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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, and dental/vision benefits. The same essential benefits as other health plans offer, but at a much lesser cost!
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 | $27,180 |
| 2 | $36,620 |
| 3 | $46,060 |
| 4 | $55,500 |
How does it save me money?
- Your monthly payment is $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 $13,590-$20,385 | Annual individual income: $20,386-$27,180 |
|---|---|---|
| Monthly Premium | $0 | $0 |
| 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 $13,590-$20,385* |
Annual individual income: $20,386-$27,180 |
|---|---|---|
| Generic | $1 | $6 |
| Preferred Brand | $3 | $15 |
| Non-Preferred Brand | $3 | $30 |
| *$0 for individuals with income below $13,590 |
| COST SHARING FOR DENTAL AND VISION BENEFITS | Annual individual income: below $13,590-$20,385 | Annual individual income: $20,386-$27,180 |
|---|---|---|
| Dental and Vision | $0 | $0 |
Molina Healthcare Essential Plans:
Please note: Effective 6/1/21, ALL Essential Plans include dental and vision benefits at no additional cost share or premium. The Subscriber Agreements below are in the process of being updated to reflect that.
2022 Essential Plan 1
Subscriber Agreement
2022 Essential Plan 2
Subscriber Agreement
2022 Essential Plan 3
Subscriber Agreement
2022 Essential Plan 4
Subscriber Agreement
Essential Plan 200-250
2024 Subscriber Agreement
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Send a check or money order to:
Molina Healthcare of New York, Inc.
P.O. Box 21474
New York, NY 10087-1474