Essential Plan
The health care you need, at a price you can afford.
With no monthly premiums and no cost for dental and vision, our Essential Plans offer all of the essential benefits you need: preventative care, emergency care, prescription drugs, mental health, and more.
Plus, there’s no deductible, so the plan starts paying for your health care right away. You get free preventive care like routine doctor exams and screenings to keep you healthy. Check out our plans below.
Plan Features
Eligibility
Monthly Premium
Deductible
Annual Checkup
Doctors & Specialists
$0 24/7 Telehealth
Hospital Visits
Adult Dental & Vision
Pediatric Dental & Vision
Hearing
Prescription Drug Coverage
Prepackaged Medications
Fitness Reimbursement
Weight Loss Program Reimbursement
Qualified New Yorkers
$0
$0
$0
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$200 every 6 mo. for member
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How can I enroll?
Enrollment for the Essential Plans is open all year long. There are three ways you can enroll:
- By Phone:
Call MetroPlusHealth Member Services at (855) 809-4073, TTY users: 711, Monday through Saturday, 8 AM – 8 PM. - In Person:
Wherever you live in New York City, our Marketplace Facilitated Enrollers (FEs), navigators, brokers and agents are available to help you complete your application in the NY State of Health Marketplace. Call us at (855) 809-4073, TTY: 711. Monday through Friday, 8 AM – 8 PM and Saturday, 9 AM – 5 PM to make an appointment. - Online:
NY State of Health, the Official Health Plan Marketplace (aka “the Exchange”) lets you compare plans and premium rates. Visit nystateofhealth.ny.gov/.
What does the Essential Plan provide?
For more information about the below mentioned preventive care benefits go to healthfinder.gov.
Outpatient care — the kind you get without being admitted to a hospital
Trips to the emergency room
Treatment in the hospital for inpatient care
Mental health and substance use disorder services: behavioral health treatment, counseling, and psychotherapy
Prescription drugs
Services and devices to help you recover if you are injured, or have a disability or chronic condition: physical and occupational therapy, speech-language pathology, psychiatric rehabilitation
Lab tests
Preventive services to keep you healthy: counseling, screenings, vaccines, managing a chronic disease
With all our plans you get:
Who is Eligible for the Essential Plan?
MetroPlusHealth has gathered a list of resources available to help New Yorkers get services such as childcare, food and nutrition, housing, and transportation. These resources are available for all our members. If you need help with any of these things, learn more here.
I have been with MetroPlusHealth for 10 years and am very satisfied with them being my health care provider. I get my questions answered from the professional, knowledgeable & caring agents every time. Everything I get with MetroPlusHealth I know doesn’t exist with other health care companies. I have inquired many times.
Covered Preventive Care Services
Frequently Asked Questions
Plan Materials
Our Certificate of Coverage explains the details of your Essential Plan coverage, including your benefits, the rules of the plan, and information about how to receive care. Here’s where to see the different certificates of all the different plans.
EP 1 and 2 members, please note, certificates are being updated to reflect the new $0 monthly premium and dental and vision benefits included at $0 cost. Revised certificates are coming soon.
If you would like a hard copy of this Certificate of Coverage, you can submit a request online here. Please be sure to tell us which plan Certificate of Coverage – for example, Essential Plan 2 Standard – you need.
Additional Member Resources
Access to your doctor—whenever and wherever you need it!
MetroPlusHealth Virtual Visit is the fast, easy way for our members to see a provider for common physical, mental, emotional, and behavioral health issues that are not emergencies. MetroPlusHealth Virtual Visit is available anytime, from anywhere in New York State, 24/7 – and in your language.
GREAT NEWS: STARTING JANUARY 1, 2023, METROPLUSHEALTH MEMBERS WILL RECEIVE THEIR DENTAL BENEFITS FROM DENTAQUEST.
Know your rights and protections against surprise medical bills!
When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.
Are you receiving care at an NYC Health + Hospitals facility?
Manage Your Health Online With MyChart. Members who receive care at NYC Health + Hospital facilities now have access to MyChart. MyChart is a free secure portal you can use to manage your health information. MyChart allows you to:
- Message your primary care provider’s office
- Request refills of your prescription drugs
- Access your test results
- Schedule appointments
Explore all MetroPlusHealth Plans
