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Healthy NY Health Insurance Program Eligibility

Eligibility Requirements for Individuals and Sole Proprietors

Healthy NY is available to individuals and sole proprietors who meet eligibility requirements.

You must meet all five eligibility requirements in order to participate in the Healthy NY program for individuals and sole proprietors.

Healthy NY Eligibility Requirements for Individuals and Sole Proprietors

1. You must be a resident of New York State and must not be eligible for Medicare.
2. You or your spouse must have worked at some time in the past 12 months.
3. You must not be eligible for health insurance provided by your employer.
4. You must meet income guidelines.
5. You must be uninsured for the 12 months prior to applying for Healthy NY or have lost coverage due to a specific event.

1. You must be a resident of New York State and not be eligible for Medicare.

You do not have to be a United States citizen, but you must be a New York State resident and legal resident of the United States. Those living in New York State part-time may apply if they maintain and claim New York State residency but should keep in mind that Healthy NY has very limited out-of-state benefits.

Medicare is federal health insurance for people of all incomes. It is usually for people ages 65 and older and people who are disabled.

2. You or your spouse must have worked at some time in the past 12 months.

You do not have to be employed at this time, as long as you or your spouse has worked within the last 12 months. Work can be full-time or part-time but must be for pay. This requirement applies to students as well.

3. You must not be eligible for health insurance provided by your employer.

If you currently work for an employer that provides comprehensive (medical and hospital) health insurance and contributes any amount to the cost, then you are not eligible for Healthy NY. If you have employer-sponsored insurance but it does not provide hospital and medical benefits, then it is not comprehensive and you might still qualify. If your employer offers coverage to some employees but you are not eligible because of hours or job duties, then you may still be eligible for Healthy NY.