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 sits above the Medicaid line but is 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. In lower Westchester, check which of the big systems the plan actually contracts with — Montefiore, WMCHealth and NewYork-Presbyterian all reach into this county and a plan can be broad in one and narrow in another.
Via employerWho: YouFirst 30 days of employment
4
Work out where you would actually go in an emergency
Yonkers has St. John's Riverside, Montefiore St. Vincent's and St. Joseph's inside the city. Westchester Medical Center in Valhalla is the regional academic trauma, burn and transplant centre for the whole Hudson Valley, and the Bronx's major hospitals are minutes over the city line. That is unusually good depth for a mid-sized city — but check which of them your plan is in network for before you need one.
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 Confirm network status with the practice itself rather than the insurer's directory, which is frequently out of date, and expect a wait for a first appointment across lower Westchester. A federally qualified health centre is the fallback if practices are closed to new patients.
OnlineWho: You
6
Get a lead test for a young child in older housing
Yonkers's rental stock is overwhelmingly pre-1978 and much of it is pre-1940. Federal law requires lead paint disclosure for pre-1978 housing, and New York requires blood lead testing for children at ages one and two. If you have a child under six moving into an old building, ask what remediation has been done and get the answer in writing, then get the test done on schedule rather than at the next well visit.
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 Kansas or Wisconsin 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.

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

Yonkers is unusually well covered for hospitals, and the reason is geography rather than size.

Three hospitals sit inside the city, WMCHealth's academic trauma and transplant centre is twenty minutes north in Valhalla, and the Bronx's teaching hospitals are over the boundary. A city of 211,000 does not normally have that. The corollary is that networks here are complicated — Montefiore, WMCHealth and NewYork-Presbyterian all compete across this county, and a plan that looks broad can exclude the hospital nearest you.

Source: Westchester County Department of Health

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.

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 the hospital nearest you — Westchester's systems compete and contract separately.
Moving a young child into pre-1978 Yonkers housing without asking about lead, or skipping the age-one and age-two blood tests.
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.