Essential Plan

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All the Essential Benefits for Less

The Essential Plan was created especially for people who make too much to qualify for Medicaid, but who may not make enough to afford a qualified exchange plan. It’s available through NY State of Health (NYSOH) for those who don’t have affordable insurance through their employer. Our 2020-21 Essential Plan was rated #1 in New York State for quality and satisfaction.

Eligibility is based on your income and the size of your household. For more information, call 1-888-679-7105 (TTY 711) or visit the NYSOH website.

What's Included?

• 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
• ExerciseRewards^™- earn up to $400 a year for working out
• Easy access to care 24/7 with our telemedicine program powered by MDLIVE^®

• Learn More About Essential Plan
• Estimate Treatment Costs with FAIR Health

Important Benefit Information:

Essential Plan 1

Refer to the Essential Plan 1 information below if you are single, over age 19, and have an income between $20,386 and $27,180.

• Summary of Benefits & CoverageOpen a PDF
• Member ContractOpen a PDF
• Summary of Benefits & Coverage for American Indian/Native AlaskanOpen a PDF
• Member Contract for American Indian/Native AlaskanOpen a PDF

Essential Plan 2

Refer to the Essential Plan 2 information below if you are single, over age 19, and have an income between $18,755 and $20,385.

• Summary of Benefits & CoverageOpen a PDF
• Member ContractOpen a PDF
• Summary of Benefits & Coverage for American Indian/Native AlaskanOpen a PDF
• Member Contract for American Indian/Native AlaskanOpen a PDF

Essential Plan 3

Refer to the Essential Plan 3 information below if you are single, over age 21, do not qualify for Medicaid based on immigration status*, and have an income between $13,590 and $18,754.

• Summary of Benefits & CoverageOpen a PDF
• Member ContractOpen a PDF

Essential Plan 4

Refer to the Essential Plan 4 information below if you are single, over age 21, do not qualify for Medicaid based on immigration status*, and have an income less than $13,589.

• Summary of Benefits & CoverageOpen a PDF
• 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 website or call the NY State of Health at 1-855-355-5777.