Individual & Family Plans Essential Plans

The Essential Plan covers important health benefits for a $0 monthly premium, plus $0 copay for dental and vision. Sponsored by New York State, our Essential Plans are for qualified individuals ages 19 to 64.

NOTE: Essential Plan 200–250 has ended.

CHOOSE PLAN LEVEL
CHOOSE PLAN LEVEL
Essential Plan 1 & 2

For U.S. citizens, eligible individuals, and permanent or legal residents.

  • Naturalized citizens
  • New York State residents
Essential Plan 3 & 4

For eligible individuals/students

  • Students with valid visas
  • Eligible residents

Essential Plan 1 & 2 highlights

Star rating

No-cost annual checkups

Hospital, emergency room, and urgent care visits

Lab tests and x-rays

Prescription drug coverage

Maternity coverage

No-cost dental and vision coverage

24/7 access to care with telemedicine (Teladoc)*

Physical, occupational, and speech therapy

Annual gym membership reimbursement**

Costs and plan details

Essential Plan 1
Essential Plan 2
Premium
$0
$0
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

Prescription drug benefits

Essential Plan 1
Essential Plan 2
Generic Drugs (Tier 1)
Essential Plan 1 $6 copay
Essential Plan 2 $1 copay
Brand Name Preferred (Tier 2)
Essential Plan 1 $15 copay
Essential Plan 2 $3 copay
Brand Name Non-Preferred (Tier 3)
Essential Plan 1 $30 copay
Essential Plan 2 $3 copay
90-Day Mail-Order Supply for Generic (Tier 1)
Essential Plan 1 $15 copay
Essential Plan 2 $2.50 copay

Additional benefits

24/7 access to telemedicine with Teladoc

Talk to a doctor any time—for a $0 copay. Connect with board-certified doctors through video chat or phone for prescriptions, help diagnosing and treating non-emergency conditions, and more. Access to dermatologists is also available.

Active&Fit ExerciseRewards™ program

Physical activity is one of the simplest ways to stay healthy, and Healthfirst makes it even more rewarding! With the Active&Fit ExerciseRewards program, you can earn up to $200 every six months if you visit a qualifying fitness center at least 50 days during the same six-month reward period.

The Active&Fit ExerciseRewards program makes working out affordable, too! For just $28/month, you get access to thousands of participating fitness centers. Premium fitness center options are available for additional monthly fees. Track your activity, monitor your progress, achieve your fitness goals, and so much more!

Plan documents

General plan information

•
•

Prescription drug information

•
  • Comprehensive Formulary (List of Covered Drugs)
See all plan documents Find member forms

Frequently asked questions

NY State Essential Plans provide health insurance for qualified New Yorkers—with $0 premiums, $0 deductibles, and copays as low as $0.

Essential Plans are for lower-income New Yorkers who don’t qualify for other health insurance options. You can apply if you are:

  • 19–64 years
  • A New York State resident
  • Within the income requirements
  • Lawfully present in the U.S.
  • Not eligible for Medicaid, Child Health Plus, or other health coverage (e.g., from your employer)

No. Essential Plans are for individuals who don’t meet the income requirements for Medicaid.

Disclaimers

This information is not a complete description of benefits. Contact the plan for more information.

Coverage is provided by Healthfirst PHSP, Inc.

Plans contain exclusions and limitations.

ATENCIÓN: Dispone de servicios de asistencia lingüística y otras ayudas, gratis. Llame al 1-866-305-0408 (TTY: 1-888-867-4132).

请注意：您可以免费获得语言协助服务和其他辅助服务。请致电 1-866-305-0408 (TTY: 1‑888‑542‑3821)。

*Telemedicine (Teladoc) isn't a replacement for your primary care provider (PCP). Your PCP should always be your first choice for care (both in-person and virtual visits).

**Up to $200 per reward period. There are two reward periods—January through June, and July through December.

††Based on 2024 earnings. The income range shown is for individuals only. The income range may increase based on the eligible members in your household. To learn more, talk to a Healthfirst representative.

Last update January 1, 2026 @ 12:07 am

Essential Plan 3 & 4 highlights

Star rating

No-cost annual checkups

Hospital, emergency room, and urgent care visits

Lab tests and x-rays

Prescription drug coverage

Maternity coverage

No-cost dental and vision coverage

24/7 access to care with telemedicine (Teladoc)*

Physical, occupational, and speech therapy

Annual gym membership reimbursement**

Costs and plan details

Essential Plan 3
Essential Plan 4
Premium
$0
$0
Deductible (individual)
Essential Plan 3 $0
Essential Plan 4 $0
Eligible Age
21 to 64
21 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 3 Income between $15,960 and $22,025††
Requires legal U.S. residency for less than five years.
Learn more about your legal status here.
Essential Plan 4 Income less than $15,960††
Requires legal U.S. residency for less than five years.
Learn more about your legal status here.
Maximum Out-of-Pocket (individual)
Essential Plan 3 $200
Essential Plan 4 $0
Your Annual Checkup
Essential Plan 3 $0 copay
Essential Plan 4 $0 copay
Primary Care Provider (PCP) Visit
Essential Plan 3 $0 copay
Essential Plan 4 $0 copay
Maternity Care
$0 copay
$0 copay
Dental Cleanings
Essential Plan 3 $0 copay
Essential Plan 4 $0 copay
Vision Exams
Essential Plan 3 $0 copay
Essential Plan 4 $0 copay
Telemedicine (Teladoc)
Essential Plan 3 $0 copay
Essential Plan 4 $0 copay
Specialist Visit
Essential Plan 3 $0 copay
Essential Plan 4 $0 copay
Retail Health Clinic
Essential Plan 3 $0 copay
Essential Plan 4 $0 copay
Urgent Care
Essential Plan 3 $0 copay
Essential Plan 4 $0 copay
Emergency Room
Essential Plan 3 $0 copay
Essential Plan 4 $0 copay
Ambulance
Essential Plan 3 $0 copay
Essential Plan 4 $0 copay
Surgeon
Essential Plan 3 $0 copay
Essential Plan 4 $0 copay
Outpatient Facility
Essential Plan 3 $0 copay
Essential Plan 4 $0 copay
Inpatient Hospital Stay
Essential Plan 3 $0 copay per admission
Essential Plan 4 $0 copay per admission

Prescription drug benefits

Essential Plan 3
Essential Plan 4
Generic Drugs (Tier 1)
Essential Plan 3 $1 copay
Essential Plan 4 $0 copay
Brand Name Preferred (Tier 2)
Essential Plan 3 $3 copay
Essential Plan 4 $0 copay
Brand Name Non-Preferred (Tier 3)
Essential Plan 3 $3 copay
Essential Plan 4 $0 copay
90-Day Mail-Order Supply for Generic (Tier 1)
Essential Plan 3 $2.50 copay
Essential Plan 4 $0 copay

Additional benefits

24/7 access to telemedicine with Teladoc

Talk to a doctor any time—for a $0 copay. Connect with board-certified doctors through video chat or phone for prescriptions, help diagnosing and treating non-emergency conditions, and more. Access to dermatologists is also available.

Active&Fit ExerciseRewards™ program

Physical activity is one of the simplest ways to stay healthy, and Healthfirst makes it even more rewarding! With the Active&Fit ExerciseRewards program, you can earn up to $200 every six months if you visit a qualifying fitness center at least 50 days during the same six-month reward period.

The Active&Fit ExerciseRewards program makes working out affordable, too! For just $28/month, you get access to thousands of participating fitness centers. Premium fitness center options are available for additional monthly fees. Track your activity, monitor your progress, achieve your fitness goals, and so much more!

Plan documents

General plan information

•
•

Prescription drug information

•
  • Comprehensive Formulary (List of Covered Drugs)
See all plan documents Find member forms

Frequently asked questions

NY State Essential Plans provide health insurance for qualified New Yorkers—with $0 premiums, $0 deductibles, and copays as low as $0.

Essential Plans are for lower-income New Yorkers who don’t qualify for other health insurance options. You can apply if you are:

  • 19–64 years
  • A New York State resident
  • Within the income requirements
  • Lawfully present in the U.S.
  • Not eligible for Medicaid, Child Health Plus, or other health coverage (e.g., from your employer)

No. Essential Plans are for individuals who don’t meet the income requirements for Medicaid.

Disclaimers

This information is not a complete description of benefits. Contact the plan for more information.

Coverage is provided by Healthfirst PHSP, Inc.

Plans contain exclusions and limitations.

ATENCIÓN: Dispone de servicios de asistencia lingüística y otras ayudas, gratis. Llame al 1-866-305-0408 (TTY: 1-888-867-4132).

请注意：您可以免费获得语言协助服务和其他辅助服务。请致电 1-866-305-0408 (TTY: 1‑888‑542‑3821)。

*Telemedicine (Teladoc) isn't a replacement for your primary care provider (PCP). Your PCP should always be your first choice for care (both in-person and virtual visits).

**Up to $200 per reward period. There are two reward periods—January through June, and July through December.

††Based on 2024 earnings. The income range shown is for individuals only. The income range may increase based on the eligible members in your household. To learn more, talk to a Healthfirst representative.

Last update January 1, 2026 @ 12:07 am

Learn about enrollment

Call to speak with a sales representative
1-844-434-7785

TTY English: 1-888-542-3821

TTY Español: 1-888-867-4132

Monday to Friday, 9am–6pm

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Our sales team will call you within one business day.

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Visit a neighborhood Community Office near you to talk to us in person, and take care of your health insurance needs.

You can also go to the NY State of Health website to view your choices, or call the NY State of Health customer service center at 1-855-355-5777.

Questions? Ready to enroll?
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