Before you start

New York residence
Income information for Medicaid, Essential Plan or subsidy eligibility
An SSN or ITIN for marketplace applications
A qualifying life event, if enrolling outside the annual window

Step-by-step

1
Apply through NY State of Health rather than HealthCare.gov
New York runs a state-based exchange. One application on it screens you for Medicaid, Child Health Plus, the Essential Plan and a subsidised qualified health plan at the same time, so you do not need to guess which programme you belong in. The state sets its own enrolment calendar; check its published dates rather than a national article's.
OnlineWho: YouWeek 1–2
2
Check the Essential Plan before assuming you must buy a marketplace plan
New York's Essential Plan is a Basic Health Program covering people whose income is above the Medicaid line but still modest, with no monthly premium and low out-of-pocket costs. Most states have nothing in this band at all — you go straight from Medicaid to a subsidised commercial plan. It is the single most-missed option for a newcomer on a part-year or entry-level income.
OnlineWho: You
3
Enrol in your employer's plan inside the new-hire window
Typically 30 days from your start date. Compare deductibles and out-of-pocket maximums rather than premiums, and check whether both of the region's hospital systems are in network — Kaleida Health and Catholic Health between them run most of the beds in Erie County, and Roswell Park is a separate contracting question again.
Via employerWho: YouFirst 30 days of employment
4
Know where Roswell Park sits in your network
Roswell Park Comprehensive Cancer Center, founded in 1898 as the first institution in the United States devoted to cancer research, is a National Cancer Institute-designated centre on the downtown medical campus. For a metro this size that is a remarkable asset — but it is a specialist centre with its own contracts, so check that a plan includes it rather than assuming a broad network does.
OnlineWho: You
5
Register with a primary care physician while you are well
Your PCP gates specialist access on most plans. Confirm network status with the practice itself rather than the insurer's directory, which is frequently out of date, and expect a wait for a first appointment. A federally qualified health centre is the fallback if practices are closed to new patients.
OnlineWho: You
6
Take the winter seriously as a health matter, not just a weather one
Cold and snow here produce a predictable set of injuries: falls on ice, cardiac events while shovelling heavy wet snow, and carbon monoxide poisoning when a snow-blocked exhaust vent backs fumes into a house. Clear the vents after a storm, fit a carbon monoxide alarm, buy boots with real grip, and do not shovel a whole driveway of wet snow in one go if you are not used to it.
In personWho: You

Documents you’ll need

Proof of New York residence
Income documentation for Medicaid, the Essential Plan or marketplace subsidies
SSN or ITIN
Immigration documents for Medicaid and marketplace eligibility categories
Evidence of losing prior coverage, if using a special enrolment period

Things most newcomers don’t know

New York has a coverage tier between Medicaid and the marketplace that most states do not.

The Essential Plan is a Basic Health Program — an option in the Affordable Care Act that only a couple of states ever took up. It covers households above the Medicaid income line with no monthly premium and low cost sharing, exactly the band where someone in most states would be buying a subsidised commercial plan with a four-figure deductible. Newcomers on part-year or entry-level incomes routinely buy a plan they did not need because nothing in the national explainers mentions it.

Source: NY State of Health

The state runs its own marketplace, with its own calendar and one combined application.

NY State of Health is not a HealthCare.gov storefront. One application screens for Medicaid, Child Health Plus, the Essential Plan and subsidised commercial coverage simultaneously, and the enrolment window is the state's rather than the federal one. Applying federal dates in New York is a documented way to lose a year of coverage.

Source: NY State of Health

Buffalo has an NCI-designated cancer centre, which almost no metro this size does.

Roswell Park was founded in 1898 as the first institution in the United States dedicated to cancer research and is one of the original National Cancer Institute-designated comprehensive cancer centres. For a household weighing a move to a smaller city, this is the kind of specialist capacity that usually requires a metro three times the size — but confirm it is in your plan's network, because specialist centres contract separately.

Source: Roswell Park Comprehensive Cancer Center

The deductible is what actually shocks people from national health systems.

US plans commonly require you to pay the first several thousand dollars of care each year before the insurer contributes. Someone arriving from the UK, Canada or India reads 'I have insurance' as 'I am covered', then receives a four-figure bill for a scan. Read the deductible and the annual out-of-pocket maximum before the premium — that is where plans genuinely differ. Note that Ontario's system, half an hour away, does not cover you at all.

Source: community-reported

Common mistakes to avoid

Applying HealthCare.gov's enrolment dates in New York. The state runs its own exchange.
Buying a marketplace plan without checking Essential Plan and Medicaid eligibility first.
Assuming a broad network includes Roswell Park — check specifically.
Shovelling heavy wet snow without acclimatising, and blocking an exhaust vent while doing it.
Choosing a plan on premium alone and meeting a five-figure out-of-pocket maximum.

Some of this may be out of date. Spotted something inaccurate? Help us keep it right for the next newcomer.