(This form has been approved by the New York State Department of Health) 2025

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Eligibility New York State residents. Lawfully present in the U.S. 19-64 years old. Not eligible for Medicaid or Child Health Plus. Not eligible for employer and other coverage. Able to meet the Essential Plan annual income requirements listed in the table below.
If you are under 21 years of age, over 65 years of age, certified blind, certified disabled, pregnant, or a parent of a child under 21 years of age, you may be eligible for Medicaid if your income is above these levels and have medical bills.
New York State of Health is your states Marketplace. Visit New Yorks website.
The New York State Department of Health (State DOH) protects, improves, and promotes the health, productivity, public safety, and wellbeing of all New Yorkers.
Qualified Health Plans are available through NY State of Health to individuals who are: New York State residents. Citizens, lawfully present applicants, and DACA recipients. Not eligible for Medicaid, the Essential Plan or Child Health Plus.