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Essential Plan

The health care you need, at a price you can afford.

With no monthly premiums and no cost for dental and vision, our Essential Plans offer all of the essential benefits you need: preventative care, emergency care, prescription drugs, mental health, and more.

Plus, there’s no deductible, so the plan starts paying for your health care right away. You get free preventive care like routine doctor exams and screenings to keep you healthy. Check out our plans below.

Effective April 1, 2024

Great news. Starting April 1, more New Yorkers will qualify for the Essential Plan!  Check out the grid below and see if you and your family qualify.

PEOPLE IN HOUSEHOLD2024 MAXIMUM INCOME
1$37,650
2$51,100
3$64,550
4$78,000

Plan Features

$0
Monthly Premium
$0
Deductible

Eligibility

Monthly Premium

Deductible

Annual Checkup

Doctors & Specialists

$0 24/7 telehealth with MetroPlusHealth Virtual Visit

Hospital Visits

Adult Dental & Vision

Pediatric Dental & Vision

Hearing

Prescription Drug Coverage

Prepackaged Medications

Fitness Reimbursement

Weight Loss Program Reimbursement

Qualified New Yorkers

$0

$0

$0

-

-

$200 every 6 mo. for member

-

How can I enroll?

Enrollment for the Essential Plans is open all year long. There are three ways you can enroll:

  1. By Phone:
    Call MetroPlusHealth Member Services at 855.348.4670, TTY users: 711, Monday through Friday, 8 AM – 6 PM and Saturday, 9 AM – 5 PM.
  2. In Person:
    Wherever you live in New York City, our Marketplace Facilitated Enrollers (FEs), navigators, brokers and agents are available to help you complete your application in the NY State of Health Marketplace. Call us at 855.348.4670, TTY: 711. Monday through Friday, 8 AM – 6 PM and Saturday, 9 AM – 5 PM to make an appointment.
  3. Online:
    NY State of Health, the Official Health Plan Marketplace (aka “the Exchange”) lets you compare plans and premium rates. Visit nystateofhealth.ny.gov/.

What does the Essential Plan provide?

For more information about the below mentioned preventive care benefits go to healthfinder.gov.

  • Outpatient care — the kind you get without being admitted to a hospital

  • Trips to the emergency room

  • Treatment in the hospital for inpatient care

  • Mental health and substance use disorder services: behavioral health treatment, counseling, and psychotherapy

  • Prescription drugs

  • Services and devices to help you recover if you are injured, or have a disability or chronic condition: physical and occupational therapy, speech-language pathology, psychiatric rehabilitation

  • Lab tests

  • Preventive services to keep you healthy: counseling, screenings, vaccines, managing a chronic disease

Covered Immunization Vaccines*

  • Hepatitis A
  • Hepatitis B
  • Herpes
  • Zoster
  • Human Papillomavirus
  • Influenza (Flu Shot)
  • Measles, Mumps, Rubella
  • Meningococcal Pneumococcal
  • Tetanus, Diphtheria, Pertussis
  • Varicella

*For more information about the above mentioned immunizations go to vaccines.gov.

With all our plans you get:

$
0
Telehealth
Unlimited mental health
Urgent care
Immunization vaccines

$0 benefits depending on health plan eligibility.

Who is Eligible for the Essential Plan?

Essential Plans are open to those who don’t qualify for Medicaid or the MetroPlusHealth Child Health Plus plan. Eligibility also depends on your income, and the size of your household.

PEOPLE IN HOUSEHOLD2024 MAXIMUM INCOME
1$30,120
2$40,880
3$51,640
4$62,400

MetroPlusHealth has gathered a list of resources available to help New Yorkers get services such as childcare, food and nutrition, housing, and transportation. These resources are available for all our members. If you need help with any of these things, learn more here.

All MetroPlusHealth Essential Plan members have access to a mail order option for their medications. Access the mail order form here.

A small child is being carried by her mother at a market

I have been with MetroPlusHealth for 10 years and am very satisfied with them being my health care provider. I get my questions answered from the professional, knowledgeable & caring agents every time. Everything I get with MetroPlusHealth I know doesn’t exist with other health care companies. I have inquired many times.

Evelyn D.
Google Review

Covered Preventive Care Services

For all adults:

For women:

  • Abdominal Aortic Aneurysm one-time screening (for men of specified age who have smoked)
  • Alcohol Misuse screening and counseling
  • Aspirin use (to prevent cardiovascular disease for men/women of certain ages)
  • Blood Pressure screening
  • Cholesterol screening (for adults of certain ages or at higher risk)
  • Depression screening
  • Diabetes screening
  • Diet counseling (for adults at higher risk for chronic disease)
  • HIV screening (ages 15-65, and other ages at increased risk)
  • *Immunization vaccines
  • Obesity screening and counseling
  • Sexually Transmitted Infection (STI) prevention counseling
  • Syphilis screening
  • Tobacco use screening (for all adults and cessation interventions for tobacco users)
  • Anemia screening (routine basis for pregnant women)
  • Breast Cancer Genetic Test Counseling (BRCA)
  • Breast Cancer Mammography screenings (every 1 to 2 yrs for women over 40)
  • Breast Cancer Chemoprevention counseling (for women at higher risk)
  • Breastfeeding comprehensive support and counseling
  • Cervical Cancer screening
  • Contraception
  • Domestic and interpersonal violence screening and counseling
  • Folic Acid (supplements for women who may become pregnant)
  • Gestational diabetes screening (for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes)
  • Gonorrhea screening
  • Hepatitis B screening (for pregnant women at their first prenatal visit)
  • HIV screening and counseling
  • Human Papillomavirus (HPV) DNA Test (every 3 years for women with normal cytology results who are 30 or older)
  • Osteoporosis screening (for women over age 60 depending on risk factors)
  • Rh Incompatibility screening (for all pregnant women and follow-up testing for women at higher risk)
  • Urinary tract or other infection screening (for pregnant women)
  • Well-woman visits (to get recommended services for women under 65)
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MetroPlusHealth Virtual Visit

Access to a doctor—whenever and wherever you need it!

MetroPlusHealth Virtual Visit is the fast, easy way for our members to see a provider for common physical, mental, emotional, and behavioral health issues that are not emergencies. MetroPlusHealth Virtual Visit is available anytime, from anywhere in New York State, 24/7 – and in your language.

GREAT NEWS: STARTING JANUARY 1, 2023, METROPLUSHEALTH MEMBERS WILL RECEIVE THEIR DENTAL BENEFITS FROM DENTAQUEST.

Recently, we sent you an announcement along with your new ID Card about our new partnership with DentaQuest, a dental vendor. Starting January 1, 2023, you can begin to use your new ID Card for all your health care needs, including dental services with DentaQuest. Remember to bring your new ID card when you visit your dentist.

Your oral health is important to us. Partnering with DentaQuest, we are able to bring their experience and passion for improving oral health care to you. Their dental network is 65% larger than what we have been offering, with more dentists and specialists available than before. Learn more about your new dental benefit here.

Know your rights and protections against surprise medical bills!

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.

Are you receiving care at an NYC Health + Hospitals facility?

Manage Your Health Online With MyChart. Members who receive care at NYC Health + Hospital facilities now have access to MyChart. MyChart is a free secure portal you can use to manage your health information. MyChart allows you to:

  • Message your primary care provider’s office
  • Request refills of your prescription drugs
  • Access your test results
  • Schedule appointments
Preventive Services Resources

Learn about all of the free preventive services for adults, women and children. Preventive care includes immunizations, physical exams, lab tests and prescriptions. If you have any questions, call one of our Member Services Representatives. We’re here to help.

Explore all MetroPlusHealth Plans

Frequently Asked Questions

Does MetroPlusHealth offer a rewards program?
Yes, MetroPlusHealth will offer a new and exciting rewards program in 2023 . . . .
Does MetroPlusHealth Gold Plan offer gym reimbursement?
Yes, MetroPlusHealth has a variety of plans that offer a variation on a fitness reimbursement . . . .
Does MetroPlusHealth offer insurance for freelancers?
Yes, MetroPlusHealth takes pride in providing health plan coverage to a variety of New York City residents, including freelancers . . . .
Does MetroPlusHealth offer plans for my family?
Yes, we offer dozens of quality health plans that are low-cost and designed to meet the needs of individuals and families . . . .
NYS Standard Form to Designate a Representative to Assist with Health Insurance Authorizations, Complaints, Grievances, and Appeals

Plan Materials

Our Certificate of Coverage explains the details of your Essential Plan coverage, including your benefits, the rules of the plan, and information about how to receive care. Here’s where to see the different certificates of all the different plans.

EP 1 and 2 members, please note, certificates are being updated to reflect the new $0 monthly premium and dental and vision benefits included at $0 cost. Revised certificates are coming soon.

If you would like a hard copy of this Certificate of Coverage, you can submit a request online here. Please be sure to tell us which plan Certificate of Coverage – for example, Essential Plan 2 Standard – you need.

Additional Member Resources

2024 Gym Reimbursement
2024 Quality Strategy: Essential Plan
2023 Member Guide
2023 Gym Reimbursement
NYS Standard Form to Designate a Representative to Assist with Health Insurance Authorizations, Complaints, Grievances, and Appeals
last updated: March 21, 2024

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