Shopping Affordable Care Act health insurance: What New Yorkers need to know

Health insurance enrollment for 2026 is now underway on New York’s Affordable Care Act marketplace, and state officials are encouraging residents to sign up with upbeat ads reassuring them that “quality health insurance” is available.

But just how affordable that insurance will be is still up in the air.

The federal government reopened last week after the longest shutdown in American history, without the main concession Democrats were seeking: A deal to extend the enhanced insurance subsidies that have helped keep health care costs down for millions of Americans in recent years.

About 140,000 New Yorkers enrolled in marketplace plans benefit from the enhanced subsidies and stand to pay an average of $1,368 more per year for coverage without them, according to the state health department.

It’s possible Congress could still vote to renew the subsidies before they expire at the end of the year. But the clock is ticking.

In New York, sign-ups for new marketplace enrollees started on Nov. 1 and the window opened for those looking to renew their coverage on Sunday.

Many New Yorkers shopping for insurance through the marketplace will still qualify for some level of financial assistance, even if the enhanced federal subsidies run out. But health policy experts say the additional aid has helped boost enrollment since it was put in place in 2021 — and predict some consumers will decline to sign up for coverage altogether as costs rise.

Here’s what New Yorkers need to know as they shop for health insurance for 2026.

Will I have to pay full price for health insurance on the ACA marketplace?

Not necessarily. Federal assistance varies based on income. If the enhanced tax credits aren’t renewed, subsidies won’t go away altogether. But for many people, they will be reduced, and those earning above a certain income will no longer be eligible.

The New York State of Health website has a calculator that allows consumers to estimate their insurance subsidies based on their income and other information and see how those subsidies change between 2025 and 2026, assuming the enhanced federal subsidies are not being extended.

Without the enhanced subsidies, those earning more than four times the federal poverty level will be cut off from federal financial assistance. That’s about $63,000 for an individual, or $129,000 for a family of four, according to federal guidelines.

This creates a subsidy cliff for middle-income New Yorkers who earn just above the cut-off, according to Elisabeth Benjamin, vice president of health initiatives at the Community Service Society of New York, who helps with insurance navigation.

“These folks are going to see serious increases,” Benjamin said.

Some who see their subsidies decrease may choose a cheaper bronze plan rather than a silver or gold plan, or even switch jobs to get insurance through an employer, said Matt McGough, a policy analyst specializing in the Affordable Care Act at the nonprofit KFF.

What if my income fluctuates?

Some of those who end up on the Affordable Care Act marketplace are freelancers or gig workers whose incomes fluctuate.

That comes with benefits and drawbacks, according to McGough. On one hand, those who are just above the cutoff for assistance may be able to forego some work to allow their income to dip below the threshold.

But underestimating your income for 2026 will also come with harsher financial penalties than it has in the past.

Health care consumers are able to project how much they will earn for the year in order to receive federal insurance subsidies upfront. As it stands, there’s a limit on how much of that money a person can be asked to pay back come tax season if they underestimate their earnings.

But the domestic policy and spending bill President Donald Trump signed in July removes that limit, creating greater liability for those who miscalculate how much they might earn.

Is there still a chance the enhanced subsidies could be renewed?

Amid negotiations over the end of the government shutdown, Sen. Majority Leader John Thune, a Republican from South Dakota, promised to hold a vote on extending the enhanced subsidies by mid-December.

There is some bipartisan support for finding a path forward, but the subsidies may look different from how they have in the past.

Thune told reporters last week the tax credits “can’t be without reforms.”

Trump, meanwhile, is now reportedly considering sending payments directly to health care consumers to help make up for the lost subsidies.

Should I sign up for coverage now or wait to see what happens?

Open enrollment in New York extends through the end of January, but for coverage to start promptly on Jan. 1 without any lapse in care, consumers should sign up by Dec. 15, the state health department says.

Still, officials acknowledge that the level of financial assistance that’s available could affect people’s choices.

“Given the uncertainty surrounding the extension of the enhanced premium tax credits, we are exploring all avenues to allow consumers to change their plans should an extension occur outside of the Open Enrollment period,” said Danielle DeSouza, a spokesperson for the state health department.

The state is also seeking to make sure anyone who signs up for coverage now can still benefit from enhanced subsidies if they’re renewed later on, DeSouza said.

“We are currently working through the scenarios of how to update premiums for consumers if the enhanced tax credits are extended,” she said.

Can I get help figuring all this out?

Yes, the New York State of Health website has options to call, text or find in-person help for assistance. Community-based organizations across the state act as health care navigators.