What do I need to enroll?
You may not know where to start if you’re looking for healthcare coverage. MetroPlusHealth offers the Essential Plan, a New York State health insurance plan for people who want good coverage without the financial strain. If you’re considering different care plans, you may want to know about income qualifications, any healthcare payment that you’ll need to make, and options for immigrants.
Below, you can learn more about the Essential Plan, including eligibility, plan coverage, potential costs and more.
Who’s eligible for the MetroPlusHealth Essential Plan?
The Essential Plan is for New York residents between 19-64 years old who aren’t eligible for Medicaid, employer-based or other health insurance options. Additionally, you must be a legal resident of the United States and meet the income requirements listed below.
As of April 1, 2025, New Yorkers who earn up to 250% of the federal poverty line are eligible for the Essential Plan. The federal poverty line changes yearly and depends on the number of people in your household. The current annual household income limits for New Yorkers eligible for the Essential Plan are:
- $39,125 for a single-person home
- $52,875 for a two-person home
- $66,625 for a three-person home
- $80,375 for a four-person home
If there are more than four people in your household, add $10,760 for each additional person to calculate your income limit.
What does the Essential Plan cover?
The Essential Plan covers various providers and health needs, from preventive visits and immunizations, to hospitalization, lab tests and prenatal care. Benefits include:
- Free preventive care
- Inpatient care
- Outpatient services
- Maternity and newborn care
- Emergency services
- Lab and imaging
- Prescription drugs
- Rehabilitative and habilitative services
- Mental health and substance use disorder services
- Wellness and chronic disease management services
- Vision and Dental
The Essential Plan also has dental and vision coverage, which includes:
- Eye exams
- Lenses and frames
- Contact lenses
- One exam per plan year
- One prescribed pair of glasses per year
- Oral exam
- Dental x-rays
- Cleaning
- Fluoride treatment
- Diagnostic services
- Extractions
There are also many preventive services covered for all adults, like blood pressure and cholesterol screening, plus some additional services for women, such as breast cancer and cervical cancer screenings.
Ready to sign up?
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