Essential Plan

There are just a few eligibility requirements that have to be met in order to qualify for the Essential Plan.

To qualify for the Essential Plan, you must:

• Be a resident of New York State
• Be a legal resident of the United States
• Be between 19–64 years old
• Not be eligible for Medicaid or Child Health Plus plans
• Not be eligible for employer-based or other health insurance options

There are also income eligibility requirements for the Essential Plan, which expanded significantly this year to include many more New Yorkers.

Previously, in order to qualify New Yorkers could earn no more than 200% of the federal poverty line. As of April 1, 2025, New Yorkers can now qualify for the Essential Plan if they earn up to 250% of the federal poverty line.

The federal poverty line changes each year and depends on the size of your household. Individuals with annual incomes up to $39,125 and a family of four with incomes up to $80,375 may qualify.

For 2025, New Yorkers are eligible for the Essential Plan based on these annual household income limits:

Have more family members than that? Calculate your household’s income limit by adding $10,760 for each additional person.

No. You do not need to be a green card holder or citizen to qualify for MetroPlusHealth’s Medicaid Managed Care plan.

Immigrants in New York have more health insurance options than in many other states. Applying for health insurance won’t affect your immigration status or application status. Your immigration status won’t be shared with federal immigration authorities.

MetroPlusHealth offers a variety of insurance plans that meet the needs of immigrants who are both documented and undocumented:

ChildHealth 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.

EssentialPlan: Free or very low cost insurance for adults with low income who don’t qualify for Medicaid. Immigrants can qualify for Essential Plan right after moving to New York, as long as they have a valid visa or deferred action status. DACA individuals don’t qualify.

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.

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

Finding a doctor or specialist within the MetroPlusHealth network is easy. Using our doctor or specialist search, you can access over 34,000 doctors and specialists located across the five boroughs who accept MetroPlusHealth insurance.

Yes, the Essential Plan includes mental health coverage. Find more details about mental health coverage here.

If you’re currently enrolled in a Qualified Health Plan that offers the Essential Plan, there’s no need to take any specific actions to transition to the Expanded Essential Plan. New York State will handle the transfer automatically and notify you of the change via email. You can expect to receive a new Essential Plan ID card, which will include details about available providers and your benefits. 

Typically, transitioning from your current Qualified Health Plan to the Expanded Essential Plan won’t require a change in your current health care providers since they’re already part of the same health care system. However, you may wish to contact your health care provider to inform your doctor of your change of coverage.

Unemployed New Yorkers may be eligible for great health insurance coverage from MetroPlusHealth.Call us at 866-496-6636 to find out which
plan is right for you.

Yes, the Expanded Essential Plan extends coverage to immigrants who meet the qualifications for Immigrants Permanently Residing Under Color of Law (PRUCOL) status. 

Yes, the Expanded Essential Plan also offers coverage to immigrants who are recipients of Deferred Action for Childhood Arrivals (DACA).