Essential Plan health insurance plan expansion could save NY residents $4.7K a year

David Robinson, New York State Team
·2 min read
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Thousands of New Yorkers will soon gain access to lower-cost health insurance under an expansion of the Essential Plan coverage sold through the state-run Affordable Care Act marketplace.

Eligibility for the health coverage will rise in April to 250% of the federal poverty level, up from the current 200%. That means New Yorkers with annual income up to $37,650 will gain access, up from $30,000 currently, Gov. Kathy Hochul said Monday in a statement.

Federal regulators approved the expansion for five years, from 2024 through 2028. It is estimated to save New Yorkers an average of $4,700 per year, compared to what they would have spent on health coverage through Qualified Health Plans, Hochul added.

What is New York's Essential Plan?

The Essential Plan is sold through New York State of Health, the state-run health coverage marketplace created as part of the Affordable Care Act, commonly called Obamacare.

More than 1 million low-income New Yorkers are currently covered by the Essential Plan, which provides health benefits with $0 monthly premiums, no deductible, and low-cost sharing, Hochul noted. It also includes free preventive care, adult vision, and dental care without cost-sharing.

Raising the income eligibility will expand Essential Plan access to 100,000 additional New Yorkers, Hochul added, noting that could help some New Yorkers who lost coverage through Medicaid due to the end of pandemic emergency measures.

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That expansion includes:

  • Nearly 70,000 New Yorkers enrolled in Qualified Health Plans who will now be eligible for more affordable coverage through the Essential Plan.

  • 12,000 DACA individuals currently enrolled in Medicaid/CHPlus, and about 20,500 currently uninsured New Yorkers.

What costs are there with NY Essential Plan?

Cost-sharing under the Essential Plan varies based on the time of health care services and incomes.

For those earning under $22,590, there are $0 cost sharing for health services, and prescription cost-sharing from $1 to $3 depending on the drug, according to the Essential Plan website.

For New Yorkers with incomes from $22,591 to $37,650, the cost sharing includes:

  • $15 for primary care visit and $25 for specialists visit.

  • $150 for inpatient hospital stay per admission, or $75 for emergency room visit.

  • Urgent care visits have a cost of $25, while drug costs can span from $6 to $30 based on the prescription.

For further details about the Essential Plan, visit the New York State of Health website at nystateofhealth.ny.gov, or call its helpline at 1.855.355.5777.

This article originally appeared on Rockland/Westchester Journal News: NY Essential Plan expansion could save NY residents $4.7K a year