Frequently asked questions

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

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.

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.

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.

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.

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).

There are a few different options if you have a gap in health care coverage.

1. COBRA: Taking advantage of COBRA lets you continue on your employer’s health plan for a limited time after leaving a job. However, you’ll have to pay both your premium and your former employer’s contribution, so it can be expensive.
2. Affordable Care Act (ACA): If you’ve lost your coverage, you’re eligible for a special enrollment period. You can visit the ACA Marketplace and enroll in a plan, with cost typically dependent on your income.
3. Medicaid/CHP: You and your dependents may qualify for Medicaid and/or Child Health Plus. Medicaid and Child Health Plus (CHP) are income-based government-funded health insurance options. Medicaid is designed for low-income individuals and families, while CHP is for children in families with incomes too high for Medicaid, but too low for private coverage.

In health insurance, PPO stands for Preferred Provider Organization. This is a type of plan that contracts with hospitals and doctors to create a network of providers. Plan members then pay less to use providers within that network.

A deductible is the amount you pay for covered health care services before your insurance takes over payment. For example, if you have a $1,000 deductible, you’ll have to pay for the first $1,000 of covered services yourself. However, some services like preventative care will be covered fully regardless of whether you’ve met your deductible or not.

If you’re self-employed, you have a range of health insurance options. The best choice will depend on your personal circumstances. Some options include:

1. Individual Plans on the New York State of Health Exchange: This could be a good affordable option if you’re just starting out. Depending on your income, you may qualify for subsidies to substantially lower your monthly payments, while still getting most essential health benefits.
2. Spouse’s plan: If you have a married spouse with an employer-sponsored health insurance plan, ask about joining.
3. Medicaid: Eligibility for Medicaid is income-based, but if you qualify you can receive low-cost or free health coverage.
4. Medicare: If you are over 65 years old or have certain disabilities, you may qualify for Medicare.
5. Private Insurance: You can buy individual private health insurance plans directly from insurance companies.

If you’re a parent who needs medical insurance for your children, you may qualify to enroll them in Child Health Plus (CHP), which provides free or low-cost health coverage. Your children must be under 19 years old and a resident of New York.

If you need a new insurance card, you should contact MetroPlusHealth directly. You can either log in to your , call customer service at 866-496-6636, or ask your employer’s human resources department for guidance.