▶Watch: Private PPO vs. ACA Marketplace — which is right for you? (50 sec)
Can you still get private health insurance in New York? Yes — but New York's individual market works differently from almost every other state. Under New York's pure community rating law, every adult on the same plan in the same region pays the same premium regardless of age, so a healthy 30-year-old pays exactly what a 63-year-old pays, and full-price premiums are among the highest in the country. Twelve insurers sell individual plans for 2027, and state regulators approved an average 6% increase. If you get little or no subsidy, comparing every route to coverage is worth real money. We compare private medical plans side by side with NY State of Health coverage, from New York City and Long Island to Albany, Rochester, and Buffalo.
New York runs its own marketplace, NY State of Health. Open enrollment for 2027 coverage runs November 1, 2026 through January 31, 2027. Enroll by December 15 for coverage that starts January 1; later enrollments start on the first of a following month. Plans, prices, and networks change by region, so we quote every option at your address and help you enroll at no cost.
Two changes hit New Yorkers hard heading into 2027. The enhanced federal subsidies expired at the end of 2025, so households earning above 400% of the federal poverty level get no premium tax credit at all. And on July 1, 2026, the Essential Plan income limit dropped back to 200% of the poverty level — roughly 450,000 New Yorkers earning between 200% and 250% were moved off the $0-premium Essential Plan and into regular marketplace plans.
For 2027, twelve insurers sell individual and family plans in New York, and availability is set by region: Anthem (formerly Empire), EmblemHealth, Fidelis Care, Healthfirst, and MetroPlus across New York City and downstate; Excellus BlueCross BlueShield (Univera Healthcare in Western NY), Highmark Blue Cross Blue Shield, and Independent Health upstate and in Western New York; CDPHP and MVP Health Care in the Capital Region, Hudson Valley, and beyond; plus UnitedHealthcare and Oscar Health, which is selling off-exchange only for 2027.
Carriers, networks, and hospital access differ sharply by region. Here is how the market breaks down:
NewYork-Presbyterian, NYU Langone, Mount Sinai, Montefiore, Memorial Sloan Kettering, and NYC Health + Hospitals. Healthfirst, Fidelis, MetroPlus, EmblemHealth, Anthem, and Oscar compete here — the state's most crowded market.
Northwell Health, NYU Langone Long Island, Stony Brook Medicine, and Catholic Health. Network breadth varies widely by carrier, so Nassau and Suffolk shoppers should verify hospitals before enrolling.
Westchester Medical Center Health Network, Northwell's Hudson Valley hospitals, and NewYork-Presbyterian and Montefiore affiliates. MVP, Fidelis, EmblemHealth, and Anthem are key carriers.
Albany Med, University of Rochester Medicine, Rochester Regional, Upstate Medical in Syracuse, and Kaleida Health in Buffalo. Excellus/Univera, Highmark, Independent Health, CDPHP, and MVP lead here.
New York's hospital systems each play a distinct role, and network access varies by plan:
The state's largest health system, with hospitals across New York City, Long Island, Westchester, and the Hudson Valley.
Academic medical center affiliated with Columbia and Weill Cornell — one of the most sought-after networks in Manhattan.
Manhattan's Tisch Hospital plus campuses in Brooklyn and on Long Island, with nationally ranked specialty care.
Mount Sinai Hospital and its system hospitals across Manhattan, Brooklyn, and Queens.
World-renowned cancer center — and one of the providers most often left out of lower-cost narrow networks.
The Bronx and Westchester's academic health system, including the Children's Hospital at Montefiore.
Whether these systems are in your network depends entirely on which plan you choose — and because most New York individual plans are HMOs or EPOs with no out-of-network coverage, this is the question that matters most. Before you enroll, we verify your doctors and preferred hospitals against each plan's current network so there are no surprises.
New York's regulators hold rate increases down better than most states, but the starting point is high: with no age-based pricing, younger adults carry a much larger share of the cost than they would anywhere else. With the enhanced federal subsidies expired and the Essential Plan cut back to 200% of the poverty level, many New York households are paying full price for the first time. Your exact premium depends on your region, plan, and household size — which is why we quote every carrier and every route to coverage before recommending anything.
Traditional marketplace and off-exchange plans are not the only route. Many New Yorkers — especially the self-employed, freelancers, independent contractors, and small-business owners — may also qualify for true employer-level group coverage regulated under federal ERISA and Department of Labor rules. Qualifying as a bona fide employee takes only a few basic requirements — full-time work is not required — and pre-existing conditions are covered, just as with any employer group plan. You get the same kind of group PPO coverage large employers offer, on the national Aetna and First Health networks, plus the MagnaCare network in New York, and enrollment is open year-round, not just during open enrollment. Availability is subject to eligibility. Call us to see if you qualify.
Private plan families we can quote in New York:
Major medical on the Aetna PPO or EPO network, with 20+ deductible options including HSA-compatible plans.
Major medical with an unlimited lifetime maximum and copay options — on the MagnaCare network in New York.
Budget-friendly coverage on the First Health network, with set copays for primary, specialist, and urgent care visits.
$0-deductible routine-care copays paired with a catastrophic cost-sharing layer for hospital and major expenses.
Compare all four private plan families side by side →
The honest answer: it depends on your income. If you earn under 200% of the poverty level, the Essential Plan is hard to beat, and if you qualify for a meaningful premium tax credit, a marketplace plan through NY State of Health is usually the better value. If you get little or no subsidy — the situation many New York households found themselves in after the enhanced credits expired at the end of 2025 — an off-exchange private medical plan or employer-level group coverage frequently wins on network, price, or both. A five-minute comparison settles it, and our service is free either way.
Between 55 and 65 and not on Medicare yet? Early retirees in New York, people between jobs, and anyone whose spouse is moving to Medicare can compare private PPO, ACA, and COBRA options side by side in our guide to health insurance before Medicare.
Yes. Beyond on- and off-exchange marketplace plans, we also offer exclusive private, employer-group (ERISA) PPO options on the national Aetna and First Health networks, plus the MagnaCare network in New York. These plans aren’t published on the public marketplace, enrollment is open year-round, and availability is subject to eligibility. Call us to see if you qualify.
Yes. Every ACA-compliant private plan covers pre-existing conditions — no medical questions, no exclusions. ERISA employer-level group plans cover pre-existing conditions as well, just as with any employer coverage.
New York is one of only two states with pure community rating: insurers must charge every adult on the same plan in the same region the same premium, regardless of age, health, or tobacco use. That keeps prices level for older buyers but makes full-price coverage expensive for younger adults. With the enhanced federal subsidies gone, anyone above 400% of the poverty level pays that full price — which is why comparing private options matters.
NY State of Health and off-exchange ACA plans: during the annual open enrollment period (New York's runs through January 31), or year-round within 60 days of a qualifying life event. The Essential Plan and Medicaid accept eligible applicants year-round. Employer-level ERISA group plans: enrollment is open year-round for those who qualify. We also have other exclusive, proprietary private healthcare PPO plan options beyond what is published online. Contact us for specific details.
No. Premiums are identical with or without an agent — carriers pay us, not you. You get the comparison and enrollment help at no cost.
Compare Every Private Health Plan Available at Your New York ZIP Code
Free comparison from a licensed advisor — NY State of Health, off-exchange, and employer-level coverage buy-in options.
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Plus exclusive, proprietary private healthcare PPO options generally not published online — click Get My Plan Options or call us for details.
Rate change figures are 2027 approved averages from the New York State Department of Financial Services; New York individual-market premiums vary by region, plan, and household size, not age. Employer-level group plan availability varies by state and is subject to eligibility requirements.
