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2020/2021 New York Essential Plan Income Guideline

Essential Plan

Sign up for an essential plan (this is the original material is being used for reference)

Federal Poverty Level Federal Poverty Level

The state government usually reviews the income of Medicaid applicants based on federal poverty line income standards. (between 100% and 400% of the federal poverty line)

Here is the standard for the 2020 US federal poverty line. (*Alaska and *Hawaii states have different federal poverty lines than other states)

Being able to find affordable health care with a low income is extremely difficult. This is completely false.

Many New Yorkers think they can't get health insurance because it costs too much, but with NY State of Health's new "Essential Plan" if you qualify, coverage could be as little as $20 a month.


I ASKED YOU TO GET MATERIAL FROM HERE, CHANGE IT A LITTLE BIT, BUT IN ESSENCE, YOU GAVE ME ACA. ACA IS A NATIONWIDE, ENTIRE USA PLAN, WHAT YOU GAVE ME IS SO USELESS, I DIDN'T USE, BUT I understand that you are not from USA, let alone not from NY, hence you have no clue, but you work does deserve 3 stars only.

Please go back and take a look at my instruction to you, which I have spend a lot of time, I want to be specific & concise, but the thing you gave me back, USELESS.

Imagine I am looking to write an article about Essential Plan, you gave me Obama ACA, which at this point already being challenged in the court as unconstitutional, why in my right mind would I still go & write about something that will be toss out right away?

The legislation of the Affordable Care Act has made it mandatory for the states that adopt it to provide basic health care facilities to all. Under the Affordable Care Act, a certain amount of minimum coverage is guaranteed to all people and 10 health essential have been listed that are to be provided to all. These include:

  • Ambulatory patient services (outpatient care).
  • Emergency Services (given in an emergency room or urgent care facility).
  • Hospitalization (when you stay in the hospital for more than 24 hours, fewer hours are covered under ambulatory services).
  • Maternity and newborn care.
  • Mental health service and drug or alcohol addiction treatment (treated as any other medical illness).
  • Prescription drugs.
  • Rehabilitative services and device (e.g. Physical therapy is one of the services and a brace is an example of a device).
  • Laboratory services including x-rays, CAT scans, ultrasounds, and such.
  • Preventative services
  • Pediatric services (not applicable to New York State Essential Plan as kids under 19 are covered by Child Health Plus).

The state of New York has also adopted the Affordable Care Act under which the Essential Health The plan is being offered by many insurance companies. Here at we compare different essential health plans as well as provide details of eligibility criterions and which plan is best for you. Mention below are the answers to some frequently asked question.

What are essential health plans?

The essential health plan offers quality health insurance to working adults with lower incomes who do not qualify for Medicaid. According to the Affordable Care Act, there are ten essential services that all health care providers must provide their customers. These include but are not limited to prescription drug coverage, pregnancy, doctor’s services, inpatient and outpatient hospital services, childbirth, mental health services and more. Under the Act it has also been made mandatory to provide dental for children, however dental service for adults is optional. These essential health packages vary state to state so it is vital that you know what your state’s requirements before you chose a health plan.

How do I apply for the essential plan?

You can apply for an essential plan any time of the year. It can be done online through the NY state of health website or on call via 855-355-5777. You can also apply for it in person through an in-person enroller. Different websites can also help you find the right insurance company to enroll with.

How much does the Essential plan cost?

Essential health plans cost as low $0 to $20 while offering the same essential benefits that are offered in New York State of Health plans. Below is a table to better understand the costing of essential health plans.

For individuals with income at or below 138% of the Federal Poverty Level (FPL) will have no premium. Those with an income higher than 138% - (less than or equal to) 150% of the FPL will have no premium unless they select a plan with dental and vision. Individual with income greater than 150%- (less than or equal to) 200% of the FPL will have a premium of $20 per individual per month and a higher premium if selecting dental and vision plan.

Is Obama Care essential plans?

The essential health plans are offered under the Affordable Care Act, which is more commonly referred to as Obama Care. The state of New York is one of the few states providing basic health plans under the Act.

Do I qualify for essential plans?

There are three eligibility criterions to qualify for an essential health plan. They are Income requirements, Residency and Immigration status, and Age.

Adults between age 19 and 65 can participate in the program if they fall within the 150% to 200% Federal Poverty Level. The income limit is also related to your family size. For each additional member, a further $8,649 is added to the upper limit. Children under age 19 may qualify for Child Health Plus and those past age 65 are usually covered by Medicare. In terms of the residency status, lower and middle-income families who are either residents of the state of New York or are legal immigrants are eligible to apply for an essential health plan.

What is Fidelis Care?

Fidelis care is part of the essential care plan and it offers four different income-based tiers of the essential care. It offers you four types of Essential Health plans; Essential plan 1,2,3 and 4.

  • Essential Plan 1 - Individuals with income greater than 150% and less than or equal to 200% of the FPL.
  • Essential Plan 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 4 - Individuals with income below 100% of the FPL and not eligible for Medicaid due to immigration status.

What is Essential plan 4?

The Essential plan 4 carries the same benefits as an essential plan as essential plans 1, 2 and 3. But it also has the added benefit of being able to avail vision and dental health care. In order to qualify for Essential plan 4 you must be eligible to qualify for Medicaid but unable to qualify for it due to immigration status. In that case, you can opt for Essential plan 4 where your income tier will determine which plan you may opt to choose.

What is the maximum income to qualify for free health care?

For an individual, a maximum income of $24,280 can qualify for the essential health plans or free health care. For a family of 2, $32,920 can qualify for an essential health plan. For a family of three, $41,560 and for a family of four, $50,200 qualify for essential health care. For each additional member of the family $8,640 are added to the annual income to deduce the maximum annual income that deems you eligible for the essential health plans. You need to stay at 200% or below the Federal Poverty Level to qualify for free health care.

Does the essential plan cover dental?

Essential Plan 1 and 2 do not cover dental; however essential plans 3 and 4 do cover dental and vision at no additional cost.

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