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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.

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

Plan Features

$0
Monthly Premium
$0
Deductible

Eligibility

Monthly Premium

Deductible

Annual Checkup

Doctors & Specialists

$0 24/7 Telehealth

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

-

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 HOUSEHOLD2022 MAXIMUM INCOME
1$27,180
2$36,620
3$46,060
4$55,500

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.

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) 809-4073, TTY users: 711, Monday through Saturday, 8 AM – 8 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) 809-4073, TTY: 711. Monday through Friday, 8 AM – 8 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/.
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 ADULTSFOR WOMEN
Abdominal Aortic Aneurysm one-time screening (for men of specified age who have smoked)Anemia screening (routine basis for pregnant women)
Alcohol Misuse screening and counselingBreast Cancer Genetic Test Counseling (BRCA)
Aspirin use (to prevent cardiovascular disease for men/women of certain ages)Breast Cancer Mammography screenings (every 1 to 2 yrs for women over 40)
Blood Pressure screeningBreast Cancer Chemoprevention counseling (for women at higher risk)
Cholesterol screening (for adults of certain ages or at higher risk)Breastfeeding comprehensive support and counseling
Depression screeningCervical Cancer screening
Diabetes screeningContraception
Diet counseling (for adults at higher risk for chronic disease)Domestic and interpersonal violence screening and counseling
HIV screening (ages 15-65, and other ages at increased risk)Folic Acid (supplements for women who may become pregnant)
*Immunization vaccinesGestational diabetes screening (for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes)
Obesity screening and counselingGonorrhea screening
Sexually Transmitted Infection (STI) prevention counselingHepatitis B screening (for pregnant women at their first prenatal visit)
Syphilis screeningHIV screening and counseling
Tobacco use screening (for all adults and cessation interventions for tobacco users)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)

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

2023 Member Guide
2022 Member Guide
2023 Gym Reimbursement
2022 Gym Reimbursement

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

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MetroPlusHealth Virtual Visit

Access to your 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.

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.

Health Risk Assessment 

HRA can be returned to:
ATTENTION: QM Health Risk Assessment Unit
MetroPlus Health Plan
50 Water Street, 7th Floor
​New York, NY 10004
or by completing our Contact form by clicking here.

IMPORTANT INFORMATION: MONKEYPOX CASES ARE RISING IN NYC.

Monkeypox cases are rising in NYC. Learn more about Monkeypox, including prevention and treatment, here.

last updated: March 31, 2022

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