The Essential Plan

The Essential Plan is a New York State health insurance program that offers comprehensive coverage to eligible adult New Yorkers who meet income and other requirements and are not eligible for Medicaid or Medicare. It is offered through NY State of Health, the state’s official health plan marketplace.

Eligibility is determined by New York State and generally considers age (adults 19–64), New York residency, household income, immigration/lawful-presence status, and whether you qualify for Medicaid or Medicare. New York has expanded Essential Plan eligibility to more residents in recent years. Because the rules and income guidelines can change, confirm current eligibility through NY State of Health or with a licensed agent.

The Essential Plan covers the essential health benefits, which typically include doctor visits, hospital and emergency care, preventive care, prescription drugs, lab tests, and more. Many enrollees also have access to dental and vision coverage. The specific benefits are defined by New York State; refer to NY State of Health for current details.

The Essential Plan is designed to be low-cost. Depending on eligibility, many enrollees pay little or nothing toward monthly premiums, and the plan has no annual deductible. Current cost details are set by New York State and available through NY State of Health. We do not set these amounts.

Our licensed agents are certified to help New Yorkers apply through NY State of Health. We can help you set up an account if needed and assist you through the enrollment process. Whether you ultimately enroll, and in which plan, depends on New York State eligibility rules.