Insurance Questions? We Have Straight Answers.
Insurance is confusing — and that's by design. We're changing that. Here are honest, plain-English answers to the questions our clients ask most.
The questions New Yorkers ask us most.
Health enrollment in New York comes with its own vocabulary — Essential Plan, CHPlus, APTC, SHOP. Here are clear answers, written by our New York advisor team.
The Essential Plan covers New York adults aged 19–64 with household income up to 250% of the Federal Poverty Level (about $37,650 for an individual or $78,000 for a family of four in 2025) who are not eligible for Medicaid or affordable employer coverage. Lawfully present immigrants and, as of 2024, certain DACA recipients also qualify. Monthly premiums range from $0 to about $15 depending on income tier — making it the most affordable comprehensive coverage available in any U.S. state.
Medicaid in New York covers very low-income residents (typically under 138% FPL for adults), pregnant women, children, and people with disabilities — with $0 premiums and minimal cost-sharing. The Essential Plan covers a higher income band (138%–250% FPL) with low monthly premiums ($0–$15) and small copays. Both include dental, vision, drugs, and mental health, and both are administered through NY State of Health. Your Plan Finder Hubs advisor confirms which one you qualify for and handles the enrollment.
Most restaurant workers in NYC qualify for either Medicaid or the Essential Plan based on hourly wage and tips. For workers above the Essential Plan threshold, Healthfirst, MetroPlus, EmblemHealth GHI HMO, and Oscar offer affordable Silver-tier plans with strong NYC networks. We routinely help servers, cooks, dishwashers, baristas, and delivery workers — including those who are tipped, undocumented children of citizens, or in mixed-status households — find coverage that fits their schedule and budget.
It depends on status. Lawfully present immigrants (green-card holders, refugees, asylees, TPS holders) are eligible for Essential Plan and ACA marketplace plans like any other resident. DACA recipients gained access to the Essential Plan and ACA marketplace coverage in 2024. Children in any immigration status are eligible for Child Health Plus. Undocumented adults can still purchase off-exchange coverage and access NYC Care, the city's free/low-cost program through NYC Health + Hospitals. Our multilingual advisors walk through every option without immigration-status judgment.
New York does not require small businesses (under 50 full-time employees) to provide health insurance, but those that do gain access to the SHOP Marketplace through NY State of Health, off-exchange small-group plans, and increasingly popular ICHRA arrangements that let employers reimburse employees for individual coverage tax-free. New York also has unique community-rating rules that make small group rates more stable than in other states. We help NYC restaurants, retail, creative studios, and startups under 25 employees structure benefits that attract talent without breaking the budget.
For 2026 coverage, New York's Open Enrollment runs from November 16, 2025 through January 31, 2026 — longer than the federal window. Coverage starting January 1 requires enrollment by December 15. The Essential Plan, Medicaid, and Child Health Plus enroll year-round with no deadline. Special Enrollment Periods (60-day windows) open after qualifying life events: losing job-based coverage, moving to NY, marriage, divorce, birth, or aging off a parent's plan.
Networks vary dramatically by carrier and by borough. EmblemHealth GHI HMO and MetroPlus have deep penetration in NYC public hospitals and clinics. Oscar and Anthem are strong with private NYC providers. Healthfirst dominates Brooklyn and Queens with broad community-doctor networks. Upstate, MVP, Excellus, and Independent Health each have regional strengths. Before any enrollment, our advisors run your specific doctors, hospitals, and pharmacies against each carrier's directory so you don't lose coverage of providers you trust.
Child Health Plus (CHPlus) is New York's coverage program for children under age 19 in families that earn too much for Medicaid but cannot afford private coverage. There is no income ceiling — any New York child not otherwise covered can enroll, with monthly contributions sliding from $0 to about $60 based on income. CHPlus covers checkups, immunizations, prescriptions, dental, vision, mental health, and hospitalization. Crucially, it covers children of any immigration status, including undocumented children.
No. Plan Finder Hubs is compensated by the carriers when New Yorkers enroll — the same way every licensed insurance broker in the state is paid. You pay the exact same premium working with us as you would enrolling directly through NY State of Health or with the carrier. The difference is you get a certified navigator who knows the New York marketplace inside and out, in your language, for free.
Self-employed New Yorkers — freelancers, contractors, gig workers, artists, consultants — typically buy through NY State of Health. Depending on income, you may qualify for the Essential Plan ($0–$15/month), Advance Premium Tax Credits that significantly reduce a Silver or Gold plan, or both. Many freelancers in income range $35K–$60K pay $80–$200/month for comprehensive Silver coverage after subsidy. Our advisors are particularly experienced with NYC's freelance creative community.