Essential Plan 1
Essential Plan 2
Deductible
(individual)
Essential Plan 1
$0
Essential Plan 2
$0
Eligible Age
19 to 64
19 to 64
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), on Long Island, and in Westchester, Orange, Rockland, and Sullivan counties
Other Eligibility Requirements
Essential Plan 1
Income between $23,940 and $31,920††
Essential Plan 2
Income between $22,025 and $23,940††
Maximum Out-of-Pocket
(individual)
Essential Plan 1
$360
Essential Plan 2
$200
Your Annual Checkup
Essential Plan 1
$0 copay
Essential Plan 2
$0 copay
Primary Care Provider (PCP) Visit
Essential Plan 1
$15 copay
Essential Plan 2
$0 copay
Maternity Care
$0 copay
$0 copay
Dental Cleanings
Essential Plan 1
$0 copay
Essential Plan 2
$0 copay
Vision Exams
Essential Plan 1
$0 copay
Essential Plan 2
$0 copay
Telemedicine
(Teladoc)
Essential Plan 1
$0 copay
Essential Plan 2
$0 copay
Specialist Visit
Essential Plan 1
$25 copay
Essential Plan 2
$0 copay
Retail Health Clinic
Essential Plan 1
$25 copay
Essential Plan 2
$0 copay
Urgent Care
Essential Plan 1
$25 copay
Essential Plan 2
$0 copay
Emergency Room
Essential Plan 1
$75 copay
Essential Plan 2
$0 copay
Ambulance
Essential Plan 1
$75 copay
Essential Plan 2
$0 copay
Surgeon
Essential Plan 1
$50 copay
Essential Plan 2
$0 copay
Outpatient Facility
Essential Plan 1
$50 copay
Essential Plan 2
$0 copay
Inpatient Hospital Stay
Essential Plan 1
$150 copay per admission
Essential Plan 2
$0 copay per admission