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Essential Plan: Welcome to better health with Molina Healthcare!
Why choose Essential Plan?
Benefits: 
- Affordable Care: Low costs so you can get the care you need without worrying about bills.
 - Full Coverage: Includes doctor visits, emergency care, maternity care, and prescription drugs.
 - Extra Benefits: Free dental and vision for 360 degrees of care.
 - Easy Access: A large network of doctors and hospitals, so help is always nearby.
 - Help you can count on: 24/7 assistance to answer all your questions and help you get the care you need.
 
Who is eligible for the Essential Plan through NY State of Health?
Individuals who are:
- New York State residents
 - Lawfully present in the US
 - 19-64 years old
 - Not eligible for Medicaid or Child Health Plus
 - Not eligible for employer coverage
 - Able to meet the Essential Plan income requirements listed in the table below
 
| 
             Household size  | 
            
             Most you can make  | 
        
| 
             1  | 
            
             $39,125  | 
        
| 
             2  | 
            
             $52,875  | 
        
| 
             3  | 
            
             $66,625  | 
        
| 
             4  | 
            
             $80,375  | 
        
How does it save me money?
- Your monthly payment is $0!
 - You pay $0 deductible!
 - Preventive care is FREE!
 
Note: The costs shared below are copays 
| 
             COST SHARING FOR HEALTH CARE SERVICES  | 
            
             Annual individual income: below $15,060-$22,590  | 
            
             Annual individual income: $22,591-$37,650  | 
        
| 
             Monthly Premium  | 
            
             $0  | 
            
             $0  | 
        
| 
             Annual Deductible  | 
            
             $0  | 
            
             $0  | 
        
| 
             Preventive Care  | 
            
             $0  | 
            
             $0  | 
        
| 
             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:  | 
            
             Annual individual income: $22,591-$37,650  | 
        
| 
             Generic  | 
            
             $1  | 
            
             $6  | 
        
| 
             Preferred Brand  | 
            
             $3  | 
            
             $15  | 
        
| 
             Non-Preferred Brand  | 
            
             $3  | 
            
             $30  | 
        
Join the Essential Plan by Affinity by Molina Healthcare today and enjoy a healthier tomorrow!
Phone: Call (800) 223-7242 (TTY: 711)
Monday - Friday 8:00 a.m. - 6:00 p.m. 
Visit us locally.  
Start Your Coverage today!
Affinity by Molina Healthcare Essential Plan Subscriber Agreements
 
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
Product offered by Affinity by Molina Healthcare, a wholly owned and subsidiary of Molina Healthcare, Inc. This is a solicitation for the insurance and an agent may contact you.
