New ESSENTIAL PLAN available on NYSOH starting in 2016

September 16, 2015


A new affordable insurance program is being rolled out starting January 1, 2016 for qualified individuals and families thru NY State of Health. These plans will cover the essential health benefits with NO annual deductible and low out of pocket costs including free preventive care. They will be available from private health insurers still to be named.

These plans will be available for no cost to consumers with incomes at between 138- 150% of the Federal Poverty Level (FPL), and for $20 per month per participant for consumers with slightly higher incomes up to 200% of FPL.

Eligible applicants will have a continuous open enrollment period, and are required to report changes in circumstances within 30 days. Eligibility will be re-evaluated annually.

Below is a listing of the cost sharing breakdown for all levels of Essential Plans. We expect only a small percentage of consumers to be eligible for these plans, but they are another option for consumers in lieu of Medicaid to help control the ever rising cost of health insurance.
essential plan cost sharing chart