Individuals and Sole Proprietors

Sole Proprietor Eligibility

Reduced-cost health insurance is available under the Healthy NY program to eligible sole proprietors.

Healthy NY defines a sole proprietor as the only employee and only owner of the business. The structure of the business does not matter. For example, the business could be a corporation, LLC or d/b/a.

In order to participate, you must meet all five of the following criteria:

1. You must reside in New York State and must 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 part-time may apply if they claim New York State residency but should keep in mind that Healthy NY has limited out-of-state benefits.

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

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

   You must be able to document that you are working as a sole proprietor or have worked at some point in the past 12 months.

3. If you have another job, your employer must not currently provide you with health insurance.

   If, in addition to your sole proprietorship, you work for an employer that provides comprehensive (medical and hospital) health insurance and contributes 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 you might still qualify. If your employer offers coverage to some employees but you are not eligible, then you may still be eligible for Healthy NY.

4. You must not have had health insurance for 12 months prior to applying for Healthy NY or must have lost coverage due to a specific event.

   Specific events include the following:

   • Losing employment, changing to a new employer, leaving the workforce or retiring
   • Death of a family member
   • Changing residence
   • Discontinuing a group health plan
   • Aging off a parent’s insurance policy
   • Canceling or exhausting COBRA coverage (if you are eligible for COBRA coverage or have COBRA coverage, you can still apply for Healthy NY as long as you or your spouse have worked at some time in the last 12 months)
   • Legal separation, divorce or annulment
   • Losing eligibility for group health insurance
   • Reaching the maximum age for dependent coverage
   • Terminating coverage in a public health program, including Family Health Plus, Child Health Plus, or Medicaid
5. Your current monthly gross household income (before taxes) must meet the following income guidelines:

   Healthy NY Income Guidelines *

   Family Size	Monthly Household Income
   1	Up to $2,394
   2	Up to $3,232
   3	Up to $4,070
   4	Up to $4,908
   5	Up to $5,746
   6	Up to $6,584
   Each Additional Person	Add $838

   * Adjusted annually.

   Income guidelines are based on your current income, which is your income over the past four to six weeks. Sole proprietors may deduct documented business expenses from income. For purposes of counting your household size, count yourself, your spouse if your spouse lives with you, and dependent children, whether they live with you or not. Count all of these people, even if you are not going to include them on your Healthy NY policy. Do not count parents, roommates or those not dependent on you for support. Pregnant women count as two people.

   Mid-year fluctuations in household income and employment status will not result in termination of your Healthy NY coverage.