Essential Plan Income Guidelines 2018 Minimal Amount Family of Four
New York Essential Plan. The #1 virtually affordable wellness program in NY
Call Now to Come across if Y'all May Qualify for the New York Essential Programme (888)215-4045
Updated for 2022: All New York Country Essential Plans volition now include Dental and Vision Coverage at no boosted price. Additionally, the monthly premium of 20 dollars for Essential Plan ane has been removed. All four essential plans volition now have a null premium.
The Essential Plan is a New York health insurance program for state residents that don't qualify for Medicaid or the Child Wellness Plus Program. At that place are a total of 4 Essential Programme options and each selection is based on your household income level.
New York Land (NYS) created this programme to fill the coverage gap that many individuals and families have every bit they do non authorize for Medicaid but cannot afford total premium coverage.
TABLE OF CONTENTS
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How to Enroll in the Essential Plan
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What does the Essential Plan Cost
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Are You Eligible for the Essential Plan?
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Essential Plan Residency Requirements
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Crumbling In & Crumbling Out of the Essential Programme
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What Is Covered Under an Essential Programme?
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Essential Plan 1 and 2
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Essential Plan 3 and 4
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Essential Plan Plus
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Dental Benefits
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Essential Plan Vision Care Benefits
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Insurers offering Essential Program
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Insurers Offering Essential Plan Vs. Essential Plan Plus (Vision and Dental Included)
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2022 Essential Plan Insurers and the Counties they Operate In
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Choosing the Right Essential Plan for You and Your Family
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Carrier Summary of Benefits and Formulary Listing
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Essential Plan Eligible Enrollment Dates
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Frequently Asked Essential Plan Questions
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2022 Essential Plan Updates
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Closing
How to Enroll in the Essential Plan
Before Enrolling in an Essential program, y'all may want to review the eligibility requirements, however your options to enroll include the post-obit:
- Contact us at our toll-costless number (888)215-4045 and we will first help you decide if y'all are eligible. Once we determine your eligibility, we then compare all of the bachelor Health insurance companies offering the essential plan in your region. Our comparison will ensure that your current doctor is function of the network also as compare network size to determine if the hospitals and labs of your choice are included in the network
- You have the choice to visit each carrier to review their plans however yous won't be able to compare plans side by side
- The New York Country of Health is another enrollment option. Y'all tin get direct or we tin enroll yous in the program of your choice
What does the Essential Program Cost?
Starting in 2021 all Essential plans have removed their monthly premium requirements and are now free! There are a total of 4 Essential plan options, each based on your current income. At that place are no family plans with the essential program, only individual coverage. Children are not eligible for the Essential Plan, however, if the parent(s) authorize for the Essential then the children are most likely eligible for Kid Health Plus (we provide enrollment services for Child Health Plus)
Are You Eligible for the Essential Plan?
At that place are three qualifying elements for you lot to be eligible for the NY Essential Plan. They are:
- Income requirements
- Residency and Immigration Status
- Crumbling In and Crumbling Out
Income limits are related to your family size. The following chart explains how your income and family size is structured.
| Household Size | Maximum Annual Income |
|---|---|
| i* | $24,280 |
| ii | $32,920 |
| iii | $41,560 |
| 4** | $50,200 |
* (150% to 200% FPL)
** Add $8,640 for each additional member of your family
Essential Programme Residency Requirements
Low and moderate-income families that are residents of New York State and legal immigrants are eligible for the Essential Program program.
All 4 Essential Plans don't take a monthly premium, yet program benefits are generous and provide yous the ten essential health benefits mandated by the Affordable Intendance Act. Following are the different variations of the NYS Essential Plan:
Essential Programme 1 - Individuals with income greater than 150% and less than or equal to 200% of the FPL.
Essential Plan 2 - Individuals with income greater than 138% and less than or equal to 150% of the FPL.
Essential Plan 3 - Individuals with income equal to or greater than 100% and less than or equal to 138% of the FPL and not eligible for Medicaid due to immigration status.
Essential Program 4 - Individuals with income below 100% of the FPL and not eligible for Medicaid due to immigration status.
Crumbling In & Aging Out of the Essential Plan
If you are an adult that is between 19 and 65 years of age and so you lot tin participate in the program. Children under age 19 may qualify for Child Health Plus and those past age 65 are usually covered past Medicare.
What Is Covered Under an Essential Program?
Under the Affordable Intendance Act, a certain level of minimum coverage is guaranteed to all insured people. The NY Land of Health Essential Plan also features the same 10 health essentials. These are:
- Ambulatory patient services (outpatient care).
- Emergency Services (given in an emergency room or urgent intendance facility).
- Hospitalization (when y'all stay in the hospital for more than 24 hours, fewer hours are covered nether ambulatory services).
- Maternity and newborn care.
- Mental wellness service and drug or alcohol habit handling (treated as any other medical illness).
- Prescription drugs.
- Rehabilitative services and devices (e.yard. Physical therapy is ane of the services and a caryatid is an example of a device).
- Laboratory services include x-rays, Cat scans, ultrasounds, and such.
- Preventative services
- Pediatric services (not applicative to New York State Essential Plan equally kids under 19 are covered by Child Health Plus).
Essential Plan 1 and Essential Program two
To qualify for either plan i or 2 your household income must exist between 138% and 200% of the federal poverty level, exist a United States citizen living in New York State, and not enrolled in Medicare or Medicaid or be under the age of 19 or older than 65.
| Benefits | Essential Plan 1 Costs & Co-pays | Essential Program 2 Costs & Co-pays |
|---|---|---|
| Individual Deductible | $0 (Med/Rx combined) | $0 (Med/Rx combined) |
| Individual Maximum Out-of-Pocket | $2,000 (Med/Rx combined) | $200 (Med/Rx combined) |
| Inpatient Hospital Care | $150 | $0 |
| Emergency Care | $75 | $0 |
| Urgent Intendance | $25 | $0 |
| Outpatient Hospital Services | $50 | $0 |
| X-rays and Labs | PCP: $15 SPC: $25 OP Facility: $50 | $0 |
| Advanced Imaging | $25 | $0 |
| PCP Role Visits | $fifteen | $0 |
| Specialist Office Visits | $25 | $0 |
| Adult Dental | $15 | $15 |
| Developed Vision | $15 | $15 |
| Non-Prescription Drugs | Not Covered | Not Covered |
| Not-Emergency Transportation | Not Covered | Non Covered |
| Generic drugs | $6 | $1 |
| Preferred Brand Drugs | $xv | $3 |
| Non-Preferred Brand and Specialty | $xxx | $3 |
Essential Plan three and Essential Programme 4
To qualify for Essential Plan 3 or Essential Program 4, you must get-go meet all of the requirements of plans ane and 2, and you must exist a legal permanent resident immigrant living in New York Land.
| Plan Proper name | Essential Plan iii Costs | Essential Plan 4 Costs |
|---|---|---|
| Private Deductible | $0 | $0 |
| Individual Maximum Out-of-pocket | $200 | $0 |
| Inpatient Hospital Care | $0 | $0 |
| Emergency Care | $0 | $0 |
| Urgent Care | $0 | $0 |
| Outpatient Hospital Services | $0 | $0 |
| X-ray/Labs | $0 | $0 |
| Avant-garde Imaging | $0 | $0 |
| PCP Office Visits | $0 | $0 |
| Specialist Function Visits | $0 | $0 |
| Adult Dental | Covered at no cost | Covered at no toll |
| Adult Vision | Covered at no cost | Covered at no cost |
| Non-prescription Drugs | Covered at no cost | Covered at no cost |
| Not-emergency transportation | Covered at no price | Covered at no toll |
| Prescription drugs | $ane | $0 |
| Preferred make drugs | $3 | $0 |
| Not-preferred make drugs and Specialty | $three | $0 |
Dental Benefits
Dental coverage is both for preventative care and routine intendance. benefits include:
- 2 Cleanings per twelvemonth
- Oral Exams including 10-rays
- Fillings
- Extractions
- Emergency care
- Orthodontics
- Dentures
- Fixed bridges
Essential Programme Vision Intendance Benefits
As well, your vision care benefits include:
- One annual middle test per yr
- Other diagnostic exams performed by an eye doc
- Lenses or contacts once a twelvemonth (more oftentimes if medically necessary
- Frame one time per year unless there is a medical need.
There is an additional toll for the Essential Plan Plus ranging from $30 to $46 per month per person.
Insurers offer Essential Plan
The followinghealth insurance companies are participating in the NY State of Health Essential Plans:
- Affinity Health Plan
- CDPHP
- EmblemHealth (Role of the HIP GHI family unit of plans)
- Excellus Blueish Cross Blue Shield
- Fidelis Care
- Healthfirst
- HealthNow Blueish Cross Blueish Shield of Western New York
- HealthPlus HP (formerly known equally Empire Blue Cross Blueish Shield Wellness Plus)
- Independent Wellness
- MetroPlus Health
- Molina Healthcare
- MVP
- United Healthcare
- Univera Healthcare
2022 Essential Plan Insurers and the Counties they Operate In
Below is a table list the Major New York Essential Plan carriers and the respective counties they operate in as of 2020. This listing is horizontally scrollable →
| County | Affinity Health Plan | BlueCross Blue Shield of Western New York | CDPHP | Keepsake Health | Empire BlueCross BlueShield HealthPlus | Excellus Blue Cross Blueish Shield | Fidelis Care | Health Start | Independent Health | MetroPlus Health | Molina Health intendance | MVP | United Health care | Univera Health care |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Albany |  | | | | ||||||||||
| Allegany | | | | | ||||||||||
| Bronx | | | | | | | | |||||||
| Broome | | | | | | |||||||||
| Cattaraugus | | | | | ||||||||||
| Cayuga | | | | |||||||||||
| Chautauqua | | | | | | |||||||||
| Chemung | | | | |||||||||||
| Chenango | | | | | ||||||||||
| Clinton | | | | |||||||||||
| Columbia | | | | | ||||||||||
| Cortland | | | | |||||||||||
| Delaware | | | | |||||||||||
| Dutchess | | | | | ||||||||||
| Erie | | | | | | | ||||||||
| Essex | | | | | ||||||||||
| Franklin | | | | | ||||||||||
| Fulton | | | | | ||||||||||
| Genesee | | | | | | | ||||||||
| Greene | | | | | ||||||||||
| Hamilton | | | ||||||||||||
| Herkimer | | | ||||||||||||
| Jefferson | | | | | ||||||||||
| Kings | | | | | | | | |||||||
| Lewis | | | | | ||||||||||
| Livingston | | | | | | |||||||||
| Madison | | | | |||||||||||
| Monroe | | | | | | |||||||||
| Montgomery | | | | |||||||||||
| Nassau | | | | | | | ||||||||
| New York | | | | | | | | |||||||
| Niagara | | | | | | |||||||||
| Oneida | | | | | ||||||||||
| Onondaga | | | | | ||||||||||
| Ontario | | | | | | |||||||||
| Orange | | | | | | | ||||||||
| Orleans | | | | | | |||||||||
| Oswego | | | | |||||||||||
| Otsego | | | ||||||||||||
| Putnam | | | ||||||||||||
| Queens | | | | | | | | |||||||
| Rensselaer | | | | | ||||||||||
| Richmond | | | | | | | | |||||||
| Rockland | | | | | | |||||||||
| Saint Lawrence | | | | |||||||||||
| Saratoga | | | | | ||||||||||
| Schenectady | | | | | ||||||||||
| Schoharie | | | ||||||||||||
| Schuyler | | | ||||||||||||
| Seneca | | | | | ||||||||||
| Steuben | | | ||||||||||||
| Suffolk | | | | | | | ||||||||
| Sullivan | | | | | ||||||||||
| Tioga | | | | | | |||||||||
| Tompkins | | | | |||||||||||
| Ulster | | | | | ||||||||||
| Warren | | | | | ||||||||||
| Washington | | | | |||||||||||
| Wayne | | | | | ||||||||||
| Westchester | | | | | | | | |||||||
| Wyoming | | | | | | |||||||||
| Yates | | | |
Choosing the Right Essential Plan for You and Your Family
Most counties in New York Country accept more than one Essential Plan health insurance company for you to cull from. Since many insurance companies have contracts with dissimilar doctors and hospitals, information technology may be that your preferred doctor and hospital are not on every plan offered. When you shop for an Essential Programme check to ensure that your md(s) and preferred hospital are part of the provider network.
Carrier Summary of Benefits and Formulary Listing
While the Essential plan only has four options that are based on income. Each carrier often includes additional benefits such as telehealth, teledoc, gym reimbursement programs, and wellness programs to create make awareness and to concenter clientele. Below is a listing of carriers that accept fabricated their plan summaries and pharmacy formulary listings available.
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Analogousness Health Plan
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EmblemHealth (Part of the HIP GHI family of plans)
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Excellus Blueish Cantankerous Bluish Shield
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Fidelis Intendance
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HealthFirst
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HealthNow Blue Cantankerous Bluish Shield of Western New York
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HealthPlus HP (formerly known every bit Empire Blue Cantankerous Blue Shield Health Plus)
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Independent Wellness
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MetroPlus Health
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MVP
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United Healthcare
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Univera Healthcare
Affinity Health Programme
- Analogousness NY Essential Plan 1
- Affinity NY Essential Program i Plus
- Affinity NY Essential Plan 2
- Affinity NY Essential Plan ii Plus
- Affinity NY Essential Plan 3
- Affinity NY Essential Plan iv
- Affinity Comparison of all 4 plans
- Analogousness Drug Formulary List
- Analogousness Over the Counter Formulary listing for plans 3 and iv
EmblemHealth (Function of the HIP GHI family unit of plans)
- EmblemHealth NYS Essential Program ane
- EmblemHealth NYS Essential Plan one Plus
- EmblemHealth NYS Essential Plan ii
- EmblemHealth NYS Essential Programme 2 Plus
- EmblemHealth NYS Essential Programme iii
- EmblemHealth NYS Essential Plan 4
- EmblemHealth NYS Drug Formulary Listing
Excellus Blue Cross Bluish Shield
- Excellus NY Essential Plan i
- Excellus NY Essential Programme 1 Plus
- Excellus NY Essential Plan ii
- Excellus NY Essential Plan 2 Plus
- Excellus NY Essential Plan 3
- Excellus NY Essential Plan 4
Fidelis Care
- Fidelis Care NYS Essential Program 1
- Fidelis Care NYS Essential Programme 1 Plus
- Fidelis Care NYS Essential Plan two
- Fidelis Care NYS Essential Plan 3
- Fidelis Intendance NYS Essential Plan four
- Fidelis Care NYS Essential Plan Side by side Comparing
- Fidelis Intendance NYS Essential Program Dental and Vision Comparison
- Fidelis Intendance NYS Drug Formulary Listing
HealthFirst
- HealthFirst NY Essential Programme 1
- HealthFirst NY Essential Programme 1 Plus
- HealthFirst NY Essential Plan 2
- HealthFirst NY Essential Plan 2 Plus
- HealthFirst NY Essential Plan 3
- HealthFirst NY Essential Plan 4
- HealthFirst NY Essential Program Drug Formulary Listing
HealthNow Blue Cross Blue Shield of Western New York
- HealthNow NYS Essential Plan 1
- HealthNow NYS Essential Plan one Plus
- HealthNow NYS Essential Plan two
- HealthNow NYS Essential Plan ii Plus
- HealthNow NYS Essential Plan 3
- HealthNow NYS Essential Program 4
- HealthNow NYS Essential Plan Drug Formulary Listing
H ealthPlus HP formerly known every bit Empire Blue Cross Blue Shield Health Plus
- HealthPlus HP NY Essential Plan 1
- HealthPlus HP NY Essential Programme 1 Plus
- HealthPlus HP NY Essential Plan two
- HealthPlus HP NY Essential Plan two Plus
- HealthPlus HP NY Essential Program 3
- HealthPlus HP NY Essential Plan 4
- HealthPlus HP NY Essential Programme Drug Formulary Listing
Contained Health
- Independent Health NY Essential Programme 1
- Independent Health NY Essential Plan 2
- Independent Health NY Essential Program 3
- Contained Health NY Essential Programme 4
- Contained Health NY Essential Plan Drug Formulary Listing
MetroPlus Health
- MetroPlus NY Essential Plan 1
- MetroPlus NY Essential Plan i Plus
- MetroPlus NY Essential Program 2
- MetroPlus NY Essential Plan 2 Plus
- MetroPlus NY Essential Plan three
- MetroPlus NY Essential Plan 4
- MetroPlus NY Essential Plan Drug Formulary Listing
MVP
- MVP Essential Plan 1
- MVP Essential Plan 2
- MVP Essential Program 3
- MVP Essential Plan four
- MVP Essential Plan Drug Formulary Listing
United Healthcare
- United HealthCare NYS Essential Plan 1
- United HealthCare NYS Essential Plan 1 Plus
- United HealthCare NYS Essential Plan ii
- United HealthCare NYS Essential Plan 2 Plus
- United HealthCare NYS Essential Plan 3
- United HealthCare NYS Essential Plan four
- United HealthCare NYS Essential Program Drug Formulary List
Univera Healthcare
- Univera HealthCare NYS Essential Plan 1
- Univera HealthCare NYS Essential Programme 1 Plus
- Univera HealthCare NYS Essential Programme 2
- Univera HealthCare NYS Essential Program 2 Plus
- Univera HealthCare NYS Essential Plan 3
- Univera HealthCare NYS Essential Plan 4
Essential Plan Eligible Enrollment Dates
Different other plans available under the Affordable Care Act, y'all can enroll in a Health Essential Plan whatever time throughout the yr.
Frequently Asked Essential Plan Questions
What medical services does the Essential Programme cover ? – The plans cover the same mandatory services covered by other plans sold in New York. These services are known equally Essential Wellness Benefits. In broad terms this includes:
- Doctor visits, including specialists
- Tests ordered by your doctor
- Prescription drugs
- Inpatient and outpatient intendance at a hospital
When is enrollment ? – Open up enrollment is twelvemonth-round.
Would I still authorize if I'm self-employed? - Yes, the plan is open to Freelancers, independent contractors, the self-employed, and all persons who don't have an affordable health insurance pick available to them at their place of employment. Additionally, for persons out of piece of work, you lot nevertheless may qualify.
What happens if I miss a premium payment? – Since premiums are paid in advance, if you miss a premium payment (if you pay premiums) you will lose your coverage for the adjacent month. But, you can re-enroll at any fourth dimension without penalty.
I have a copay, are any services free? – Yes! Preventative care similar a routine physical and some screening tests are not subject to the copay.
I'm pregnant, can I be covered past the NYS Essential Programme? – No, but that is because yous are eligible for coverage under the New York Land Medicaid Programme.
Does my immigration condition thing? – Information technology does. However, near immigrants tin authorize if they see other eligibility requirements. These requirements include:
- Y'all became a denizen
- You are a legal permanent resident
- A lawfully present resident
- In a valid and non-immigrant status, such as a visiting student with a valid visa.
How much does the Essential programme wellness insurance cost? Get-go in 2021, all Essential plans accept removed the monthly premium, making the plan free
2022 Essential Plan Updates
For 2022, there will exist a total of xiv health insurance carriers offering essential program coverage throughout the 62 counties of New York.
The following 16 counties will have 1 Essential Plan carrier in their area: Allegany, Broome, Cattaraugus, Chautauqua, Chenango, Erie, Genesee, Livingston, Monroe, Ontario, Orleans, Putnam, Seneca, Tioga, Wayne, and Westchester.
The Essential Plan has lost 2 carriers for 2022; WellCare of New York and YourCare Health Programme of New York.
Fidelis Care is at present offering the essential plan in Putnam county, for a total of 61 out of 62 new york counties
Molina Healthcare, a relatively new carrier in New York (who recently purchased YourCare Health Plan of New York) has expanded its Essential plan offering to a total of 18 counties, of which the following 15 counties are new for 2022; Allegany, Broome, Cattaraugus, Chautauqua, Chenango, Erie, Genesee, Livingston, Monroe, Ontario, Orleans, Seneca, Tioga, Wayne, and Wyoming
Closing
The Essential programme is a cost-effective NY wellness insurance program available to those who earn too much to qualify for Medicaid while providing all of the essential health benefits required by police force.
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Source: https://www.nyhealthinsurer.com/new-york-essential-plan/
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