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Essential Plan

Generated from the delivery-benefits catalog. It lists what the owner record states. It is not an eligibility decision; confirm current rules with the program.

The Essential Plan provides comprehensive health coverage, including dental and vision care, hospital care, prescription drugs, and preventive care.

  • Owner record: ny/essential-plan
  • Jurisdiction code: NY
  • Frame: care_recipient
  • Review by: 2026-11-28
  • Authority: NY State of Health

Offering 1: health_insurance

Comprehensive health coverage with $0 monthly premiums and very low-cost sharing.

  • Availability (owner codes): {"intake": "open", "type": "entitlement"}

Conditions:

  • All of these:
  • Stated condition, not checked automatically: "New York State residents"
  • Stated condition, not checked automatically: "Lawfully present in the U.S."
  • Fact rule: recipient.age ≥ 19
  • Fact rule: recipient.age ≤ 64
  • Stated condition, not checked automatically: "Not eligible for Medicaid or Child Health Plus"
  • Stated condition, not checked automatically: "Not eligible for employer and other coverage"
  • Stated condition, not checked automatically: "Able to meet the Essential Plan annual income requirements listed in the table below"

Access route 1.1

  • Where: NY State of Health website
  • How: Apply online through the NY State of Health website.
  • Url: https://nystateofhealth.ny.gov/

Access route 1.2

  • Where: NY State of Health by phone
  • How: Apply by phone.
  • Phone: 1-855-355-5777

Access route 1.3

  • Where: Enrollment Assistor or Broker
  • How: Enroll with the free help of a trained and certified Enrollment Assistor or Broker.
  • Url: https://nystateofhealth.ny.gov/agent/hx_brokerSearch

Tables (as stated by the owner)

  • annual_income_limit: {"1": 31920, "2": 43280, "3": 54640, "4": 66000}

Owner confirmations

  • /offerings/0/availability: sha256:aa10cad77bbe0c615458da1ae2f479edb218a93f3f24ac5d05511fed6270f9d6
  • /offerings/0/rules/all/0: sha256:900d316274558ba7ba1899bd5c58a69f1919f583556fc21368166a5de4135d28
  • /offerings/0/rules/all/2: sha256:1daec8f42d6c6f4126ea284d0be3e22bef7c88f95691296f51143162acebfab2

Evidence

  • /name: "# Essential Plan Information" (source, capture 8a43bfa1e7050a16a46c7de27ab7a840d4c66b537fcd08f2c580a9d656351ea5)
  • /authority: "This is the official informational website of NY State of Health The Official Health Plan Marketplace. View our Privacy Policy." (source, capture 8a43bfa1e7050a16a46c7de27ab7a840d4c66b537fcd08f2c580a9d656351ea5)
  • /caregiving_effect: "* Has no deductible, so the plan starts paying for your health care right away.\n* Covers comprehensive benefits, including dental and vision, inpatient and outpatient hospital care, prescription drugs and more.\n* Covers free preventive care like routine exams and screenings.\n* Has continuous open enrollment, meaning you can enroll at any time during the year through NY State of Health. " (source, capture 8a43bfa1e7050a16a46c7de27ab7a840d4c66b537fcd08f2c580a9d656351ea5)
  • /offerings/0/summary: "NY State of Health's Essential Plan includes comprehensive benefits with $0 monthly premiums and very low-cost sharing. The Essential Plan:" (source, capture 8a43bfa1e7050a16a46c7de27ab7a840d4c66b537fcd08f2c580a9d656351ea5)
  • /offerings/0/rules: "* New York State residents\n* Lawfully present in the U.S.\n* 19-64 years old\n* Not eligible for Medicaid or Child Health Plus\n* Not eligible for employer and other coverage\n* Able to meet the Essential Plan annual income requirements listed in the table below" (source, capture 8a43bfa1e7050a16a46c7de27ab7a840d4c66b537fcd08f2c580a9d656351ea5)
  • /offerings/0/rules: "##### Essential Plan Eligibility\n###### Household Size###### Most You Can Make in 2026\n1$31,920\n2$43,280\n3$54,640\n4$66,000" (source, capture 8a43bfa1e7050a16a46c7de27ab7a840d4c66b537fcd08f2c580a9d656351ea5)
  • /offerings/0/rules: "Individuals are eligible for the Essential Plan if they are:" (source, capture 8a43bfa1e7050a16a46c7de27ab7a840d4c66b537fcd08f2c580a9d656351ea5)
  • /offerings/0/rules: "* New York State residents\n* Lawfully present in the U.S.\n* 19-64 years old\n* Not eligible for Medicaid or Child Health Plus\n* Not eligible for employer and other coverage\n* Able to meet the Essential Plan annual income requirements listed in the table below" (source, capture 8a43bfa1e7050a16a46c7de27ab7a840d4c66b537fcd08f2c580a9d656351ea5)
  • /offerings/0/access/0: "There are three ways to enroll in the Essential Plan through NY State of Health: \n•Apply through the NY State of Health website \n•By phone at 1-855-355-5777 (TTY: 1-800-662-1220) \n•With the free help of a trained and certified Enrollment Assistor or Broker " (source, capture 8a43bfa1e7050a16a46c7de27ab7a840d4c66b537fcd08f2c580a9d656351ea5)
  • /offerings/0/access/1: "There are three ways to enroll in the Essential Plan through NY State of Health: \n•Apply through the NY State of Health website \n•By phone at 1-855-355-5777 (TTY: 1-800-662-1220) \n•With the free help of a trained and certified Enrollment Assistor or Broker " (source, capture 8a43bfa1e7050a16a46c7de27ab7a840d4c66b537fcd08f2c580a9d656351ea5)
  • /offerings/0/access/2: "There are three ways to enroll in the Essential Plan through NY State of Health: \n•Apply through the NY State of Health website \n•By phone at 1-855-355-5777 (TTY: 1-800-662-1220) \n•With the free help of a trained and certified Enrollment Assistor or Broker " (source, capture 8a43bfa1e7050a16a46c7de27ab7a840d4c66b537fcd08f2c580a9d656351ea5)
  • /offerings/0/availability: "* Has no deductible, so the plan starts paying for your health care right away.\n* Covers comprehensive benefits, including dental and vision, inpatient and outpatient hospital care, prescription drugs and more.\n* Covers free preventive care like routine exams and screenings.\n* Has continuous open enrollment, meaning you can enroll at any time during the year through NY State of Health. " (source, capture 8a43bfa1e7050a16a46c7de27ab7a840d4c66b537fcd08f2c580a9d656351ea5)