New York Essential Plan Income Limits & Eligibility

The Federal Poverty Level, often called FPL, is a measure used by the federal government to determine eligibility for certain health insurance programs and financial assistance. For the Essential Plan, income limits are based on a percentage of the Federal Poverty Level and household size.

For example, one Essential Plan category may apply to people with income up to 100% FPL, while another may apply to people with income over 150% and up to 200% FPL. NY State of Health uses these income ranges, along with other eligibility factors, to determine which Essential Plan category a person may qualify for.

Essential Plan income limits are based on annual Federal Poverty Level guidelines. These figures are updated each year and are used by NY State of Health to help determine eligibility for Medicaid, Child Health Plus, and the Essential Plan.

Your household size and yearly household income are used to determine where you fall within the Essential Plan income bands. Final eligibility and plan placement are determined by NY State of Health.

Household income generally includes the expected annual income of everyone in your tax household. This may include wages, salaries, self-employment income, unemployment benefits, Social Security benefits when applicable, retirement income, and certain other sources of taxable income.

Because every household is different, NY State of Health reviews your application to determine which sources of income count toward eligibility. If you are unsure what to include, complete an application through NY State of Health or speak with a Fidelis Care representative by calling 1-888-FIDELIS (TTY: 711).

Essential Plan categories are based largely on income as a percentage of the Federal Poverty Level. The higher your household income, the higher your Essential Plan income band may be.

• EP 4: For eligible individuals with income up to 100% of the Federal Poverty Level.
• EP 3: For eligible individuals with income over 100% and up to 138% of the Federal Poverty Level.
• EP 2: For eligible individuals with income over 138% and up to 150% of the Federal Poverty Level.
• EP 1: For eligible individuals with income over 150% and up to 200% of the Federal Poverty Level.

For 2026, the maximum annual income shown in this chart is based on 200% of the Federal Poverty Level. For a household of one, that amount is $31,920. For a household of four, that amount is $66,000.

For households larger than eight, use the "Each Additional Person" row in the income chart to calculate the applicable income limit. NY State of Health determines final eligibility based on your complete application.

The income chart includes income limits for households of one through eight people, along with the amount added for each additional household member. If your household has more than eight people, add the applicable amount shown in the "Each Additional Person" row for every additional member.

NY State of Health will calculate your final income limit when determining your eligibility.

The Essential Plan provides comprehensive health coverage with a $0 monthly premium for eligible New Yorkers. Depending on your Essential Plan category, you may have low or no out-of-pocket costs for covered services.

The income chart can help you estimate which Essential Plan category may apply to your household. However, it does not guarantee eligibility. NY State of Health determines final eligibility based on your application, household size, income, age, immigration status, and access to other health insurance.

Essential Plan income limits are typically updated annually to reflect changes to the Federal Poverty Level (FPL). NY State of Health uses the updated federal guidelines when determining eligibility for the Essential Plan and other New York health insurance programs.

Fidelis Care updates this page as new income guidelines become available.

Essential Plan 200–250 coverage ended on June 30, 2026. Beginning July 1, 2026, individuals with household income over 200% of the Federal Poverty Level are no longer eligible for the Essential Plan based on income.

If your income is above the Essential Plan limit, you may still qualify for other health insurance options through NY State of Health, including a Qualified Health Plan with financial assistance.

Looking for more information about the recent changes to the Essential Plan? Visit our Important Changes for Essential Plan 200–250 webpage to learn how these changes may affect your coverage and available health insurance options.