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.
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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.
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Monthly Premium: Dental / Vision Coverage Included
||January 2017 - December 2017
||January 2018 - December 2018
|Essential Plan 1
|Essential Plan 2
Effective January 2018
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.
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Preventive Care Benefits
|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
||Cervical Cancer screening
|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
|Sexually Transmitted Infection (STI) prevention counseling
||Hepatitis B screening (for pregnant women at their first prenatal visit)
||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
||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)
* Covered Immunization Vaccines
- Hepatitis A
- Hepatitis B
- Human Papillomavirus
- Influenza (Flu Shot)
- Measles, Mumps, Rubella
- Meningococcal Pneumococcal
- Tetanus, Diphtheria, Pertussis
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Certificate of Coverage
To learn more about the drugs covered by our Essential Plans, please visit the MetroPlus Formulary Page
All MetroPlus Essential Plan members have access to a mail order option for their medications. Access the mail order form here: https://www.caremark.com/portal/asset/mof_unauth.pdf
To search our provider network for our Essential Plans, please visit the MetroPlus Provider Directory Page.
How Do I Enroll?
Enrollment for the Essential Plan is open all year long. If you live the Bronx, Brooklyn, Manhattan, Queens or Staten Island area, we can help. MetroPlus has Marketplace Facilitated Enrollers who can help you complete your application on the NY State of Health Marketplace.
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.