What’s The Difference Between NY’s Essential Plan 1 and 2?

Because most New Yorkers qualify for the first two tiers of the Essential Plan, let’s break down the differences between NY’s Essential Plan 1 and 2.

The Essential Plan 1

The Essential Plan 1 is defined by income limits which are based on family size.

These are the income limits for the Essential Plan 1:

• Individuals: $37,650
• Families of 2: $51,100
• Families of 3: $64,550
• Families of 4: $78,000

If you qualify for the Essential Plan 1, you’re in the highest income tier of all four categories. So there will be some small costs associated with your plan.

The costs for common Essential Plan 1 services are:

• $0 deductible
• $20 monthly premium
• $2,000 out-of-pocket maximum
•  $0 for preventative care
• $15 to see your primary care physician
• $25 to see a specialist
• $75 for an ambulance ride or emergency room visit

The Essential Plan 2

Like the Essential Plan 1, the Essential Plan 2 is also defined by income limits that are based on family size.

These are the income limits for the Essential Plan 2:

• Individuals: $16,245 – $17,655
• Families of 2: $21,983 – $23,895
• Families of 3: $27,724 – $30,134
• Families of 4: $33,465 – $36,374

Individuals and families who qualify for the Essential Plan 2 will have virtually free health care. The only money that people on the Essential Plan 2 will spend is for an out-of-pocket maximum and prescription drugs.

The costs associated with the Essential Plan 2 are:

• $200 out-of-pocket maximum
• Between $1 – $3 for prescription drugs