Great news! More people now qualify for a $0 premium plan.
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Essential Plan in New York
*A card that can be used to purchase over-the-counter (OTC) health-related items and food.
Which Essential Plan Do I Qualify For?
Depending on your income and other factors, you may be eligible for an Essential Plan with a $0 premium.
Helpful Resources
Our Enhanced Care network offers access to top health care professionals and conveniently-located pharmacies. Use our search tools to find care and pharmacies near you.
The EmblemHealth Difference
Your health and well-being depends on more than just going to the doctor. That’s why we offer you additional wellness benefits to keep you feeling your best.
**Free, with no obligation to enroll.
Frequently Asked Questions
Get the answers you need to make the most of your plan.
Eligibility for the Essential Plan is based on income, where you live, your citizenship/immigration status, and other factors. EmblemHealth can help you learn if you’re eligible and help enroll you in a plan if you are. Please contact our Essential Plan team at 866-230-1071 (TTY: 711) to see if you qualify.
If you’re not eligible for the Essential Plan, you may qualify for one of our Medicaid plans. Visit our state-sponsored programs page to learn more.
Yes, Essential Plan 3 and 4 are available to legally-residing immigrants. During your enrollment process, you will need to provide documentation to support your legally-residing status. You can download a helpful checklist of documentation you may be asked to provide. In addition, if you have Deferred Action for Childhood Arrivals (DACA) status, you may be eligible for the Essential Plan if you meet other requirements. For more information, contact 866-230-1071 (TTY: 711).
Essential Plan members must renew their coverage every year. Visit our renewing coverage page for helpful resources, including a renewal checklist and short video on how to renew.
If you need assistance, we’re here to help. Call us at 888-432-8026 (TTY: 711) from 8 a.m. to 6 p.m., Monday through Friday. Prefer in-person support? Stop by or schedule an appointment at an EmblemHealth Sales Office or Neighborhood Care location near you.
The Essential Plan provides coverage for preventive care, mental health/substance use disorder services, lab services, ER visits, hospital stays, rehabilitative and habilitative services, prescription drugs, and more as required by the Affordable Care Act (ACA). Coverage for adult vision and dental care is also included.
The Essential Plan offered through EmblemHealth also includes convenient telemedicine through Teladoc® Primary360, which is available by phone, video, or messaging through a mobile app at no additional cost. This benefit includes:
- General medicine.
- Primary care.
- Behavioral health.
- Dermatology services.
Members can see the same doctor throughout their care with no limit on the number of Teladoc virtual visits. Teladoc also provides care for nonemergency conditions 24/7 and prescription medicines when medically necessary through on-demand general medical physician services.*
*Not all services available 24/7.
Yes, if an Essential Plan member becomes pregnant or enrolls in the plan while they are pregnant, they will have coverage. If your Essential Plan includes cost-sharing for certain services, those will be waived during your pregnancy and 12-month postpartum period.
Please note: To report a pregnancy, call the NY State of Health at 855-355-5777 or sign in to your account at nystateofhealth.ny.gov. Newborns need to be enrolled in Medicaid before or shortly after their birth, as coverage for children under the age of 19 is not available through the Essential Plan.
EmblemHealth’s Enhanced Care network is designed to offer access to top providers where you live and work. The Essential Plan offers in-network coverage only. Members who receive out-of-network services are responsible for the full cost of such care, except in the case of a medical emergency.
Use the FAIR Health Calculator** to estimate the cost of nonemergency medical services and procedures by ZIP code.
**FAIR Health, Inc. is an independent nonprofit organization that uses actual provider charges when calculating fees. FAIR Health ensures that its fee information is accurate and complete. Please review the privacy policy and terms and conditions on the FAIR Health website.
