Essential Plan

Essential Plans

The Essential Plan provides all of the covered benefits offered on the NY State of Health, The Official Health Plan Marketplace. A new health plan for New Yorkers, it costs much less than other health plans. And it offers the same essential benefits.
 

Learn if you qualify

Our cost treatment calculator is intended for individuals who are uninsured or covered by private insurance. Cost estimates reflect health care professional fees and are not the negotiated rates which may be available through insurance plan networks. 

Calculate Costs 

Get The Details

The Essential Plan is a new plan for New Yorkers. It cost less than other plans, and offers the same essential benefits!

Who is Eligible?

Eligibility is dependent on income and to those who don’t qualify for Medicaid or Child Health Plus.

← scroll →

 
Household Max Income
1 $23,540
2 $31,860
3 $40,180
4 $48,500

How Much Does It Cost?

Depending on your income, either $20 a month per person — less than a dollar a day — or nothing. Yes, that’s $0 a month.

← scroll →

Monthly Premium: Dental / Vision Coverage Included
  January 2016 - December 2016 January 2017 - December 2017 Rate Increase
Essential Plan 1 $46.56 $47.60 $1.04
Essential Plan 2 $30.77 $31.91 $1.20
 

Effective January 2017

 

How else does it save me money?

It has no deductible, so the plan starts paying for your health care right away. You get free preventive care like routine doctor exams and screenings to keep you healthy.

What does the Essential Plan cover?

Covered Health Benefits:
  • Outpatient care — the kind you get without being admitted to a hospital
  • Trips to the emergency room
  • Treatment in the hospital for inpatient care
  • Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy
  • Your prescription drugs
  • Services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.
  • Your lab tests
  • Preventive services including counseling, screenings, and vaccines to keep you healthy and care for managing a chronic disease.
 

← scroll →

Preventive Care Benefits
For Adults For Women
Abdominal Aortic Aneurysm one-time screening (for men of specified age who have smoked) Anemia screening (routine basis for pregnant women)
Alcohol Misuse screening and counseling Breast Cancer Genetic Test Counseling (BRCA)
Aspirin use (to prevent cardiovascular disease for men/women of certain ages) Breast Cancer Mammography screenings (every 1 to 2 yrs for women over 40)
Blood Pressure screening Breast Cancer Chemoprevention counseling (for women at higher risk)
Cholesterol screening (for adults of certain ages or at higher risk) Breastfeeding comprehensive support and counseling
Depression screening Cervical Cancer screening
Diabetes screening Contraception
Diet counseling (for adults at higher risk for chronic disease) Domestic and interpersonal violence screening and counseling
HIV screening (ages 15-65, and other ages at increased risk) Folic Acid (supplements for women who may become pregnant)
* Immunization vaccines Gestational diabetes screening (for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes)
Obesity screening and counseling Gonorrhea screening
Sexually Transmitted Infection (STI) prevention counseling Hepatitis B screening (for pregnant women at their first prenatal visit)
Syphilis screening HIV screening and counseling
Tobacco use screening (for all adults and cessation interventions for tobacco users) Human Papillomavirus (HPV) DNA Test (every 3 years for women with normal cytology results who are 30 or older)
  Osteoporosis screening (for women over age 60 depending on risk factors)
  Rh Incompatibility screening (for all pregnant women and follow-up testing for women at higher risk)
  Sexually Transmitted Infection (STI) prevention counseling
  Syphilis screening
  Tobacco use screening (for all adults and cessation interventions for tobacco users)
  Urinary tract or other infection screening (for pregnant women)
  Well-woman visits (to get recommended services for women under 65)

For more information about the above mentioned preventive care benefits go to healthfinder.gov.

* Covered Immunization Vaccines

  • Hepatitis A
  • Hepatitis B
  • Herpes
  • Zoster
  • Human Papillomavirus
  • Influenza (Flu Shot)
  • Measles, Mumps, Rubella
  • Meningococcal Pneumococcal
  • Tetanus, Diphtheria, Pertussis
  • Varicella

*For more information about the above mentioned immunizations go to vaccines.gov.

← scroll →

Certificate of Coverage
  English EspaƱol
Essential Plan 1 Standard Download Download
Essential Plan 1 Non-Standard Download Download
Essential Plan 1 American Indian Standard Download Download
Essential Plan 1 American Indian Non-Standard Download Download
     
Essential Plan 2 Standard Download Download
Essential Plan 2 Non-Standard Download Download
Essential Plan 2 American Indian Standard Download Download
Essential Plan 2 American Indian Non-Standard Download Download
     
Essential Plan 3 Download Download
     
Essential Plan 4 Download Download

MetroPlus Health Plan Formulary Page 


How Do I Enroll?

The Essential Plan has a year-round open enrollment period. On November 1, 2016, open enrollment will be open to anyone looking for a health plan. Starting on November 1, anyone that is not currently enrolled in any plan will have an opportunity to browse and select a plan. All enrollment will go through the NY State of Health Marketplace.

Enrollment in November will begin coverage in January 2017.

There are three ways you can enroll:

Choose us Online:
NY State of Health, The Official Health Plan Marketplace – or Exchange – lets you compare plans and look at premium rates on their website. Visit https://nystateofhealth.ny.gov/ and check us out at http://www.metroplus.org

Call us by Phone:
Member Services at 1.855.809.4073, TTY users: 711
Monday through Saturday, 8 am – 8 pm.

We’ll see if you qualify and help you enroll in the health plan that’s right for you.

Visit us in Person:
Marketplace Facilitated Enrollers (FEs), Navigators, brokers and agents are available to help you enroll in the Marketplace. Call us at 1.855.809.4073, TTY users: 711,
Monday through Saturday, 8 am – 8 pm to make an appointment.