Eligibility Criteria for Individuals

Reduced-cost health insurance is available under the Healthy NY program to certain working uninsured individuals.

In order to participate, you must meet the following eligibility criteria:

• You must reside in New York State.
• You or your spouse must either be currently employed or must have been employed within the past 12 months.
• Your employer does not currently provide you with health insurance.  (Please see the FAQs and the exceptions listed below to see if this rule applies to you.)
• You have not had health insurance for twelve months prior to your Healthy NY application or have lost that coverage due to a specific event.

  Specific events include but are not limited to the following:

  • loss of employment
  • death of a family member
  • change to a new employer
  • change of residence
  • discontinuation of a group health plan
  • termination or cancellation of COBRA coverage (if you are eligible for COBRA coverage or have COBRA coverage, you can still apply for Healthy NY)
  • termination of participation in a public health insurance program, including Family Health Plus, Child Health Plus or Medicaid
  • legal separation, divorce or annulment
  • loss of eligibility for group health insurance coverage
  • aging off of a parent’s insurance policy

• You must be ineligible for Medicare.
• Your current gross (before taxes) household income meets the income guidelines of the program.

The Healthy NY Income Guidelines table below displays family size in column one and monthly household income in column two.  The amounts are effective as of January 1, 2009.  Pregnant women count as two people.

Healthy NY Income Guidelines*

*For purposes of counting your household size, count yourself, your spouse if your spouse lives with you, and dependent children, whether they live with you or not. Count all of these people, even if you are not going to include them on your Healthy NY policy. Do not count parents, roommates, or those not dependent on you for support.

Mid-year fluctuations in household income and employment status will not result in termination of your Healthy NY coverage. Proof of income will be required annually when an enrollee recertifies.