Empire Blue Cross N the Bronx Child Health Plus
New York Essential Program. The #one most affordable wellness programme in NY
Telephone call Now to See if Y'all May Qualify for the New York Essential Programme (888)215-4045
Updated for 2022: All New York Land Essential Plans will now include Dental and Vision Coverage at no additional cost. Additionally, the monthly premium of 20 dollars for Essential Plan 1 has been removed. All four essential plans volition now accept a zip premium.
The Essential Program is a New York health insurance programme for state residents that don't authorize for Medicaid or the Child Wellness Plus Programme. There are a total of four Essential Program options and each option is based on your household income level.
New York State (NYS) created this program to fill the coverage gap that many individuals and families take as they do non qualify for Medicaid but cannot afford full premium coverage.
Table OF CONTENTS
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How to Enroll in the Essential Plan
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What does the Essential Programme Price
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Are You Eligible for the Essential Plan?
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Essential Plan Residency Requirements
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Aging In & Crumbling Out of the Essential Plan
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What Is Covered Under an Essential Plan?
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Essential Plan i and 2
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Essential Programme iii and 4
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Essential Programme Plus
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Dental Benefits
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Essential Plan Vision Care Benefits
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Insurers offering Essential Plan
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Insurers Offering Essential Plan Vs. Essential Programme Plus (Vision and Dental Included)
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2022 Essential Program Insurers and the Counties they Operate In
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Choosing the Right Essential Plan for You and Your Family
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Carrier Summary of Benefits and Formulary Listing
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Essential Plan Eligible Enrollment Dates
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Frequently Asked Essential Program Questions
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2022 Essential Program Updates
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Closing
How to Enroll in the Essential Plan
Before Enrolling in an Essential program, you may want to review the eligibility requirements, all the same your options to enroll include the following:
- Contact us at our toll-gratuitous number (888)215-4045 and we volition commencement help you determine if you are eligible. Once we determine your eligibility, nosotros then compare all of the bachelor Health insurance companies offer the essential plan in your region. Our comparing will ensure that your electric current doctor is part of the network as well equally compare network size to determine if the hospitals and labs of your pick are included in the network
- You take the option to visit each carrier to review their plans nonetheless you won't be able to compare plans side by side
- The New York Land of Health is another enrollment choice. You can become direct or we can enroll you in the plan of your choice
What does the Essential Plan Cost?
Starting in 2021 all Essential plans have removed their monthly premium requirements and are now costless! There are a total of 4 Essential program options, each based on your current income. In that location are no family plans with the essential program, just individual coverage. Children are not eligible for the Essential Programme, nonetheless, if the parent(south) authorize for the Essential and then the children are most probable eligible for Kid Health Plus (we provide enrollment services for Kid Health Plus)
Are You Eligible for the Essential Program?
There are three qualifying elements for yous to be eligible for the NY Essential Program. They are:
- Income requirements
- Residency and Immigration Status
- Aging In and Crumbling Out
Income limits are related to your family unit size. The following chart explains how your income and family size is structured.
| Household Size | Maximum Almanac Income |
|---|---|
| i* | $24,280 |
| 2 | $32,920 |
| 3 | $41,560 |
| 4** | $l,200 |
* (150% to 200% FPL)
** Add $8,640 for each additional member of your family
Essential Program Residency Requirements
Low and moderate-income families that are residents of New York Country and legal immigrants are eligible for the Essential Programme program.
All 4 Essential Plans don't accept a monthly premium, yet plan benefits are generous and provide you the ten essential health benefits mandated by the Affordable Care Act. Following are the different variations of the NYS Essential Program:
Essential Plan ane - Individuals with income greater than 150% and less than or equal to 200% of the FPL.
Essential Programme 2 - Individuals with income greater than 138% and less than or equal to 150% of the FPL.
Essential Plan 3 - Individuals with income equal to or greater than 100% and less than or equal to 138% of the FPL and not eligible for Medicaid due to immigration status.
Essential Plan four - Individuals with income below 100% of the FPL and not eligible for Medicaid due to clearing status.
Aging In & Aging Out of the Essential Programme
If you lot are an adult that is betwixt 19 and 65 years of age then you can participate in the program. Children under historic period 19 may authorize for Kid Health Plus and those past age 65 are unremarkably covered by Medicare.
What Is Covered Under an Essential Plan?
Under the Affordable Intendance Act, a certain level of minimum coverage is guaranteed to all insured people. The NY State of Health Essential Plan also features the same 10 health essentials. These are:
- Convalescent patient services (outpatient care).
- Emergency Services (given in an emergency room or urgent care facility).
- Hospitalization (when you stay in the hospital for more 24 hours, fewer hours are covered under convalescent services).
- Maternity and newborn care.
- Mental health service and drug or alcohol addiction handling (treated as whatsoever other medical disease).
- Prescription drugs.
- Rehabilitative services and devices (e.m. Physical therapy is one of the services and a brace is an example of a device).
- Laboratory services include x-rays, Cat scans, ultrasounds, and such.
- Preventative services
- Pediatric services (non applicable to New York State Essential Program as kids under 19 are covered by Child Health Plus).
Essential Plan one and Essential Program 2
To qualify for either plan 1 or 2 your household income must be betwixt 138% and 200% of the federal poverty level, be a Usa denizen living in New York State, and not enrolled in Medicare or Medicaid or exist under the age of nineteen or older than 65.
| Benefits | Essential Programme one Costs & Co-pays | Essential Programme 2 Costs & Co-pays |
|---|---|---|
| Individual Deductible | $0 (Med/Rx combined) | $0 (Med/Rx combined) |
| Private Maximum Out-of-Pocket | $two,000 (Med/Rx combined) | $200 (Med/Rx combined) |
| Inpatient Hospital Care | $150 | $0 |
| Emergency Care | $75 | $0 |
| Urgent Care | $25 | $0 |
| Outpatient Hospital Services | $l | $0 |
| Ten-rays and Labs | PCP: $xv SPC: $25 OP Facility: $50 | $0 |
| Advanced Imaging | $25 | $0 |
| PCP Office Visits | $15 | $0 |
| Specialist Office Visits | $25 | $0 |
| Adult Dental | $15 | $xv |
| Adult Vision | $15 | $fifteen |
| Non-Prescription Drugs | Not Covered | Not Covered |
| Non-Emergency Transportation | Not Covered | Not Covered |
| Generic drugs | $6 | $ane |
| Preferred Brand Drugs | $15 | $3 |
| Non-Preferred Brand and Specialty | $thirty | $iii |
Essential Programme 3 and Essential Plan iv
To qualify for Essential Programme iii or Essential Plan four, yous must offset encounter all of the requirements of plans i and two, and you must be a legal permanent resident immigrant living in New York State.
| Program Name | Essential Plan 3 Costs | Essential Plan 4 Costs |
|---|---|---|
| Private Deductible | $0 | $0 |
| Individual Maximum Out-of-pocket | $200 | $0 |
| Inpatient Hospital Care | $0 | $0 |
| Emergency Care | $0 | $0 |
| Urgent Care | $0 | $0 |
| Outpatient Infirmary Services | $0 | $0 |
| X-ray/Labs | $0 | $0 |
| Advanced Imaging | $0 | $0 |
| PCP Office Visits | $0 | $0 |
| Specialist Function Visits | $0 | $0 |
| Adult Dental | Covered at no price | Covered at no cost |
| Adult Vision | Covered at no toll | Covered at no cost |
| Not-prescription Drugs | Covered at no cost | Covered at no cost |
| Non-emergency transportation | Covered at no cost | Covered at no cost |
| Prescription drugs | $i | $0 |
| Preferred make drugs | $3 | $0 |
| Non-preferred brand drugs and Specialty | $3 | $0 |
Dental Benefits
Dental coverage is both for preventative care and routine care. benefits include:
- Two Cleanings per yr
- Oral Exams including X-rays
- Fillings
- Extractions
- Emergency care
- Orthodontics
- Dentures
- Stock-still bridges
Essential Plan Vision Care Benefits
Also, your vision care benefits include:
- One annual eye exam per twelvemonth
- Other diagnostic exams performed past an eye doc
- Lenses or contacts in one case a twelvemonth (more ofttimes if medically necessary
- Frame one time per twelvemonth unless in that location is a medical need.
There is an additional cost for the Essential Plan Plus ranging from $30 to $46 per month per person.
Insurers offering Essential Plan
The followingwellness insurance companies are participating in the NY State of Health Essential Plans:
- Analogousness Wellness Plan
- CDPHP
- EmblemHealth (Role of the HIP GHI family of plans)
- Excellus Blue Cantankerous Blue Shield
- Fidelis Intendance
- Healthfirst
- HealthNow Blueish Cross Blue Shield of Western New York
- HealthPlus HP (formerly known every bit Empire Blueish Cantankerous Blueish Shield Health Plus)
- Independent Health
- MetroPlus Health
- Molina Healthcare
- MVP
- United Healthcare
- Univera Healthcare
2022 Essential Plan Insurers and the Counties they Operate In
Below is a table list the Major New York Essential Program carriers and the respective counties they operate in as of 2020. This list is horizontally scrollable →
| County | Affinity Wellness Plan | BlueCross Blueish Shield of Western New York | CDPHP | Keepsake Wellness | Empire BlueCross BlueShield HealthPlus | Excellus Blue Cross Blue Shield | Fidelis Care | Health First | Independent Health | MetroPlus Health | Molina Health intendance | MVP | United Health care | Univera Health care |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Albany |  | | | | ||||||||||
| Allegany | | | | | ||||||||||
| Bronx | | | | | | | | |||||||
| Broome | | | | | | |||||||||
| Cattaraugus | | | | | ||||||||||
| Cayuga | | | | |||||||||||
| Chautauqua | | | | | | |||||||||
| Chemung | | | | |||||||||||
| Chenango | | | | | ||||||||||
| Clinton | | | | |||||||||||
| Columbia | | | | | ||||||||||
| Cortland | | | | |||||||||||
| Delaware | | | | |||||||||||
| Dutchess | | | | | ||||||||||
| Erie | | | | | | | ||||||||
| Essex | | | | | ||||||||||
| Franklin | | | | | ||||||||||
| Fulton | | | | | ||||||||||
| Genesee | | | | | | | ||||||||
| Greene | | | | | ||||||||||
| Hamilton | | | ||||||||||||
| Herkimer | | | ||||||||||||
| Jefferson | | | | | ||||||||||
| Kings | | | | | | | | |||||||
| Lewis | | | | | ||||||||||
| Livingston | | | | | | |||||||||
| Madison | | | | |||||||||||
| Monroe | | | | | | |||||||||
| Montgomery | | | | |||||||||||
| Nassau | | | | | | | ||||||||
| New York | | | | | | | | |||||||
| Niagara | | | | | | |||||||||
| Oneida | | | | | ||||||||||
| Onondaga | | | | | ||||||||||
| Ontario | | | | | | |||||||||
| Orange | | | | | | | ||||||||
| Orleans | | | | | | |||||||||
| Oswego | | | | |||||||||||
| Otsego | | | ||||||||||||
| Putnam | | | ||||||||||||
| Queens | | | | | | | | |||||||
| Rensselaer | | | | | ||||||||||
| Richmond | | | | | | | | |||||||
| Rockland | | | | | | |||||||||
| Saint Lawrence | | | | |||||||||||
| Saratoga | | | | | ||||||||||
| Schenectady | | | | | ||||||||||
| Schoharie | | | ||||||||||||
| Schuyler | | | ||||||||||||
| Seneca | | | | | ||||||||||
| Steuben | | | ||||||||||||
| Suffolk | | | | | | | ||||||||
| Sullivan | | | | | ||||||||||
| Tioga | | | | | | |||||||||
| Tompkins | | | | |||||||||||
| Ulster | | | | | ||||||||||
| Warren | | | | | ||||||||||
| Washington | | | | |||||||||||
| Wayne | | | | | ||||||||||
| Westchester | | | | | | | | |||||||
| Wyoming | | | | | | |||||||||
| Yates | | | |
Choosing the Right Essential Plan for You lot and Your Family unit
Virtually counties in New York Country have more than one Essential Program wellness insurance company for you lot to cull from. Since many insurance companies have contracts with unlike doctors and hospitals, it may exist that your preferred medico and hospital are non on every plan offered. When you lot shop for an Essential Plan check to ensure that your doctor(s) and preferred hospital are part of the provider network.
Carrier Summary of Benefits and Formulary List
While the Essential plan but has four options that are based on income. Each carrier often includes additional benefits such as telehealth, teledoc, gym reimbursement programs, and wellness programs to create brand awareness and to concenter clientele. Beneath is a list of carriers that have fabricated their plan summaries and pharmacy formulary listings available.
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Affinity Health Program
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EmblemHealth (Part of the HIP GHI family unit of plans)
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Excellus Blue Cross Blue Shield
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Fidelis Intendance
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HealthFirst
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HealthNow Bluish Cross Blue Shield of Western New York
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HealthPlus HP (formerly known as Empire Blue Cantankerous Blue Shield Health Plus)
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Contained Health
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MetroPlus Health
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MVP
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United Healthcare
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Univera Healthcare
Analogousness Health Programme
- Affinity NY Essential Plan ane
- Analogousness NY Essential Programme 1 Plus
- Affinity NY Essential Program 2
- Affinity NY Essential Program 2 Plus
- Affinity NY Essential Plan iii
- Affinity NY Essential Plan 4
- Affinity Comparing of all 4 plans
- Affinity Drug Formulary Listing
- Affinity Over the Counter Formulary listing for plans 3 and four
EmblemHealth (Part of the HIP GHI family of plans)
- EmblemHealth NYS Essential Programme 1
- EmblemHealth NYS Essential Plan 1 Plus
- EmblemHealth NYS Essential Plan two
- EmblemHealth NYS Essential Plan 2 Plus
- EmblemHealth NYS Essential Program three
- EmblemHealth NYS Essential Programme iv
- EmblemHealth NYS Drug Formulary Listing
Excellus Bluish Cross Blue Shield
- Excellus NY Essential Plan 1
- Excellus NY Essential Plan 1 Plus
- Excellus NY Essential Program 2
- Excellus NY Essential Plan 2 Plus
- Excellus NY Essential Program 3
- Excellus NY Essential Program 4
Fidelis Care
- Fidelis Care NYS Essential Plan 1
- Fidelis Care NYS Essential Program 1 Plus
- Fidelis Care NYS Essential Plan 2
- Fidelis Intendance NYS Essential Plan 3
- Fidelis Care NYS Essential Plan 4
- Fidelis Care NYS Essential Plan Side past Side Comparison
- Fidelis Care NYS Essential Plan Dental and Vision Comparison
- Fidelis Care NYS Drug Formulary Listing
HealthFirst
- HealthFirst NY Essential Plan 1
- HealthFirst NY Essential Plan 1 Plus
- HealthFirst NY Essential Plan 2
- HealthFirst NY Essential Programme 2 Plus
- HealthFirst NY Essential Programme three
- HealthFirst NY Essential Program four
- HealthFirst NY Essential Plan Drug Formulary Listing
HealthNow Blueish Cross Blueish Shield of Western New York
- HealthNow NYS Essential Plan 1
- HealthNow NYS Essential Plan 1 Plus
- HealthNow NYS Essential Program 2
- HealthNow NYS Essential Program 2 Plus
- HealthNow NYS Essential Plan 3
- HealthNow NYS Essential Plan four
- HealthNow NYS Essential Plan Drug Formulary List
H ealthPlus HP formerly known as Empire Blue Cross Blue Shield Health Plus
- HealthPlus HP NY Essential Programme i
- HealthPlus HP NY Essential Plan 1 Plus
- HealthPlus HP NY Essential Plan ii
- HealthPlus HP NY Essential Plan 2 Plus
- HealthPlus HP NY Essential Plan iii
- HealthPlus HP NY Essential Plan iv
- HealthPlus HP NY Essential Plan Drug Formulary List
Contained Wellness
- Independent Wellness NY Essential Plan ane
- Contained Health NY Essential Programme 2
- Independent Wellness NY Essential Program 3
- Independent Health NY Essential Plan 4
- Independent Health NY Essential Programme Drug Formulary Listing
MetroPlus Health
- MetroPlus NY Essential Plan i
- MetroPlus NY Essential Plan 1 Plus
- MetroPlus NY Essential Plan 2
- MetroPlus NY Essential Plan two Plus
- MetroPlus NY Essential Plan 3
- MetroPlus NY Essential Program 4
- MetroPlus NY Essential Plan Drug Formulary Listing
MVP
- MVP Essential Plan ane
- MVP Essential Plan 2
- MVP Essential Plan iii
- MVP Essential Programme 4
- MVP Essential Plan Drug Formulary List
United Healthcare
- United HealthCare NYS Essential Programme 1
- United HealthCare NYS Essential Plan 1 Plus
- United HealthCare NYS Essential Plan two
- United HealthCare NYS Essential Plan 2 Plus
- United HealthCare NYS Essential Plan iii
- United HealthCare NYS Essential Program 4
- United HealthCare NYS Essential Plan Drug Formulary Listing
Univera Healthcare
- Univera HealthCare NYS Essential Plan 1
- Univera HealthCare NYS Essential Plan 1 Plus
- Univera HealthCare NYS Essential Plan ii
- Univera HealthCare NYS Essential Plan ii Plus
- Univera HealthCare NYS Essential Program three
- Univera HealthCare NYS Essential Plan iv
Essential Plan Eligible Enrollment Dates
Unlike other plans available nether the Affordable Care Act, you can enroll in a Health Essential Plan whatever fourth dimension throughout the year.
Frequently Asked Essential Plan Questions
What medical services does the Essential Programme comprehend ? – The plans cover the aforementioned mandatory services covered by other plans sold in New York. These services are known as Essential Health Benefits. In broad terms this includes:
- Doctor visits, including specialists
- Tests ordered past your doctor
- Prescription drugs
- Inpatient and outpatient care at a hospital
When is enrollment ? – Open up enrollment is year-circular.
Would I nonetheless qualify if I'm self-employed? - Yes, the program is open up to Freelancers, independent contractors, the self-employed, and all persons who don't have an affordable health insurance option bachelor to them at their place of employment. Additionally, for persons out of work, you lot still may authorize.
What happens if I miss a premium payment? – Since premiums are paid in advance, if you miss a premium payment (if you lot pay premiums) you will lose your coverage for the next calendar month. Simply, you can re-enroll at any time without punishment.
I accept a copay, are any services gratis? – Yes! Preventative care like a routine physical and some screening tests are non subject to the copay.
I'one thousand pregnant, tin I exist covered by the NYS Essential Program? – No, but that is because y'all are eligible for coverage nether the New York State Medicaid Program.
Does my clearing condition matter? – It does. Even so, virtually immigrants tin qualify if they come across other eligibility requirements. These requirements include:
- You became a citizen
- You are a legal permanent resident
- A lawfully present resident
- In a valid and non-immigrant condition, such as a visiting student with a valid visa.
How much does the Essential program health insurance cost? Beginning in 2021, all Essential plans take removed the monthly premium, making the plan free
2022 Essential Plan Updates
For 2022, there will be a total of 14 health insurance carriers offering essential programme coverage throughout the 62 counties of New York.
The following 16 counties will have 1 Essential Plan carrier in their area: Allegany, Broome, Cattaraugus, Chautauqua, Chenango, Erie, Genesee, Livingston, Monroe, Ontario, Orleans, Putnam, Seneca, Tioga, Wayne, and Westchester.
The Essential Plan has lost 2 carriers for 2022; WellCare of New York and YourCare Health Programme of New York.
Fidelis Care is now offering the essential plan in Putnam canton, for a total of 61 out of 62 new york counties
Molina Healthcare, a relatively new carrier in New York (who recently purchased YourCare Health Plan of New York) has expanded its Essential plan offer to a total of eighteen counties, of which the following xv counties are new for 2022; Allegany, Broome, Cattaraugus, Chautauqua, Chenango, Erie, Genesee, Livingston, Monroe, Ontario, Orleans, Seneca, Tioga, Wayne, and Wyoming
Closing
The Essential plan is a cost-effective NY health insurance program available to those who earn too much to qualify for Medicaid while providing all of the essential wellness benefits required by law.
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Source: https://www.nyhealthinsurer.com/new-york-essential-plan/
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