Essential Plan Family Size & Income Eligibility Ny 2019
New York Essential Plan. The #i almost affordable health program in NY
Phone call Now to Encounter if You May Qualify for the New York Essential Plan (888)215-4045
Updated for 2022: All New York Country Essential Plans will now include Dental and Vision Coverage at no additional cost. Additionally, the monthly premium of twenty dollars for Essential Plan i has been removed. All four essential plans will now have a zero premium.
The Essential Plan is a New York health insurance programme for state residents that don't qualify for Medicaid or the Child Health Plus Program. At that place are a full of 4 Essential Plan options and each pick is based on your household income level.
New York State (NYS) created this program to fill the coverage gap that many individuals and families have as they exercise not qualify for Medicaid but cannot afford full premium coverage.
Tabular array OF CONTENTS
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How to Enroll in the Essential Program
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What does the Essential Program Cost
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Are Yous Eligible for the Essential Plan?
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Essential Plan Residency Requirements
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Aging In & Aging Out of the Essential Program
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What Is Covered Under an Essential Program?
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Essential Plan i and 2
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Essential Plan 3 and iv
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Essential Programme Plus
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Dental Benefits
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Essential Plan Vision Care Benefits
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Insurers offering Essential Program
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Insurers Offering Essential Plan Vs. Essential Programme Plus (Vision and Dental Included)
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2022 Essential Plan Insurers and the Counties they Operate In
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Choosing the Correct Essential Program for You and Your Family
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Carrier Summary of Benefits and Formulary Listing
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Essential Plan Eligible Enrollment Dates
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Oftentimes Asked Essential Programme Questions
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2022 Essential Plan Updates
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Closing
How to Enroll in the Essential Plan
Before Enrolling in an Essential programme, you may desire to review the eligibility requirements, nonetheless your options to enroll include the following:
- Contact united states of america at our toll-gratuitous number (888)215-4045 and we will outset help yous determine if you are eligible. Once we decide your eligibility, we then compare all of the available Wellness insurance companies offering the essential plan in your region. Our comparing will ensure that your current doctor is role of the network likewise as compare network size to determine if the hospitals and labs of your selection are included in the network
- You have the option to visit each carrier to review their plans notwithstanding you won't be able to compare plans adjacent
- The New York Country of Health is some other enrollment selection. You tin can go direct or we tin can enroll you in the plan of your choice
What does the Essential Programme Cost?
Starting in 2021 all Essential plans have removed their monthly premium requirements and are now free! There are a full of 4 Essential plan options, each based on your current income. There are no family plans with the essential plan, only individual coverage. Children are non eligible for the Essential Program, notwithstanding, if the parent(southward) qualify for the Essential then the children are almost likely eligible for Child Health Plus (nosotros provide enrollment services for Child Health Plus)
Are You Eligible for the Essential Plan?
There are 3 qualifying elements for you to be eligible for the NY Essential Program. They are:
- Income requirements
- Residency and Immigration Status
- Crumbling In and Aging Out
Income limits are related to your family size. The post-obit chart explains how your income and family size is structured.
| Household Size | Maximum Annual Income |
|---|---|
| i* | $24,280 |
| 2 | $32,920 |
| 3 | $41,560 |
| iv** | $50,200 |
* (150% to 200% FPL)
** Add together $8,640 for each additional member of your family unit
Essential Plan Residency Requirements
Low and moderate-income families that are residents of New York Land and legal immigrants are eligible for the Essential Plan program.
All four Essential Plans don't have a monthly premium, all the same plan benefits are generous and provide y'all the 10 essential health benefits mandated past the Affordable Intendance Act. Post-obit are the different variations of the NYS Essential Plan:
Essential Plan 1 - Individuals with income greater than 150% and less than or equal to 200% of the FPL.
Essential Program 2 - Individuals with income greater than 138% and less than or equal to 150% of the FPL.
Essential Plan 3 - Individuals with income equal to or greater than 100% and less than or equal to 138% of the FPL and non eligible for Medicaid due to clearing condition.
Essential Plan four - Individuals with income below 100% of the FPL and not eligible for Medicaid due to immigration status.
Crumbling In & Aging Out of the Essential Plan
If you are an adult that is betwixt nineteen and 65 years of historic period then you can participate in the program. Children nether age 19 may qualify for Child Wellness Plus and those by historic period 65 are usually covered past Medicare.
What Is Covered Under an Essential Plan?
Nether the Affordable Care Act, a certain level of minimum coverage is guaranteed to all insured people. The NY Country of Wellness Essential Plan too features the same ten health essentials. These are:
- Ambulatory patient services (outpatient care).
- Emergency Services (given in an emergency room or urgent care facility).
- Hospitalization (when yous stay in the hospital for more than 24 hours, fewer hours are covered nether ambulatory services).
- Maternity and newborn care.
- Mental health service and drug or alcohol addiction handling (treated every bit any other medical affliction).
- Prescription drugs.
- Rehabilitative services and devices (eastward.g. Physical therapy is i of the services and a brace is an case of a device).
- Laboratory services include x-rays, Cat scans, ultrasounds, and such.
- Preventative services
- Pediatric services (not applicable to New York State Essential Programme every bit kids under 19 are covered by Kid Wellness Plus).
Essential Plan 1 and Essential Programme 2
To qualify for either plan 1 or 2 your household income must be between 138% and 200% of the federal poverty level, be a Us denizen living in New York State, and non enrolled in Medicare or Medicaid or be under the age of xix or older than 65.
| Benefits | Essential Plan 1 Costs & Co-pays | Essential Programme 2 Costs & Co-pays |
|---|---|---|
| Individual Deductible | $0 (Med/Rx combined) | $0 (Med/Rx combined) |
| Individual Maximum Out-of-Pocket | $2,000 (Med/Rx combined) | $200 (Med/Rx combined) |
| Inpatient Hospital Care | $150 | $0 |
| Emergency Intendance | $75 | $0 |
| Urgent Care | $25 | $0 |
| Outpatient Infirmary Services | $l | $0 |
| 10-rays and Labs | PCP: $15 SPC: $25 OP Facility: $50 | $0 |
| Advanced Imaging | $25 | $0 |
| PCP Office Visits | $15 | $0 |
| Specialist Office Visits | $25 | $0 |
| Adult Dental | $15 | $15 |
| Adult Vision | $15 | $15 |
| Non-Prescription Drugs | Not Covered | Not Covered |
| Not-Emergency Transportation | Non Covered | Non Covered |
| Generic drugs | $6 | $1 |
| Preferred Brand Drugs | $xv | $3 |
| Not-Preferred Brand and Specialty | $30 | $3 |
Essential Plan iii and Essential Plan iv
To qualify for Essential Programme 3 or Essential Plan 4, you must first meet all of the requirements of plans ane and 2, and yous must be a legal permanent resident immigrant living in New York Country.
| Programme Proper name | Essential Programme iii Costs | Essential Plan 4 Costs |
|---|---|---|
| Individual Deductible | $0 | $0 |
| Individual Maximum Out-of-pocket | $200 | $0 |
| Inpatient Hospital Care | $0 | $0 |
| Emergency Care | $0 | $0 |
| Urgent Intendance | $0 | $0 |
| Outpatient Hospital Services | $0 | $0 |
| X-ray/Labs | $0 | $0 |
| Advanced Imaging | $0 | $0 |
| PCP Role Visits | $0 | $0 |
| Specialist Office Visits | $0 | $0 |
| Adult Dental | Covered at no price | Covered at no price |
| Developed Vision | Covered at no price | Covered at no cost |
| Not-prescription Drugs | Covered at no toll | Covered at no cost |
| Not-emergency transportation | Covered at no toll | Covered at no cost |
| Prescription drugs | $ane | $0 |
| Preferred brand drugs | $3 | $0 |
| Non-preferred make drugs and Specialty | $3 | $0 |
Dental Benefits
Dental coverage is both for preventative care and routine care. benefits include:
- Two Cleanings per year
- Oral Exams including X-rays
- Fillings
- Extractions
- Emergency care
- Orthodontics
- Dentures
- Stock-still bridges
Essential Plan Vision Intendance Benefits
Besides, your vision care benefits include:
- I almanac middle test per year
- Other diagnostic exams performed by an eye doctor
- Lenses or contacts once a year (more than frequently if medically necessary
- Frame in one case per twelvemonth unless in that location is a medical need.
There is an additional cost for the Essential Program Plus ranging from $30 to $46 per calendar month per person.
Insurers offering Essential Plan
The post-obithealth insurance companies are participating in the NY Land of Health Essential Plans:
- Analogousness Health Plan
- CDPHP
- EmblemHealth (Role of the HIP GHI family of plans)
- Excellus Blue Cantankerous Blue Shield
- Fidelis Intendance
- Healthfirst
- HealthNow Blue Cross Blue Shield of Western New York
- HealthPlus HP (formerly known as Empire Blue Cross Blue Shield Health Plus)
- Contained Wellness
- MetroPlus Health
- Molina Healthcare
- MVP
- United Healthcare
- Univera Healthcare
2022 Essential Plan Insurers and the Counties they Operate In
Beneath is a table list the Major New York Essential Plan carriers and the corresponding counties they operate in as of 2020. This list is horizontally scrollable →
| County | Affinity Health Plan | BlueCross Blue Shield of Western New York | CDPHP | Emblem Health | Empire BlueCross BlueShield HealthPlus | Excellus Blueish Cantankerous Blue Shield | Fidelis Care | Wellness Showtime | Contained Health | MetroPlus Wellness | Molina Wellness care | MVP | United Health care | Univera Health intendance |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Albany |  | | | | ||||||||||
| Allegany | | | | | ||||||||||
| Bronx | | | | | | | | |||||||
| Broome | | | | | | |||||||||
| Cattaraugus | | | | | ||||||||||
| Cayuga | | | | |||||||||||
| Chautauqua | | | | | | |||||||||
| Chemung | | | | |||||||||||
| Chenango | | | | | ||||||||||
| Clinton | | | | |||||||||||
| Columbia | | | | | ||||||||||
| Cortland | | | | |||||||||||
| Delaware | | | | |||||||||||
| Dutchess | | | | | ||||||||||
| Erie | | | | | | | ||||||||
| Essex | | | | | ||||||||||
| Franklin | | | | | ||||||||||
| Fulton | | | | | ||||||||||
| Genesee | | | | | | | ||||||||
| Greene | | | | | ||||||||||
| Hamilton | | | ||||||||||||
| Herkimer | | | ||||||||||||
| Jefferson | | | | | ||||||||||
| Kings | | | | | | | | |||||||
| Lewis | | | | | ||||||||||
| Livingston | | | | | | |||||||||
| Madison | | | | |||||||||||
| Monroe | | | | | | |||||||||
| Montgomery | | | | |||||||||||
| Nassau | | | | | | | ||||||||
| New York | | | | | | | | |||||||
| Niagara | | | | | | |||||||||
| Oneida | | | | | ||||||||||
| Onondaga | | | | | ||||||||||
| Ontario | | | | | | |||||||||
| Orangish | | | | | | | ||||||||
| Orleans | | | | | | |||||||||
| Oswego | | | | |||||||||||
| Otsego | | | ||||||||||||
| Putnam | | | ||||||||||||
| Queens | | | | | | | | |||||||
| Rensselaer | | | | | ||||||||||
| Richmond | | | | | | | | |||||||
| Rockland | | | | | | |||||||||
| Saint Lawrence | | | | |||||||||||
| Saratoga | | | | | ||||||||||
| Schenectady | | | | | ||||||||||
| Schoharie | | | ||||||||||||
| Schuyler | | | ||||||||||||
| Seneca | | | | | ||||||||||
| Steuben | | | ||||||||||||
| Suffolk | | | | | | | ||||||||
| Sullivan | | | | | ||||||||||
| Tioga | | | | | | |||||||||
| Tompkins | | | | |||||||||||
| Ulster | | | | | ||||||||||
| Warren | | | | | ||||||||||
| Washington | | | | |||||||||||
| Wayne | | | | | ||||||||||
| Westchester | | | | | | | | |||||||
| Wyoming | | | | | | |||||||||
| Yates | | | |
Choosing the Right Essential Program for You and Your Family
Most counties in New York Country have more than ane Essential Programme health insurance company for you to choose from. Since many insurance companies have contracts with different doctors and hospitals, it may be that your preferred doctor and hospital are not on every programme offered. When you shop for an Essential Plan check to ensure that your physician(s) and preferred hospital are part of the provider network.
Carrier Summary of Benefits and Formulary Listing
While the Essential plan merely has four options that are based on income. Each carrier often includes additional benefits such every bit telehealth, teledoc, gym reimbursement programs, and wellness programs to create make awareness and to attract clientele. Below is a list of carriers that have made their programme summaries and pharmacy formulary listings available.
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Affinity Wellness Plan
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EmblemHealth (Role of the HIP GHI family of plans)
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Excellus Blueish Cantankerous Bluish Shield
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Fidelis Care
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HealthFirst
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HealthNow Blue Cross Blue Shield of Western New York
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HealthPlus HP (formerly known as Empire Blue Cross Blueish Shield Health Plus)
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Independent Health
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MetroPlus Health
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MVP
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United Healthcare
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Univera Healthcare
Affinity Wellness Plan
- Affinity NY Essential Plan 1
- Affinity NY Essential Programme 1 Plus
- Analogousness NY Essential Programme ii
- Analogousness NY Essential Plan 2 Plus
- Affinity NY Essential Programme 3
- Affinity NY Essential Plan 4
- Affinity Comparison of all 4 plans
- Affinity Drug Formulary Listing
- Affinity Over the Counter Formulary listing for plans 3 and 4
EmblemHealth (Part of the HIP GHI family of plans)
- EmblemHealth NYS Essential Plan 1
- EmblemHealth NYS Essential Plan i Plus
- EmblemHealth NYS Essential Program 2
- EmblemHealth NYS Essential Programme 2 Plus
- EmblemHealth NYS Essential Plan 3
- EmblemHealth NYS Essential Program 4
- EmblemHealth NYS Drug Formulary Listing
Excellus Blue Cantankerous Blueish Shield
- Excellus NY Essential Programme 1
- Excellus NY Essential Plan 1 Plus
- Excellus NY Essential Plan two
- Excellus NY Essential Plan two Plus
- Excellus NY Essential Program 3
- Excellus NY Essential Plan four
Fidelis Care
- Fidelis Intendance NYS Essential Programme 1
- Fidelis Intendance NYS Essential Plan 1 Plus
- Fidelis Care NYS Essential Plan 2
- Fidelis Care NYS Essential Plan 3
- Fidelis Care NYS Essential Program iv
- Fidelis Intendance NYS Essential Program Next Comparison
- Fidelis Intendance NYS Essential Plan Dental and Vision Comparison
- Fidelis Care NYS Drug Formulary Listing
HealthFirst
- HealthFirst NY Essential Plan i
- HealthFirst NY Essential Plan 1 Plus
- HealthFirst NY Essential Program ii
- HealthFirst NY Essential Plan 2 Plus
- HealthFirst NY Essential Program 3
- HealthFirst NY Essential Plan 4
- HealthFirst NY Essential Plan Drug Formulary Listing
HealthNow Blueish Cross Blue Shield of Western New York
- HealthNow NYS Essential Plan one
- HealthNow NYS Essential Plan 1 Plus
- HealthNow NYS Essential Plan ii
- HealthNow NYS Essential Plan 2 Plus
- HealthNow NYS Essential Plan 3
- HealthNow NYS Essential Program four
- HealthNow NYS Essential Plan Drug Formulary List
H ealthPlus HP formerly known equally Empire Bluish Cross Bluish Shield Health Plus
- HealthPlus HP NY Essential Plan 1
- HealthPlus HP NY Essential Plan i Plus
- HealthPlus HP NY Essential Programme ii
- HealthPlus HP NY Essential Plan 2 Plus
- HealthPlus HP NY Essential Plan iii
- HealthPlus HP NY Essential Plan 4
- HealthPlus HP NY Essential Plan Drug Formulary Listing
Contained Health
- Independent Wellness NY Essential Plan 1
- Independent Health NY Essential Plan 2
- Independent Health NY Essential Program 3
- Independent Wellness NY Essential Program iv
- Independent Health NY Essential Plan Drug Formulary Listing
MetroPlus Health
- MetroPlus NY Essential Plan i
- MetroPlus NY Essential Program 1 Plus
- MetroPlus NY Essential Plan 2
- MetroPlus NY Essential Program two Plus
- MetroPlus NY Essential Plan 3
- MetroPlus NY Essential Plan iv
- MetroPlus NY Essential Programme Drug Formulary Listing
MVP
- MVP Essential Plan i
- MVP Essential Plan two
- MVP Essential Program iii
- MVP Essential Plan four
- MVP Essential Plan Drug Formulary Listing
United Healthcare
- United HealthCare NYS Essential Plan 1
- United HealthCare NYS Essential Programme i Plus
- United HealthCare NYS Essential Program ii
- United HealthCare NYS Essential Plan 2 Plus
- United HealthCare NYS Essential Plan 3
- United HealthCare NYS Essential Plan 4
- United HealthCare NYS Essential Programme Drug Formulary List
Univera Healthcare
- Univera HealthCare NYS Essential Plan one
- Univera HealthCare NYS Essential Plan i Plus
- Univera HealthCare NYS Essential Plan 2
- Univera HealthCare NYS Essential Programme two Plus
- Univera HealthCare NYS Essential Plan 3
- Univera HealthCare NYS Essential Plan four
Essential Program Eligible Enrollment Dates
Dissimilar other plans available nether the Affordable Care Act, you tin can enroll in a Health Essential Plan whatever time throughout the year.
Ofttimes Asked Essential Program Questions
What medical services does the Essential Plan cover ? – The plans cover the aforementioned mandatory services covered by other plans sold in New York. These services are known as Essential Health Benefits. In broad terms this includes:
- Doctor visits, including specialists
- Tests ordered by your doctor
- Prescription drugs
- Inpatient and outpatient care at a hospital
When is enrollment ? – Open enrollment is twelvemonth-circular.
Would I still qualify if I'1000 self-employed? - Yes, the program is open up to Freelancers, independent contractors, the self-employed, and all persons who don't have an affordable wellness insurance option available to them at their identify of employment. Additionally, for persons out of work, yous still may authorize.
What happens if I miss a premium payment? – Since premiums are paid in advance, if you miss a premium payment (if you pay premiums) yous will lose your coverage for the next month. Just, yous can re-enroll at any fourth dimension without penalty.
I have a copay, are whatever services gratis? – Yes! Preventative care similar a routine concrete and some screening tests are non discipline to the copay.
I'm pregnant, can I be covered by the NYS Essential Programme? – No, only that is because you are eligible for coverage under the New York Country Medicaid Program.
Does my immigration status thing? – Information technology does. Withal, most immigrants tin can qualify if they meet other eligibility requirements. These requirements include:
- Y'all became a citizen
- You are a legal permanent resident
- A lawfully present resident
- In a valid and non-immigrant status, such as a visiting student with a valid visa.
How much does the Essential plan health insurance cost? Beginning in 2021, all Essential plans have removed the monthly premium, making the plan costless
2022 Essential Plan Updates
For 2022, there volition be a full of xiv health insurance carriers offering essential plan coverage throughout the 62 counties of New York.
The post-obit sixteen counties will have 1 Essential Plan carrier in their surface area: Allegany, Broome, Cattaraugus, Chautauqua, Chenango, Erie, Genesee, Livingston, Monroe, Ontario, Orleans, Putnam, Seneca, Tioga, Wayne, and Westchester.
The Essential Plan has lost 2 carriers for 2022; WellCare of New York and YourCare Health Plan of New York.
Fidelis Care is at present offering the essential program in Putnam county, for a full of 61 out of 62 new york counties
Molina Healthcare, a relatively new carrier in New York (who recently purchased YourCare Health Plan of New York) has expanded its Essential plan offer to a full of 18 counties, of which the following 15 counties are new for 2022; Allegany, Broome, Cattaraugus, Chautauqua, Chenango, Erie, Genesee, Livingston, Monroe, Ontario, Orleans, Seneca, Tioga, Wayne, and Wyoming
Closing
The Essential plan is a cost-effective NY wellness insurance plan available to those who earn too much to qualify for Medicaid while providing all of the essential health benefits required past police force.
Source: https://www.nyhealthinsurer.com/new-york-essential-plan/
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