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Essential Plan

Unbelievably good health care. For an unbelievable $0.

The health care you need meets the health care you deserve.

With $0 benefits that really are $0, like $0 premiums, $0 dental, $0 vision that includes frames, $0 urgent care, and $0 mental health care, our Essential Plans bring to life our philosophy perfectly: Health care for people. Not profit. And now, more New Yorkers than ever may qualify for Essential Plans with MetroPlusHealth.

Why Join MetroPlusHealth

$0 Doctor Visits

Doctor visits are cost free, including $0 mental health

$0 Vision

Get an annual eye exam and glasses

$0 Dental

Annual dental visits covered

Health Rewards

We offer a $0 personalized plan from a dietician to keep you healthy

Find out if you’re eligible for $0 coverage

We are available 7 days a week

Monday – Saturday | 8am – 8pm (ET), Sunday | 9am – 5pm (ET)

With all our plans you get:

$0 Telehealth
$0 Unlimited mental health care
$0 Urgent care
$0 Immunizations & vaccines
* $0 benefits depending on health plan eligibility

Access top doctors, hospitals, and care

MetroPlusHealth Essential Plan does more than offer great benefits. Our network includes 34,000+ of the City’s top doctors, 40+ hospitals including Mount Sinai, NYU Langone, and NY Health + Hospitals, and 110+ urgent care sites including CityMD locations.

A New York-only health care plan

National Health Care Chains

Focused on the bottom line: their profits
Based outside of NYC
Impersonal customer service
Unknown network
Not for profit
By New Yorker, for New Yorkers
Customer service from real people who live in NYC
34,000+ providers in all five boroughs

Essential Plan Features

Monthly Premium


Monthly Premium


Annual Checkup

Doctors & Specialists

$0 24/7 Telehealth

Hospital Visits

Adult Dental & Vision

Prescription Drug Coverage

Prepackaged Medications

Fitness Reimbursement

Qualified New Yorkers




$200 every 6 mo. for member

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.



EP AL 200-250EP 1EP 1 ALEP 2EP 2 ALEP 3EP 4
Product Type200 – 250% FPL200 – 250% FPL150 – 250% FPL150 – 250% FPL138 – 150% FPL138 – 150% FPL100 – 138% FPLBelow 100% FPL
Max Out of Pocket$2000$0$360$0$200$0$200$0
Urgent Care$25$0$25$0$0$0$0$0
Prescription Drug**$6/$15/$30$0$6/$15/$30$0$1/$3/$3$0$1/$3/$3$0/$0/$0
Dental / VisionYesYesYesYesYesYesYesYes
Mail Order RXYesYesYesYesYesYesYesYes
Exercise Facility Reimb.YesYesYesYesYesYesYesYes

Important information on the Expansion of the Essential Plan

With expanded coverage for the Essential Plan through the NY State of Health Marketplace, you may now qualify for the Essential Plan 200-250 offered by MetroPlusHealth. The Essential Plan 200-250 offered by MetroPlusHealth is designed for lower-income adults under the age of 65 who don’t qualify for Medicaid or Child Health Plus.

Frequently asked questions about the Essential Plan

Who is eligible for the 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, 2024, 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. For 2024, New Yorkers are eligible for the Essential Plan based on these annual household income limits:

  • $30,120 for a single person
  • $40,880 for a family of two
  • $51,640 for a family of three
  • $62,400 for a family of four

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



Do I have to be a green card holder or citizen to apply for MetroPlusHealth?

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.

How do I find a doctor that takes MetroPlusHealth insurance?

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.

What steps should I take to start my enrollment in the Expanded Essential Plan?

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. 

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

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.

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

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). 

4+ stars from over 700,000 members

It’s always easy to get in contact with someone when needed. Best insurance I’ve had!

Alicia S.
Google Review

Representative was very professional and helpful, showed empathy for my well being with no attitude …. Thank you….. 😊 👍👍

Betsy J.
Google Review

They’re very helpful and took care of me when I had an emergency 👍🏾👌🏾💯

Mateo V.
Google Review

Personally I’ve always had and still have very great experiences with MetroPlusHealth, I would recommend it to anyone who is looking for the best health insurance services. Thank you MPH for always taking great care of me and mines.

Michaelle J.
Google Review

Thank you. It was super easy to get appt and to be able to speak to my doctor.

Lourdes S.
Google Review

I have been with them for many years and have only good things to say about MetroPlusHealth. They are always helpful, understanding, and working with me.

Ireen S.
Google Review

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
NYS Standard Form to Designate a Representative to Assist with Health Insurance Authorizations, Complaints, Grievances, and Appeals

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)

Covered Immunization Vaccines*

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


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

last updated: May 14, 2024

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