Health insurance in New York for Australians

In New York, your health cover is a job perk, a government marketplace plan or a very large bill. Pick one before you land.

The short version

There is no reciprocal health care agreement between Australia and the United States, so Medicare doesn't cover you in New York [1].
Most Australians on an E-3, L-1 or H-1B get cover through their employer. Learn three words fast: premium, deductible and network.
If you don't have a job-based plan, NY State of Health is the state marketplace. Lawfully present residents can apply, but the rules for visa holders tightened in 2026 and tighten again in 2027 [3][5].
The free Essential Plan now covers New Yorkers aged 19 to 64 with incomes up to about US$31,920 for a single person in 2026 [2]. About 450,000 people above 200% of the poverty line lost it on 1 July 2026 [4].
For anything that isn't life-threatening, urgent care is usually far cheaper than the emergency room.

Why Australians get caught out

At home, Medicare quietly sits underneath everything. You can get private cover on top, but a broken wrist won't bankrupt you. The US has no equivalent safety net for working-age visa holders.

Smartraveller is blunt about it: US medical costs are much higher than Australia's, a doctor's visit for even a minor issue can cost thousands of dollars, and providers may ask for proof of insurance or your ability to pay before treating you [1]. The Australian Government won't pay those costs, and because there's no reciprocal agreement, you aren't covered by Medicare while you're in the United States [1].

That matters from day one. Many employer plans don't start until your first day of work, or even the first of the following month. Bridge the gap with travel insurance that covers medical treatment until your US plan kicks in. And check whether your Australian travel policy covers you once you're a resident, because many stop when you move rather than visit.

For what to do with your cover back home, read our guides to Medicare when you live abroad and private health insurance when you move overseas.

How employer plans work

Most New Yorkers with a salaried job get health insurance through work. Your employer picks an insurer and offers a handful of plans, usually during onboarding and then once a year at "open enrolment". You choose a plan, add your partner or kids if you want, and your share of the premium comes out of each pay before tax.

Here are the terms you'll see on every plan summary:

Term	What it means	The Australian equivalent, roughly
Premium	What you pay each pay period to be insured	Your private health premium
Deductible	What you pay each year before the plan starts paying for most care	A bit like an excess, but per year
Copay	A flat fee per visit or prescription	A gap payment
Coinsurance	Your percentage of the bill after the deductible	No real equivalent
Out-of-pocket maximum	The most you pay in a year for covered, in-network care	Medicare Safety Net, loosely
Network	The doctors and hospitals that have a deal with your insurer	Your fund's "member choice" providers

Plan types in plain English

HMO. Cheaper premiums. You pick a primary care doctor, need referrals for specialists, and usually get nothing outside the network except emergencies.
PPO. Higher premiums, more freedom. You can see specialists without a referral and get some cover out of network.
High-deductible plan with an HSA. Low premiums and a high deductible. You can put pre-tax money into a health savings account to pay for care. Good if you're young and healthy, painful if you're not.
EPO. A middle ground: no referrals, but in-network only.

Choosing well

Check the network first. Search the insurer's directory for the hospital and doctors near you. In Manhattan, it's worth confirming the big hospital systems you'd actually use are in network.
Add up the worst case. Annual premiums plus the out-of-pocket maximum is your real exposure in a bad year.
Look at the deductible. A low premium with a high deductible can mean paying full price for every visit until well into the year.
Check prescriptions. If you take regular medication, look it up in the plan's drug list, called a formulary.
Think about a baby. If you're planning one, the plan with the lower out-of-pocket maximum often wins. See our guide to having a baby in New York.
Ask about dental and vision. They're usually separate plans with their own premiums.

If you leave or lose your job, you can usually enrol in a marketplace plan through a special enrolment period. Don't let it lapse. A gap of even a few weeks is a real financial risk in New York.

NY State of Health and the Essential Plan

NY State of Health is New York's official marketplace. It's where you buy a private "Qualified Health Plan" if you don't have job-based cover, and where you apply for the state's low-cost programmes.

The Essential Plan

The Essential Plan is New York's free plan for people on lower incomes who don't get Medicaid. To qualify, you must live in New York, be lawfully present in the US, be aged 19 to 64, not be eligible for Medicaid or Child Health Plus, and not have access to employer or other cover [2]. Enrolment is continuous, so you can sign up at any time of year [2].

The income limits for 2026 are [2]:

Household size	Maximum annual income, 2026
1	US$31,920
2	US$43,280
3	US$54,640
4	US$66,000

The premium is US$0, with small copays at the top of that range. For example, a primary care visit costs US$15 for a single person earning between US$23,941 and US$31,920 [2].

What changed in 2026

New York expanded the Essential Plan in 2024 to people earning between 200% and 250% of the federal poverty line. Federal law H.R. 1 then removed premium tax credit eligibility for most lawfully present immigrants, which undermined the funding for that expansion [4]. In March 2026 the federal government approved New York's request to return the Essential Plan to its older Basic Health Program model [3][4].

The result: about 1.3 million people below 200% of the poverty line keep the Essential Plan, while roughly 450,000 people above it lost eligibility on 1 July 2026 and were moved towards marketplace plans with premiums and deductibles [3][4]. The state also noted that, without the enhanced federal tax credits that expired at the end of 2025, marketplace costs are nearly 40% higher [4].

What it means for Australians on visas

Most Australians in New York on an E-3 or similar visa earn well above the Essential Plan limits, so it won't be your main option. The marketplace still matters if you're between jobs, self-employed on a visa that allows it, or a partner who isn't on your employer's plan.

The bigger change is coming. From 2027, federal premium tax credits are limited to green card holders, certain Cuban and Haitian entrants, and people under the Compacts of Free Association [5]. Temporary visa holders aren't on that list, so from 2027 an E-3 holder buying a marketplace plan should expect to pay the full premium with no subsidy [5]. You can still buy the plan. It just costs more.

If your situation is borderline, call NY State of Health on 1-855-355-5777 or use its free local help search before you assume either way [3].

Urgent care, the ER and the bill that follows

Where you go matters as much as having insurance.

Where	Use it for	Cost, in general
Your primary care doctor	Check-ups, referrals, ongoing issues	Lowest, often just a copay
Telehealth through your plan	Colds, rashes, prescription renewals	Low, often a small copay
Urgent care clinic	Sprains, stitches, infections, fevers, after hours	Moderate, a fraction of the ER
Emergency room	Chest pain, serious injury, trouble breathing, anything life-threatening	Highest by far, before the deductible

New York has walk-in urgent care clinics in most neighbourhoods, often open into the evening and on weekends. Check they take your insurance before you walk in. In a real emergency, call 911 and go to the nearest ER, whatever your network. Emergency care is treated as in-network by most plans, but the follow-up bills can still be large.

A few habits that save money:

Always ask "are you in network?" for every doctor, lab and scan, not just the clinic.
Read the Explanation of Benefits your insurer sends before paying any bill. Billing errors are common.
Don't pay on the spot if you can avoid it. Let the claim go through insurance first.
Ask for an itemised bill and query anything that looks wrong. Hospitals often negotiate, especially if you pay promptly.

Your first-month checklist

Buy travel medical insurance that covers you from landing until your US plan starts [1].
Pick your employer plan during onboarding. You usually have only about a month to decide, and you can't switch until the next open enrolment.
Download the insurer's app and save your member card. Clinics ask for it before anything else.
Choose a primary care doctor in network, even if you're well. New patient appointments can take weeks.
Find your nearest in-network urgent care before you need it.
Decide what to do with your Australian cover. Suspend or cancel your private health fund, and tell Medicare if you're leaving for good.

Want to know which plan other Aussies picked, or which urgent care in Brooklyn took their insurance without fuss? Join Cooee USA, our Facebook group for Australians in the USA, and ask. Members compare notes on deductibles all the time.

Health insurance in New York: employer plans, the Essential Plan and no Medicare