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, Essential Plans, from NY State of Health, 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.
Member Rewards Program for Essential Plan Members
MetroPlusHealth Member Rewards program enhances the member experience by offering incentives for engaging in healthy behaviors. Essential Plan members can earn rewards by completing activities such as annual check-ups, screenings, and vaccinations.
Earn rewards for making healthy choices!
With all our plans you get:
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
Essential Plan Features
Eligibility
Monthly Premium
Deductible
Annual Checkup
Doctors & Specialists
24/7 Telehealth
Hospital Visits
Adult Dental & Vision
Discount Drug Program
Prepackaged Medications
Fitness (Gym) Reimbursement
Qualified New Yorkers
$0
$0
$0
$200 every 6 mo. for member
Who is Eligible for the Essential Plan?
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.
New to the Essential Plan?
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.
| PEOPLE IN HOUSEHOLD | 2024 MAXIMUM INCOME EFFECTIVE APRIL 1 |
|---|---|
| 1 | $37,650 |
| 2 | $51,100 |
| 3 | $64,550 |
| 4 | $78,000 |
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
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
Essential Plan 2025
Covered Preventive Care Services
To learn more about applying for health insurance, including Medicaid, Child Health Plus, the Essential Plan, and Qualified Health Plans through NY State of Health, The Official Health Plan Marketplace, visit www.nystateofhealth.ny.gov or call 1.855.355.5777.
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.
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
