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View Benefits

The Essential Plan is available through the NY State of Health to eligible New Yorkers who do not qualify for QHP, Medicaid or Child Health Plus and do not have access to employer coverage. The Essential Plan covers doctor visits, tests ordered by your provider, prescription drugs, hospital care—the same essential benefits as other health plans. But it costs much less!

Who is eligible for Essential Plan?

Individuals who are:

  • New York State residents
  • Able to meet the Essential Plan income requirements
  • Lawfully present in the United States
  • 19-64 years old; in some cases 21 years old
  • Not eligible for QHP, Medicaid or Child Health Plus
  • Not eligible for employer coverage

Household size Most you can make
1 $24,120
2 $32,480
3 $40,840
4 $49,200

How does it save me money?

  • Your monthly payment is just $20 or $0!
  • You pay $0 deductible!
  • Preventive care is FREE!

Below are some examples of cost sharing levels.

COST SHARING FOR HEALTH CARE SERVICES Annual individual income: below $12,060-$18,090 Annual individual income: $18,091-$24,120
Monthly Premium $0 $20
Annual Deductible None None
Preventive Care Free Free
Primary Care Physician Visit $0 $15
Specialist Visit $0 $25
Inpatient Hospital Stay per admission $0 $150
Behavioral Health Outpatient Visit $0 $15
Behavioral Health Inpatient Visit per admission $0 $150
Emergency Room $0 $75
Urgent Care $0 $25
Physical Therapy, Speech Therapy, Occupational Therapy $0 $15
COST SHARING FOR PRESCRIPTION DRUGS Annual individual income: below $12,060-$18,090* Annual individual income: $18,091-$24,120
Generic $1 $6
Preferred Brand $3 $15
Non-Preferred Brand $3 $30
*$0 for individuals with income below $12,060.
COST SHARING FOR DENTAL AND VISION BENEFITS Annual individual income: below $12,060-$18,090 Annual individual income: $18,091-$24,120
Dental and Vision $0 (lower income enrollees)
Can be purchased for an additional premium (higher income enrollees)
Can be purchased for an additional premium

Molina Healthcare Essential Plans

Essential Plan 1
Subscriber Contract

Essential Plan 1 PLUS
Subscriber Contract

Essential Plan 2
Subscriber Contract

Essential Plan 2 PLUS
Subscriber Contract

Essential Plan 3
Subscriber Contract

Essential Plan 4
Subscriber Contract

Estimate Your Treatment Costs

Make a Payment
Send a check or money order to:

Molina Healthcare of New York, Inc.
P.O. Box 21474
New York, NY 10087-1474

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This information is for Doctors and
Health Care Professionals only.

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