Essential Plan

Frequently asked questions

MetroPlusHealth representative helping a member understand Essential Plan benefits and enrollment details.

Everything you need to know about the Essential Plan

We know you may have a lot of questions, and we’re here to help. We’ve gathered some of the most frequently asked questions to help make you feel prepared to enroll. Learn more about what services are covered, the enrollment process, and what costs you can expect.

Who is eligible for the Essential Plan?

There are a handful of basic requirements that you’ll need to meet to be eligible for the Essential Plan. You must:

  • Be a resident of New York State
  • Be able to meet the income requirements
  • Be a legal resident of the United States
  • Not be eligible for Medicaid or Child Health Plus
  • Not be eligible for employer or other coverage

 

What are the income requirements for the Essential Plan?

As of April 1, 2025, New Yorkers qualify if they earn up to 250% of the federal poverty line. The maximum household incomes are:

  • $39,125 for single-person households
  • $52,875 for households of two
  • $66,625 for households of three
  • $80,375 for households of five

If your household exceeds five, add $10,760 for each additional person to calculate your income limit. Note that the federal poverty line can change each year, so you may want to check back annually.

Do I have to be a green card holder or citizen to apply for the Essential Plan?

No, you do not need to be a citizen or green card holder to qualify for MetroPlusHealth’s Essential Plan.

Applying for health insurance will not affect your immigration status or application status, and your immigration status will not be shared with federal immigration authorities.

Private/Qualified Health Plans: Insurance plans on the NY State of Health Marketplace (financial help is available) and directly from insurance companies. Most immigrants can purchase private plans on the NY State of Health Marketplace. Financial help is available. Anyone can purchase private health insurance directly from an insurance company by calling the insurance company or visiting their website.

Child Health Plus: All New York children can get Child Health Plus, regardless of immigration status or income.

Medicaid: Free or very low cost insurance for New Yorkers with low income.

  • If you are pregnant, you can get Medicaid regardless of immigration status, as long as you meet other requirements.
  • If you are undocumented and not pregnant, you can still get Medicaid for emergency services, as long as you meet other requirements.
  • DACAmented New Yorkers with Deferred Action for Childhood Arrivals status can qualify for Medicaid.

To learn more about immigration status requirements when applying for health insurance, check out the Guide to Health Insurance and Health Care Services for Immigrants in New York City.

 

 

How do I find a doctor that takes MetroPlusHealth insurance?

There are more than 34,000 doctors and specialists across the five boroughs who accept MetroPlusHealth. Use our Find a Doctor tool to find an in-network provider.

Can I keep my current doctors and healthcare providers under the Expanded Essential Plan?

You will likely be able to keep your current providers since they’re already part of the same healthcare system. However, you may want to contact your doctor’s office and inform them of your change of coverage.

Does the Expanded Essential Plan provide coverage for immigrants, including DACA recipients?

Yes, this coverage extends to immigrants who meet the qualifications for Immigrants Permanently Residing Under Color of Law (PRUCOL) status. It also offers coverage to immigrants who are recipients of Deferred Action for Childhood Arrivals (DACA).

 

I just lost my job, what health insurance options are available for unemployed New Yorkers?

You may still be eligible for health insurance from MetroPlusHealth. Call us at 855.809.4073 (TTY: 771) to talk with a representative about your options.

Have questions about the Essential Plan?

1-800-475-6387 (TTY: 771) 1-800-475-6387 (TTY: 771)

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last updated: August 22, 2025
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