Essential Plan

All the essential benefits for less

Benefit highlights

A plan for adults who make too much for Medicaid, but not enough to afford a Qualified Health Plan.

$0 monthly premium
Coverage accepted by a large network of doctors and hospitals in your area
Free preventive care, including check-ups, flu shots, vaccines, screenings, and more
Vitalize^SM - Our health and wellbeing benefit, in partnership with Personify Health
Easy access to care 24/7 with our telemedicine program powered by MDLIVE^®

Learn more about what's included in the Essential Plan

Eligibility

All Essential Plan levels have the same benefits and features. Eligibility for each level is based on income, household size, and other criteria.

Household Size	Essential Plan 200-250	Essential Plan 1	Essential Plan 2	Essential Plan 3*	Essential Plan 4*
1	$31,301 - $39,125	$23,476 - $31,300	$21,598 - $23,475	$15,650 - $21,597	$0 - $15,649
2	$42,301 - $52,875	$31,726 - $42,300	$29,188 - $31,725	$21,150 - $29,187	$0 - $21,149
3	$53,301 - $66,625	$39,976 - $53,300	$36,778 - $39,975	$26,650 - $36,777	$0 - $26,649
4	$64,301 - $80,375	$48,226 - $64,300	$44,368 - $48,225	$32,150 - $44,367	$0 - $32,149
5	$75,301 - $94,125	$56,476 - $75,300	$51,958 - $56,475	$37,650 - $51,957	$0 - $37,649
6	$86,301 - $107,875	$64,726 - $86,300	$59,548 - $64,725	$43,150 - $59,547	$0 - $43,149

For more information, visit the NYSOH website to see the income range eligibility for each household size and plan level.

Have questions or ready to enroll?

Enroll online

Go to NY State of Health to begin
your application

Enroll

Call us

Call: 1-800-679-7166
TTY: 711

Monday - Thursday: 8 a.m. to 7 p.m.
Friday: 9 a.m. to 7 p.m.

Plan documents and member contracts

The following documents contain important information about each Essential Plan level. The Summary of Benefits and Coverage (SBC) document outlines how you and the plan share costs for covered services. The Member Contract is a legal document that has complete information about the benefits and services included in that plan.

Essential Plan 200-250

Essential Plan 1

Essential Plan 2

Essential Plan
3*

Essential Plan
4*

Summary of Benefits and Coverage (SBC)

EP 200-250 SBCOpen a PDF

EP 200-250 SBC for American Indian/Native AlaskanOpen a PDF

EP 1 SBCOpen a PDF

EP 1 SBC for American Indian/Native AlaskanOpen a PDF

EP 2 SBCOpen a PDF

EP 2 SBC for American Indian/Native AlaskanOpen a PDF

EP 3 SBCOpen a PDF

EP 4 SBCOpen a PDF

Member Contract

EP 200-250 Member ContractOpen a PDF

EP 200-250 Member Contract for American Indian/Native AlaskanOpen a PDF

EP 1 Member ContractOpen a PDF

EP 1 Member Contract for American Indian/Native AlaskanOpen a PDF

EP 2 Member ContractOpen a PDF

EP 2 Member Contract for American Indian/Native AlaskanOpen a PDF

EP 3 Member ContractOpen a PDF

EP 4 Member ContractOpen a PDF

* Must be a lawfully present immigrant. The term “lawfully present” includes immigrants who have "qualified non-citizen” immigration status without a waiting period; humanitarian statuses or circumstances (including Temporary Protected Status, Special Juvenile Status, asylum applicants, Convention Against Torture, victims of trafficking); valid non-immigration visas; and legal status conferred by other laws (temporary resident status, LIFE Act, Family Unity individuals). To see a full list of eligible immigration statuses, please visit the HealthCare.gov websiteOpens a New Tab or call NY State of Health at 1-855-355-5777 .