Understanding the Essential Plan: Is It the Right Plan for You?
3/27/2025
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Posted by Fidelis Care
The Essential Plan is a low-cost health insurance plan through NY State of Health, the Official Health Plan Marketplace. It has no monthly premium, no deductibles, and no or low out-of-pocket costs. The Essential Plan provides medical, dental, and vision coverage. Eligible individuals can include:
- Lower-income individuals who don’t qualify for Medicaid or Child Health Plus
- Young adults who no longer qualify for Child Health Plus
- Individuals who don’t have health coverage through their employer
Which Essential Plan is right for you?
Your income will determine which plan you are eligible for. For example, the 2025 Income Guidelines for a single individual are:
- Essential Plan 200-250: Annual income between $31,301 and $39,125
- Essential Plan 1: Annual income between $23,476 and $31,300
- Essential Plan 2: Annual income between $21,598 and $23,475
The Essential Plan also offers coverage to lawfully present immigrants in the first five years of their qualified status with incomes at or below 138% of the Federal Poverty Level. These individuals may be ineligible for Medicaid due to non-citizen status. Guidelines for those individuals are:
- Essential Plan 3: Annual income between $15,650 and $21,597
- Essential Plan 4: Annual income below $15,650
If you meet eligibility requirements, you can apply for the Essential Plan at any time during the year through NY State of Health, The Official Health Plan Marketplace.
What are some of the benefits included in the Essential Plan?
- Free preventive care, like checkups with your primary care provider (PCP) and routine screenings
- Dental and vision coverage
- Immunizations for flu and COVID-19
- Diabetes coverage
- Inpatient and outpatient hospital care
- Prescription drug coverage
- Maternity and prenatal care, including Fidelis Care’s free BabyCare program
- Fitness reimbursement of up to $400 each year
- Convenient and cost-saving Mail Order Pharmacy Program
- Lab tests, X-rays, and more
Visit fideliscare.org/Essential-Plan to learn more about the benefits.
How much does the Essential Plan cost?
The Essential Plan has no monthly premium. Depending on your eligibility, plans have either no or low cost sharing at the time of service.
If you have any questions about the Essential Plan, please contact Fidelis Care at 1-888-343-3547 (TTY: 711). A Fidelis Care representative can answer your questions and help you apply for the Essential Plan. You can also visit fideliscare.org/Essential-Plan.