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Essential Plan, essential healthcare, affordable healthcare, healthcare coverage, faqs, frequently asked questions, QHP to EP

Unbelievably good news:
You may now qualify for our $0 health care.

Look below for answers to frequently asked questions.

Important information on the expansion of the Essential Plan

With expanded coverage for the Essential Plan through the NY State of Health Marketplace, you may now qualify for the Essential Plan 200-250 offered by MetroPlusHealth. The Essential Plan 200-250 offered by MetroPlusHealth is designed for lower-income adults under the age of 65 who don’t qualify for Medicaid or Child Health Plus.

Frequently Asked Questions

I received a letter about switching to the Essential Plan 200-250 offered by MetroPlusHealth. Why did I get this?

You may now qualify for the Essential Plan 200-250 offered by MetroPlusHealth at $0 per month, effective April 1, 2024.
The Essential Plan 200-250 offered by MetroPlusHealth will cover all essential health benefits with low copays for certain services and no annual deductible.

Why was I selected?

NY State of Health looked at your household size, income and other information listed in your application, and information from state and federal data sources to decide your eligibility. We based this decision on income information from federal or state data sources. Your household income is between $39,442.00 and $49,300.00. This is the income range for the Essential Plan 200-250 offered by MetroPlusHealth for your household size. If you are a qualified member of a federally recognized tribe or an Alaska Native, your co-pays will be waived.

Do I have choices?

Yes. Carefully read any communications from New York State to understand your options. You can:

  • Switch to the Essential Plan 200-250 offered by MetroPlusHealth: New York State will automatically move you to the Essential Plan 200-250 offered by MetroPlusHealth unless you opt out of the change.
  • Stay in your current MetroPlusHealth Qualified Health Plan: You can choose to stay in your current plan by opting out of the Essential Plan 200-250 offered by MetroPlusHealth. Follow the directions in the letter from New York State by the provided deadline. If you opt out of the Essential Plan 200-250 offered by MetroPlusHealth, you will lose any subsidies that you receive to lower the cost of your premium.

What benefits will I receive if I switch to the Essential Plan 200-250 offered by MetroPlusHealth?

The Essential Plan 200-250 offered by MetroPlusHealth is a quality, low-cost health plan and it is the same health plan you know and trust. The plan features a $0 monthly premium, $0 deductible, and low or no out-of pocket costs.

The Essential Plan 200-250 offered by MetroPlusHealth includes a full range of benefits to support your health and wellness, including:

FREE preventive care like checkups with your primary care provider and routine screenings
Dental and vision
Hospital care
Prenatal care
Prescription drugs
Lab tests, X-rays, and more!

I want to move my current plan to the Essential Plan 200-250 offered by MetroPlusHealth. What happens next?

You do not have to do anything. If you qualify, your current plan will automatically by switched to the Essential Plan 200-250 offered by MetroPlusHealth.

New York State will determine the date that you are moved to the Essential Plan 200-250 offered by MetroPlusHealth which will be on or around April 1, 2024. Read the communication from New York State. MetroPlusHealth will also communicate this information to you. You will receive your ID card and other important information in the mail 6-10 days after your enrollment date.

If you need your ID card before you receive it in the mail, you can download one from the member portal.

Do I need to do anything else?

If you don’t already have a primary care provider (PCP), you will need to choose one. If you already have a PCP call the doctor’s office to inform of your new health plan. You can find a doctor by clicking the button below.

Essential Plan Resources

Log in to the Member Portal to view your contract and benefits. Essential Plan members can also visit our Essential Plan Member page for information about benefits.

Comparing the MetroplusHealth QHP Plan to the Essential Plan 200-250 offered by MetroPlusHealth

MetroPlusHealth QHP Plan (your old health plan)

You pay a Premium
Higher Copays
You pay Deductibles
Adult Dental and Vision for non-standard plans is included
Free Virtual Visit - 24/7 online access to doctors at HHC facilities
Higher copays for generic pharmacy drugs
$0 Premium
Lower Copays
No Deductible
Adult Dental and Vision for non-standard plans is included
Free Virtual Visit - 24/7 online access to doctors at HHC facilities
Lower copays for generic pharmacy drugs
last updated: April 2, 2024