Coming Soon: The Essential Plan in New York!

Posted September, 8 2015 by Hannah Lupien

By Andrew Leonard, Sr. Policy Associate for Health, Housing and Income Security, Children’s Defense Fund – NY


Starting this November, many low- and moderate-income New Yorkers will be able to enroll in a new comprehensive and affordable health insurance product, known as the Essential Plan. Without a doubt, the New York State of Health Marketplace has been a huge success in New York State, enrolling over 2 million people in coverage, many for the first time! Yet, despite these significant gains, some New Yorkers find themselves without insurance or struggling to afford the private insurance have, even with financial assistance from the Marketplace. Many of these individuals will be newly eligible for the Essential Plan.

o-BEST-HEALTHCARE-facebookLike Qualified Health Plans, the Essential Plan will cover all of the ten Essential Health Benefits, including emergency services, inpatient hospitalization, primary care, urgent care, sick visits, lab work, radiology, reproductive health care and more.

Those who qualify for the Essential Plan will pay a premium of either $0 or $20, depending on their income. There will be no deductible, but some consumers may be required to pay a small co-pay for services like doctor visits, hospital stays, and prescription drugs.

The Essential Plan will be available to US citizens earning more than the Medicaid eligibility threshold, but less than 200% of the Federal Poverty Level (FPL) (e.g. a single person earning more than $16,242 but less than $23,540). Lawfully-present immigrants, such as green card holders and those seeking refugee status, will be eligible for Essential Plan coverage as long as they earn less than 200% of the FPL. That means that most lawfully-present immigrants below the Medicaid income threshold, currently eligible for state-funded Medicaid, will be transitioned to Essential Plan coverage.

Enrollment in the Essential Plan begins November 1, 2015 for coverage beginning January 1, 2016. From then on, eligible individuals will be able to enroll all year long, not just during the Marketplace’s Open Enrollment period. It’s an exciting time in New York State!

To enroll or learn more about the Essential Plan, contact the NY State of Health at (855)-355-5777 or

You can also get free one-on-one help from a Navigator or Certified Application Counselor, certified by NY State of Health, who serves your area: Or contact Community Health Advocates: (888)-614-5400 or

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