- How will I know if I can get help paying for my health insurance?
Complete an application through NY State of Health. We will tell you if you qualify for financial assistance.
- How much do I have to pay for my health insurance?
The cost of health insurance varies based on many things, including your income, the program you are eligible for, and the plan you select. You can view the cost of health plans (if there is one) available to you in the plan selection section of your application. If you are eligible for premium tax credits, you can estimate the financial help you could receive through the Compare Plans and Estimate Costs tool.
- What are Insurance Affordability Programs?
Insurance Affordability Programs include Medicaid, Child Health Plus, the Essential Plan, Advance Premium Tax Credits, and Cost-Sharing Reductions. NY State of Health will determine if you qualify for any of these programs, which can lower the cost of your health insurance.
- What is the premium tax credit?
The premium tax credit is the financial assistance provided by the federal government to help you and your household pay the monthly premium for the qualified health plan you enroll into. This assistance is only available to Qualified Health Plans through NY State of Health.
- How can I use the premium tax credit?
The premium tax credit can be used "in advance." This means that the federal government will send the amount of the premium tax credit you choose to use to help pay for your qualified health plan’s monthly premium. This will help make insurance more affordable because you will pay less each month. If the advance premium tax credit does not cover all of the monthly premium, then you will pay for the remaining amount. You can choose to use all, some, or none of the tax credit. If there are household members that want to enroll in different plan, you can allocate the amount of the tax credit across the household members.
- How will changes in my income or family size affect my premium tax credit?
Changes in your income and family size during the coverage year may increase or decrease the premium tax credit you qualify for. When you file your federal income taxes for this year, the IRS will look at the annual income provided on your taxes and compare it to what you told us in your application that you expected your income to be for the year. Since the premium tax credit you get depends on your annual income, the IRS looks at the premium tax credit you took in advance and compares it to what you are eligible to take when you file your taxes.
If the advance premium tax credit you get for the year is less than the tax credit you are entitled to when you file taxes, you will get the difference as a refundable credit when you file your federal income tax return.
If your advance payments for the year are more than the amount of your credit you are eligible for, you must repay the excess advance payments with your tax return. There is a limit on the repayment total for some consumers.
If you experience any changes in your income or family size, you should update your Marketplace account or call customer service at 1-855-355-5777.
- How do I pay the health plan premium?
If a premium is due, you must pay the first month's premium in order for your coverage to be effective and to start using health care services. NY State of Health does not accept premium payments for the health plans for individuals and families. Your health plan will send you information about how to pay this premium or you can contact them directly.
- Do I have to file taxes to get help paying for health insurance?
Each program has its own rules regarding filing taxes. To determine which program you and your family may be eligible for, we need to know about the filing status of everyone on your application for the upcoming tax year. If someone is married, we need to know whether they file jointly with their spouse. We will also need to know about dependents whom you plan to claim. You also need to let us know if you or other household members will not be filing taxes.
One of the eligibility criteria for advanced premium tax credits and cost sharing reductions is that you must file taxes, and if married, you must file jointly. There are some exceptions to this rule.
- How do my marital and tax filing statuses affect my eligibility for financial assistance with health coverage?
We need to ask about marital status and tax filing status as in order to determine who should be included in your household composition.
To qualify for the premium tax credit, most married individuals applying through NY State of Health must file their federal taxes jointly. However, there may be situations when married individuals may qualify without filing taxes jointly. You may qualify for a premium tax credit if you were legally separated by the end of the year, and you have a court decree of separate maintenance or divorce. Signing and filing a separation agreement with the court is not a decree. You may also qualify for the premium tax credit if you are married but live apart from your spouse and meet the requirements to file as Head of Household. You should consult a tax advisor or the Internal Revenue Service to determine whether your situation exempts you from the requirement to file jointly to receive a premium tax credit. If you are in one of these situations, call the Marketplace at 1-855-355-5777 for more information.
- Can I still get a tax credit if I will be claimed as a dependent on another person's tax return?
Eligibility for advanced premium tax credits is based on a variety of factors, including tax filing status. If you will be claimed as a dependent on another person's tax return, the income of everyone on that tax return will be considered in determining eligibility for tax credits.
- Do I qualify for premium tax credits if my employer offers a health plan that meets minimum value standard?
An employer-sponsored health plan meets "minimum value standard" if the health plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of those costs. If your employer offers a health plan that does meet minimum value and is affordable, then you do not qualify for premium tax credits.
In 2025, if the employee has an offer of employee-only coverage that is considered affordable (costs them less than 9.02% percent of household income), the employee will not qualify for financial help, but their family members may still be eligible for financial help.
If the employee must pay more than 9.02% of household income towards the premium for a family plan, the plan is considered unaffordable, and the employee’s family members may qualify for financial assistance.
- What is cost-sharing help? How do I know if I qualify?
"Co-pays" and "coinsurance" are the part of a medical bill that are charged to you, not your insurance company. A "deductible" is the total you must pay in health costs before your insurance kicks in. At NY State of Health, you may get help paying these extra costs if your income falls below a certain point. When you apply for a health plan, we will tell you if you can get this kind of help.