Essential Plan Information

Jump to: Important Changes in April 2024

Overview

Many New Yorkers think they can't get health insurance because it costs too much, but NY State of Health's Essential Plan includes comprehensive benefits with $0 monthly premiums and very low cost sharing, if you qualify.

  • It has no deductible, so the plan starts paying for your health care right away.
  • It covers comprehensive benefits, including dental and vision, inpatient and outpatient hospital care, prescription drugs and more.
  • It also covers free preventive care like routine doctor exams and screenings to keep you healthy.
  • You can enroll in the Essential Plan at any time during the year through NY State of Health.  Instructions on how to enroll are available here.

Learn more about the Essential Plan:

  • Read the Essential Plan At a Glance card or Fact Sheet to learn about eligibility factors, benefits, cost sharing, and out-of-pocket costs.
  • Use the Plans by County Tool to learn what health plans are available in your county for the Essential Plan.
  • Use the NYS Provider & Health Plan Look-Up tool when you are deciding which health plan to enroll in or when you are looking for a provider, for example a hospital or doctor, that works with your plan.

 

Do you or a family member already have health insurance through the Essential Plan? 

Annual renewals for Medicaid, Child Health Plus and the Essential Plan have restarted in New York.  You may need to take action to keep your health insurance or the insurance of your family members.  Learn more about Essential Plan renewals.

 

New for 2024! More New Yorkers Will Be Able to Enroll in the Essential Plan

Eligibility rules have changed and more New Yorkers are now eligible for the Essential Plan!  This change starts in April 2024.  

If you enrolled in a Qualified Health Plan for 2024 and are now eligible for the Essential Plan, you may have questions about how this change will affect you.

Do I need to do anything to start my Essential Plan $0 coverage? 

If you’re currently in a Qualified Health Plan you don’t have to take any action to move to the Essential Plan, unless you want to change health insurers.

If the Essential Plan is offered by the health plan that offers your current Qualified Health Plan:

  • NY State of Health will move you to the Essential Plan automatically.  You will receive an email about this change.

  • Look for a notice from your health plan.  It will have your new Essential Plan ID card.  It will also have information about your benefits and available providers.

If the Essential Plan is not offered in your county by the health plan that offers your current Qualified Health Plan: 

  • You will need to choose a new health plan.  You will receive an email about this change.  If you do not choose a new plan, one will be chosen for you. 

  • To choose a new health plan, log into your nystateofhealth.ny.gov account, call the Customer Service Center at 1-855-355-5777, or contact a certified enrollment assistor

  • After you are enrolled in a new health plan, they will send you a notice.  It will have your new Essential Plan ID card.  It will also have information about your benefits and available providers.

You have the option to change your health plan.  For more information about changing health plans, please contact our Customer Service Center at 1-855-355-5777 or a certified enrollment assistor.

Will I be able to keep my same doctors and other health care providers?

Most health care providers who accept your Qualified Health Plan will likely accept the same insurer’s Essential Plan. 

  • To make sure, call your health care provider to confirm they accept your new Essential Plan health insurance.
  • You can also use the NYS Provider & Health Plan Look-Up tool to find Essential Plan options that work with your current health care providers. 

You have the option to change your health plan.  For more information about changing health plans, please contact our Customer Service Center at 1-855-355-5777 or a certified enrollment assistor.

Will the cost-sharing payments I have already made for 2024 apply to my new Essential Plan health insurance?

Yes.  This means that any out-of-pocket costs you paid, including copayments, coinsurance, and deductible, for your 2024 Qualified Health Plan will apply to your Essential Plan maximum out-of-pocket limit. 

Can I keep my Qualified Health Plan instead of changing to the Essential Plan? 

Yes.  You have the choice to keep your Qualified Health Plan.  However, your premium tax credit will no longer apply.  You will be responsible for the full premium cost without financial assistance.

I have other questions.  How can I find answers? 

NY State of Health wants to make this change as easy as possible for you.  We are here to help.  If you have questions, you can:

  • Contact a certified enrollment assistor.
  • Call the NY State of Health Customer Service Center at 1-855-355-5777.  Customer Service Center representatives are available Monday through Friday from 8:00am to 8:00pm and on Saturday from 9:00am to 1:00pm.

Read more details about this change.

   

essential health plan