 60 days before the loss).

What a yes looks like

An enrollment confirmation with the premium, the credit and the start date; the hospital confirms it is in network.

What a no looks like, and the next move

"No qualifying event" or "outside the period": ask about COBRA and Medicaid, which has no season.

Watch out

  • A diagnosis alone opens nothing. A lost plan, a move, a birth or a Medicaid or Child Health Plus loss does. Keep the loss letter with its date.
  • Check the exact plan's network for the treating hospital and the specialty pharmacy before paying.
  • The expanded tax credits ended December 31, 2025; above 400% of the poverty line there is no credit in 2026.

Dates that change this

2025-12-31: The expanded premium tax credits ended December 31, 2025 and were not continued for 2026.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 9, 2026.

What it is worth

An individual plan with a premium tax credit by income, bought after a qualifying event. Report the event within 60 days; apply up to 60 days before an expected coverage loss.

  • $60 — Days to report a qualifying life event
  • $60 — Days before an expected coverage loss you can apply

Legal protection: Pre-existing-condition protection · Premium tax credit by income (100 to 400% of the poverty line in 2026)

What it costs the family: Plan-specific premium and cost sharing. No credit above 400% of the poverty line in 2026.

The eligibility facts, as published

Qualifying event
coverage loss or another qualifying life event, reported within 60 days
Advance application
up to 60 days before the current insurance ends
Medicaid loss window
a distinct longer window after losing Medicaid was NOT FOUND (do not import HealthCare.gov's 90 days)
Premium tax credit
none above 400% FPL in 2026 (IRS); expanded credits ended 2025-12-31

Decisions this site cannot make: Event and subsidy eligibility

Expect friction on: Network and formulary checks · Enrollment timing

The trap: The expanded tax credits ended after 2025; above 400% of the poverty line there is no credit in 2026. We found no longer deadline in New York after losing Medicaid, so use 60 days.

Where I read this

← Back to your options