Essential Plan

Offered by Independent Health to residents of Erie & Niagara Counties

The Essential Plan is a new program for eligible residents of Erie and Niagara counties enrolling for coverage through the NY State of Health. The Essential Plan is for individuals with lower incomes.

There are four Essential Plan programs, eligibility for each is dependent on your family’s household income. Your out of pocket costs may be $0, $200 or a maximum $2,000 per plan year.

You are eligible for the Essential Plan:

  • If you meet certain income requirements (varies per Essential Plan)
  • If you are a resident of New York State
  • If you are a U.S. citizen or fall within the Aliessa immigration status
  • If you do not qualify for Medicare or Medicaid
  • If you are age 19 – 64

Premium:

$0

Copayments:

The share you pay for each health service – your co-payments are also very low, sometimes as low as $0 – depending on the Essential Plan program you qualify for.

Your Essential Plan benefits include:

  • Doctor visits – including specialists
  • Prescriptions (copayments may apply)
  • Immunizations
  • Inpatient or outpatient care at a hospital
  • Maternity care
  • Laboratory tests and X-rays
  • Emergency/Urgent services
  • Family planning and reproductive services, including HIV testing
  • Occupational therapy, physical therapy and speech therapy
  • Drug, alcohol and mental health treatment
  • Behavioral health services managed by Beacon Health Options
  • Vision care managed by Eyemed
  • Dental care managed by HealthPlex

Essential Plans 3 & 4 include these additional benefits:

  • Orthotics/Orthopedic footwear
  • Medicaid transportation, if needed (Common Benefits card)

 

To learn more about applying for health insurance through NY State of Health, The Official Health Plan Marketplace, visit www.nystateofhealth.ny.gov or call 1-855-355-5777.

Schedule a RedShirt Meeting

Select a convenient appointment time to talk to a RedShirt about which plan option is right for you.

To Find Out If You Are Eligible and To Apply

You should apply for health insurance through the NY State of Health Marketplace at www.nystateofhealth.ny.gov or call 1-855-355-5777. (TTY: 1-800-662-1220) Monday-Friday, 8 a.m.-8 p.m. Saturday, 9 a.m.-1 p.m.

Helpful Resources

Summary of Benefits:

Contracts:

NYstateofhealth_logo