Voltage programmable anti-fuse structures and methods are provided that include at least one conductive material island atop a dielectric surface that is located between two adjacent conductive features. In one embodiment, the anti-fuse structure includes a dielectric material having at least two adjacent conductive features embedded therein. At least one conductive material island is located on an upper surface of the dielectric material that is located between the at least two adjacent conductive features. A dielectric capping layer is located on exposed surfaces of the dielectric material, the at least one conductive material island and the at least two adjacent conductive features. When the anti-fuse structure is in a programmed state, a dielectric breakdown path is present in the dielectric material that is located beneath the at least one conductive material island which conducts electrical current to electrically couple the two adjacent conductive features.