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.

Plan Highlights:

  • 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**
Choose Plan Year
Choose Plan Level
Plan Tier
Essential Plan 200-250
Premium
$0
Eligible Age
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
Income between $30,120 and $37,650††
Deductible (individual)
$0
Maximum Out-of-Pocket (individual)
$2,000
Your Annual Checkup
$0 copay
Primary Care Provider (PCP) Visit
$15 copay
Dental Cleanings
$0
Vision Exams
$0
Telemedicine (Teladoc)
$0
Specialist Visit
$25 copay
Retail Health Clinic
$25 copay
Urgent Care
$25 copay
Emergency Room
$75 copay
Ambulance
$75 copay
Surgeon
$50 copay
Outpatient Facility
$50 copay
Inpatient Hospital Stay
$150 copay per admission

Prescription Drug Benefits

Plan Tier
Essential Plan 200-250
Generic Drugs (Tier 1)
$6 copay
Brand Name Preferred (Tier 2)
$15 copay
Brand Name Non-Preferred (Tier 3)
$30 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$15 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 Direct

Healthfirst makes working out affordable too! For just $28/month, you get a standard membership to a fitness center in your area. Premium fitness center options are available for an additional fee. Track your activity, monitor your progress, achieve your fitness goals, and so much more! Visit activeandfitdirect.com to learn more.

E8F603C3-4D94-4DCE-818B-75031FE268CE Created with sketchtool.

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 $200 every six months if you visit a qualifying fitness center at least 50 days during the same six-month reward period. Contact ExerciseRewards at 1-877-810-2746 to learn more about qualifying fitness centers.

Plan Documents

2025 Essential Plan 200-250

General Plan Information
Summary of Benefits and Coverage
Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
See all forms & documents

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.

Healthfirst complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-305-0408 (TTY 1-888-867-4132). 注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 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).

DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.

EyeMed® is contracted with Healthfirst to provide vision benefits to its members.

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

††Based on 2023 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.

Plan Tier
Essential Plan 1
Essential Plan 2
Premium
$0
Eligible Age
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 $22,590 and $30,120††
Essential Plan 2 Income between $20,783 and $22,590††
Deductible (individual)
Essential Plan 1 $0
Essential Plan 2 $0
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
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

Plan Tier
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 Direct

Healthfirst makes working out affordable too! For just $28/month, you get a standard membership to a fitness center in your area. Premium fitness center options are available for an additional fee. Track your activity, monitor your progress, achieve your fitness goals, and so much more! Visit activeandfitdirect.com to learn more.

E8F603C3-4D94-4DCE-818B-75031FE268CE Created with sketchtool.

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 $200 every six months if you visit a qualifying fitness center at least 50 days during the same six-month reward period. Contact ExerciseRewards at 1-877-810-2746 to learn more about qualifying fitness centers.

Plan Documents

2025 Essential Plan 1 & 2

General Plan Information
Summary of Benefits and Coverage - Essential Plan 1
Summary of Benefits and Coverage - Essential Plan 2
Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
See all forms & documents

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.

Healthfirst complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-305-0408 (TTY 1-888-867-4132). 注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 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).

DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.

EyeMed® is contracted with Healthfirst to provide vision benefits to its members.

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

††Based on 2023 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.

Plan Tier
Essential Plan 3
Essential Plan 4
Premium
$0
Eligible Age
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 $15,060 and $20,783††
Requires legal U.S. residency for less than five years.
Learn more about your legal status here.
Essential Plan 4 Income less than $15,060††
Requires legal U.S. residency for less than five years.
Learn more about your legal status here.
Deductible (individual)
Essential Plan 3 $0
Essential Plan 4 $0
Maximum Out-of-Pocket (individual)
Essential Plan 3 $200
Essential Plan 4 $200
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
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

Plan Tier
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 Direct

Healthfirst makes working out affordable too! For just $28/month, you get a standard membership to a fitness center in your area. Premium fitness center options are available for an additional fee. Track your activity, monitor your progress, achieve your fitness goals, and so much more! Visit activeandfitdirect.com to learn more.

E8F603C3-4D94-4DCE-818B-75031FE268CE Created with sketchtool.

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 $200 every six months if you visit a qualifying fitness center at least 50 days during the same six-month reward period. Contact ExerciseRewards at 1-877-810-2746 to learn more about qualifying fitness centers.

Plan Documents

2025 Essential Plan 3 & 4

General Plan Information
Summary of Benefits and Coverage - Essential Plan 3
Summary of Benefits and Coverage - Essential Plan 4
Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
See all forms & documents

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.

Healthfirst complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-305-0408 (TTY 1-888-867-4132). 注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 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).

DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.

EyeMed® is contracted with Healthfirst to provide vision benefits to its members.

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

††Based on 2023 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.

Choose Plan Level
Plan Tier
Essential Plan 200-250
Premium
$0
Eligible Age
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
Income between $30,120 and $37,650††
Deductible (individual)
$0
Maximum Out-of-Pocket (individual)
$2,000
Your Annual Checkup
$0 copay
Primary Care Provider (PCP) Visit
$15 copay
Dental Cleanings
$0
Vision Exams
$0
Telemedicine (Teladoc)
$0
Specialist Visit
$25 copay
Retail Health Clinic
$25 copay
Urgent Care
$25 copay
Emergency Room
$75 copay
Ambulance
$75 copay
Surgeon
$50 copay
Outpatient Facility
$50 copay
Inpatient Hospital Stay
$150 copay per admission

Prescription Drug Benefits

Plan Tier
Essential Plan 200-250
Generic Drugs (Tier 1)
$6 copay
Brand Name Preferred (Tier 2)
$15 copay
Brand Name Non-Preferred (Tier 3)
$30 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$15 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 Direct

Healthfirst makes working out affordable too! For just $28/month, you get a standard membership to a fitness center in your area. Premium fitness center options are available for an additional fee. Track your activity, monitor your progress, achieve your fitness goals, and so much more! Visit activeandfitdirect.com to learn more.

E8F603C3-4D94-4DCE-818B-75031FE268CE Created with sketchtool.

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 $200 every six months if you visit a qualifying fitness center at least 50 days during the same six-month reward period. Contact ExerciseRewards at 1-877-810-2746 to learn more about qualifying fitness centers.

Plan Documents

2024 Essential Plan 200-250

General Plan Information
Summary of Benefits and Coverage
Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
See all forms & documents

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.

Healthfirst complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-305-0408 (TTY 1-888-867-4132). 注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 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).

DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.

EyeMed® is contracted with Healthfirst to provide vision benefits to its members.

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

††Based on 2023 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.

Plan Tier
Essential Plan 1
Essential Plan 2
Premium
$0
Eligible Age
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 $22,590 and $30,120††
Essential Plan 2 Income between $20,783 and $22,590††
Deductible (individual)
Essential Plan 1 $0
Essential Plan 2 $0
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
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

Plan Tier
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 Direct

Healthfirst makes working out affordable too! For just $28/month, you get a standard membership to a fitness center in your area. Premium fitness center options are available for an additional fee. Track your activity, monitor your progress, achieve your fitness goals, and so much more! Visit activeandfitdirect.com to learn more.

E8F603C3-4D94-4DCE-818B-75031FE268CE Created with sketchtool.

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 $200 every six months if you visit a qualifying fitness center at least 50 days during the same six-month reward period. Contact ExerciseRewards at 1-877-810-2746 to learn more about qualifying fitness centers.

Plan Documents

2024 Essential Plan 1 & 2

General Plan Information
The Healthfirst Essential Plan is rated a 5-Star-Rated Plan in 2024
The NY State of Health (NYSOH) Marketplace rates Essential Plan insurers based on member experience and clinical care indicators, with the overall rating measured on a five-star scale. These ratings are published on the NYSOH public website.
Summary of Benefits and Coverage - Essential Plan 1
Summary of Benefits and Coverage - Essential Plan 2
Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
See all forms & documents

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.

Healthfirst complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-305-0408 (TTY 1-888-867-4132). 注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 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).

DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.

EyeMed® is contracted with Healthfirst to provide vision benefits to its members.

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

††Based on 2023 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.

Plan Tier
Essential Plan 3
Essential Plan 4
Premium
$0
Eligible Age
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 $15,060 and $20,783††
Requires legal U.S. residency for less than five years.
Learn more about your legal status here.
Essential Plan 4 Income less than $15,060††
Requires legal U.S. residency for less than five years.
Learn more about your legal status here.
Deductible (individual)
Essential Plan 3 $0
Essential Plan 4 $0
Maximum Out-of-Pocket (individual)
Essential Plan 3 $200
Essential Plan 4 $200
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
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

Plan Tier
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 Direct

Healthfirst makes working out affordable too! For just $28/month, you get a standard membership to a fitness center in your area. Premium fitness center options are available for an additional fee. Track your activity, monitor your progress, achieve your fitness goals, and so much more! Visit activeandfitdirect.com to learn more.

E8F603C3-4D94-4DCE-818B-75031FE268CE Created with sketchtool.

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 $200 every six months if you visit a qualifying fitness center at least 50 days during the same six-month reward period. Contact ExerciseRewards at 1-877-810-2746 to learn more about qualifying fitness centers.

Plan Documents

2024 Essential Plan 3 & 4

General Plan Information
The Healthfirst Essential Plan is rated a 5-Star-Rated Plan in 2024
The NY State of Health (NYSOH) Marketplace rates Essential Plan insurers based on member experience and clinical care indicators, with the overall rating measured on a five-star scale. These ratings are published on the NYSOH public website.
Summary of Benefits and Coverage - Essential Plan 3
Summary of Benefits and Coverage - Essential Plan 4
Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
See all forms & documents

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.

Healthfirst complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-305-0408 (TTY 1-888-867-4132). 注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 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).

DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.

EyeMed® is contracted with Healthfirst to provide vision benefits to its members.

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

††Based on 2023 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.

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.

Essential Plan 200–250 offers the same benefits as Essential Plans 1, 2, 3, and 4, with $0 premiums, $0 deductibles, and copays as low as $0. This plan has a higher income limit, so more people can qualify for affordable health insurance.

Have questions about your plan? Looking to enroll?

Have questions or
ready to enroll?

We can help!

Support When You Need It

We’re happy to answer your questions.

Learn about enrollment 1-844-488-1486

Monday to Friday, 9am—6pm

TTY English: 1-888-542-3821

TTY Español: 1-888-867-4132
Member Services 1-888-250-2220

Monday to Saturday, 8am—8pm

TTY English: 1-888-542-3821
TTY Español: 1-888-867-4132

Need help enrolling in a health plan?

Request a call and our sales team will call you within one business day.

You can also visit our Virtual Community Office to connect with a local Healthfirst representative or to find a community office near you.

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.