Coming Soon: The Essential Plan


More than 2.1 million people in New York State, nearly 12 percent of who live in Nassau and Suffolk counties, were enrolled in health insurance through the New York State of Health Marketplace by the close of the second open enrollment period, which ended on February 28, 2015. However, many people remain uninsured or struggle to pay for coverage, even with financial assistance. Starting November 1, 2015 a new, comprehensive and affordable option will be available through the New York State of Health Marketplace, known as the Essential Plan.

The Essential Plan will cover the same Essential Health Benefits covered by Qualified Health Plans, which includes emergency services, prescriptions, primary and preventive care, lab work, hospitalization, mental health services, habilitative and rehabilitative services, pediatrics and maternity and newborn care. Eligibility for the Essential Plan will be based on yearly income, with some consumers paying no premium and some consumers paying 20$ per month. There is no deductible for the Essential Plan but some consumers may have small co-payments for doctor visits, hospitals visits, prescriptions drugs and other services. The Essential Plan will be available to U.S Citizens under the age of 65 who earn too much to be eligible for Medicaid (more than $16,243 a year for single person, or more than $33,465 a year for a family of four) and lawfully present non-citizens with income below 200% of Federal Poverty Levels (less than $23,540 a year for a single person or less than $48,500 a year for a family of four).

Enrollment for the Essential Plan begins November 1, 2015 for coverage starting January 1, 2016 and enrollment is available all year long. Enrollment in the Essential Plan is not limited to new enrollees- those with current Marketplace coverage may switch during their recertification period, if eligible.

To enroll in health insurance through the New York State of Health Marketplace or to learn more about your insurance options visit https://nystateofhealth.ny.gov/ or call 1-855-355-5777 to enroll over the phone.