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Essential Plan

Announcements & Plan Documents

Plan Materials

2025 Members Guide - Essential Plan

Additional Member Resources

2025 Gym Reimbursement
Provider Access and Availability Standards

Behavioral Health Access & Availability

Medical Access & Availability

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

At MetroPlusHealth, we always want you to be at your best. That’s why we encourage you and your family to take advantage of preventive care services available to you at low or no cost. We’ve listed dozens of FREE preventive services here for adults, women and children that just may help you be your healthiest yet.

Free or Low-Cost Preventive Health Care Services

Find a doctor or specialist in your area today

Important Notices

September 27, 2025
MetroPlusHealth Celebrates 10 Years of Dedicated Service to Jackson Heights Community
September 26, 2025
Menopause Care Reaches New York Women with Elektra Health as the Leading Insurance-Covered Provider
September 24, 2025
Virtual Menopause Care Provider Elektra Health Adds Payer Partners in N.Y.
September 08, 2025
SCNs for Medicaid Members: Support for Health and Daily Needs
July 18, 2025
MetroPlusHealth Opens Community Office in Brighton Beach, Further Expanding Access to Care in Brooklyn
July 14, 2025
Important Update on Settlement in Consumer Directed Personal Assistance Program (CDPAP)
July 01, 2025
AMNY METRO, POLITICSNY, and Gay City News’ “2025 LGBTQ+ Power Players” Recognizes Mitchell Katz, MD, and Ken Louie
May 29, 2025
POLITICSNY and AMNY Honor NYC Health + Hospitals and MetroPlusHealth Leaders on 2025 “AAPI Power Players” List
April 25, 2025
Coverage for Prenatal Vitamins

MetroPlusHealth Wellness Card for Essential Plan members

At MetroPlusHealth, we believe that staying healthy should be simple and rewarding. That’s why we make it easy for our Essential Plan members to access nutritious foods and wellness essentials while earning valuable incentives. Whether you are stocking up on fresh fruits and vegetables or purchasing everyday health products, your MetroPlusHealth Wellness Card is here to help.

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 Yorkers enrolling in the MetroPlusHealth Essential Plan to access affordable, quality healthcare.

New to the Essential Plan?

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


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.

Members and providers accessing MetroPlusHealth's online resource library
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.

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.

last updated: November 6, 2025
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