Essential Plan

A new health plan for New Yorkers. It costs much less than other health plans. And it offers the same essential benefits.

Why Choose

Crystal Run
Health Plans?

Get the health coverage you need for $0 or $20/month* with our new Essential Plan.
It offers the same coverage as other plans, including:

  • Doctor visits, including specialists
  • Tests ordered by your doctor
  • Prescription drugs
  • Inpatient and outpatient care at a hospital

WHO CAN BUY IT?

Lower-income people who don’t qualify for Medicaid or Child Health Plus.

Household size Most you can make
1 $24,120
2 $32,480
3 $40,840
4 $49,200

HOW MUCH DOES IT COST?

Either $20 a month per person — less than a dollar a day or NOTHING.

HOW ELSE DOES IT SAVE ME MONEY?

It has NO DEDUCTIBLE, so the plan starts paying for your health care right away.You get FREE PREVENTIVE CARE like routine doctor exams and screenings to keep you healthy.

ENROLLMENT

Enrollment for the Essential Plan is open all year long.
Assistance is available in your language by phone and in person.

 

 

#ONLINE

To apply for the Essential Plan online, visit nystateofhealth.ny.gov on your desktop or mobile device.

#TELEPHONE

Call us on our toll-free number at
1-855-355-5777 or TTY:1-800-662-1220.

#IN-PERSON

We also offer free help from a certified in-person assistor near your home or work.

WHO IS ELIGIBLE?

INDIVIDUALS WHO ARE:

  • New York State residents
  • Able to meet the Essential Plan income requirements
  • Lawfully present in the U.S.
  • 19-64 years old
  • Not eligible for Medicaid or Child Health Plus
  • Not eligible for employer coverage

WHAT’S COVERED?

  • Free preventive care
  • Inpatient care
  • Outpatient services
  • Maternity and newborn care
  • Emergency services
  • Lab and imaging
  • Prescription drugs
  • Rehabilitative and habilitative services
  • Mental health and substance abuse disorder services
  • Wellness and chronic disease management services

 

 

 

HOW MUCH DOES THE ESSENTIAL PLAN COST?

PREMIUMS: The monthly premium is $20 or $0, depending on income.

COST SHARING: There is NO DEDUCTIBLE. Below are some examples of Essential Plan cost sharing levels.

COST SHARING FOR HEALTHCARE SERVICES Annual individual income:
below $12,060-$18,090		 Annual individual income:
$18,091-$24,120
Monthly Premium $0 $20
Annual Deductible None None
Preventive Care Free Free
Primary Care Physician Visit $0 $15
Specialist Visit $0 $25
Inpatient Hospital Stay per admission $0 $150
Behavioral Health Outpatient Visit $0 $15 outpatient
Behavioral Health In Patient Visit per admission $0 $150
Emergency Room $0 $75
Urgent Care $0 $25
Physical Therapy, Speech Therapy, Occupational Therapy $0 $15
COST SHARING FOR PRESCRIPTION DRUGS Annual individual income:
below $12,060-$18,090*		 Annual individual income:
$18,091-$24,120
Generic $1 $6
Preffered Brand $3 $15
Non-Preferred Brand $3 $30
COST SHARING FOR DENTAL AND VISION BENEFITS Annual individual income:
below $12,060-$18,090		 Annual individual income:
$18,091-$24,120
Dental and Vision $0 (lower income enrollees) Can be purchased for an additional premium (higher income enrollees) Can be purchased for an additional premium

*$0 for individuals with income below $11,880