Frequently Asked Questions

What’s The Difference Between NY’s Essential Plan 1 and 2?

Visual comparison of New York’s Essential Plan 1 and Essential Plan 2 with MetroPlusHealth explaining benefits and coverage differences.

Understanding your health coverage is key to making the right choice. At MetroPlusHealth, we’re here to simplify the differences between New York’s Essential Plan 1 and Essential Plan 2 so you can find the option that best fits your needs and budget. Both Essential Plans offer affordable, high-quality healthcare with low or no premiums, but the benefits, eligibility, and cost-sharing may vary. This FAQ guide on Essential Plan 1 vs Essential Plan 2 helps you compare side-by-side and choose the plan that works for you.

Side-by-side comparison of New York Essential Plan 1 and Essential Plan 2 with MetroPlusHealth explaining benefits, eligibility, and coverage differences. — *MetroPlusHealth helps members understand the difference between New York’s Essential Plan 1 and Essential Plan 2*.

Have you heard? New York offers $0 health insurance to income-qualified individuals and families.

One of the most popular $0 health insurance plans in New York is called the Essential Plan. The Essential Plan is made up of four categories: Essential Plan 1, Essential Plan 2, Essential Plan 3, and Essential Plan 4.

Qualifying for the Essential Plan used to be limited to individuals and families with income equal to or less than 200% of the federal poverty line. But this year, the limit for the Essential Plan has been expanded to include individuals and families who make up to 250% of the federal poverty line.

Essential Plan

Because most New Yorkers qualify for the first two tiers of the Essential Plan, let’s break down the differences between NY’s Essential Plan 1 and 2.

The Essential Plan 1

The Essential Plan 1 is defined by income limits which are based on family size.

These are the income limits for the Essential Plan 1:

Individuals: $37,650
Families of 2: $51,100
Families of 3: $64,550
Families of 4: $78,000

If you qualify for the Essential Plan 1, you’re in the highest income tier of all four categories. So there will be some small costs associated with your plan.

The costs for common Essential Plan 1 services are:

$0 deductible
$20 monthly premium
$2,000 out-of-pocket maximum
$0 for preventative care
$15 to see your primary care physician
$25 to see a specialist
$75 for an ambulance ride or emergency room visit

The Essential Plan 2

Like the Essential Plan 1, the Essential Plan 2 is also defined by income limits that are based on family size.

These are the income limits for the Essential Plan 2:

Individuals: $16,245 – $17,655
Families of 2: $21,983 – $23,895
Families of 3: $27,724 – $30,134
Families of 4: $33,465 – $36,374

Individuals and families who qualify for the Essential Plan 2 will have virtually free health care. The only money that people on the Essential Plan 2 will spend is for an out-of-pocket maximum and prescription drugs.

The costs associated with the Essential Plan 2 are:

$200 out-of-pocket maximum
Between $1 – $3 for prescription drugs

The difference between New York’s Essential Plan 1 and 2

As you can see, the biggest difference between New York’s Essential Plan 1 and 2 is the cost associated with it.

There are small costs associated with services under the Essential Plan 1. The Essential Plan 2 is different — there are almost no costs associated with it.

The last thing to know about the Essential Plan 1 and the Essential Plan 2 are that there are some other eligibility requirements (in addition to the income requirements) that have to be met in order to qualify.

Still have questions about the Essential Plan? Please reach out! We’re always here to help answer any questions you have. We can even help you enroll if you’d like.

Just give our MetroPlusHealth Member Services line a call at (855) 809-4073 or stop by one of our many offices throughout the five boroughs, from Staten Island to The Bronx. We can’t wait to hear from you!