What’s The Difference Between NY’s Essential Plan 1 and 2?

The Essential Plan 1 is defined by income limits which are based on family size.

These are the income limits for the Essential Plan 1:

• Individuals: $37,650
• Families of 2: $51,100
• Families of 3: $64,550
• Families of 4: $78,000

If you qualify for the Essential Plan 1, you’re in the highest income tier of all four categories. So there will be some small costs associated with your plan.

The costs for common Essential Plan 1 services are:

• $0 deductible
• $20 monthly premium
• $2,000 out-of-pocket maximum
•  $0 for preventative care
• $15 to see your primary care physician
• $25 to see a specialist
• $75 for an ambulance ride or emergency room visit

Like the Essential Plan 1, the Essential Plan 2 is also defined by income limits that are based on family size.

These are the income limits for the Essential Plan 2:

• Individuals: $16,245 – $17,655
• Families of 2: $21,983 – $23,895
• Families of 3: $27,724 – $30,134
• Families of 4: $33,465 – $36,374

Individuals and families who qualify for the Essential Plan 2 will have virtually free health care. The only money that people on the Essential Plan 2 will spend is for an out-of-pocket maximum and prescription drugs.

The costs associated with the Essential Plan 2 are:

• $200 out-of-pocket maximum
• Between $1 – $3 for prescription drugs

As you can see, the biggest difference between New York’s Essential Plan 1 and 2 is the cost associated with it.

There are small costs associated with services under the Essential Plan 1. The Essential Plan 2 is different — there are almost no costs associated with it.

The last thing to know about the Essential Plan 1 and the Essential Plan 2 are that there are some other eligibility requirements (in addition to the income requirements) that have to be met in order to qualify.