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Essential Plan FAQs
Get answers to your questions on eligibility, coverage, and how to enroll in affordable health insurance.
EmblemHealth can help you find out if you’re eligible† for the Essential Plan and guide you through enrollment if you qualify. Eligibility is based on income, immigration status, where you live, and other factors. Call us at 866-230-1071 (TTY: 711) for one-on-one support and our team can walk you through your options.
If you’re not eligible for the Essential Plan, you may qualify for one of our Medicaid plans. Visit our state-sponsored programs page to learn more.
†Eligibility must be confirmed by NY State of Health.
The Essential Plan provides coverage for the essential health benefits established by the Affordable Care Act (ACA), including:
- Preventive care.
- Mental health and substance use disorder services.
- Lab services.
- Emergency room visits.
- Hospital stays.
- Rehabilitative and habilitative services.
- Prescription drugs.
- And more.
Plus, dental coverage and vision care are also included. Visit our Essential Plan page to learn more.
It’s easy to find in-network care close to home or work using our Find Care tool. The EmblemHealth Enhanced Care Prime Network gives Essential Plan members a choice of top health care professionals and hospitals, with no referrals required to see specialists.
The Enhanced Care Prime Network includes†:
- 48,000+ in-network health care professionals.
- 9,600+ primary care providers (PCPs).
- 40,000+ specialists.
- 115+ hospitals, and a wide range of urgent care, imaging, and lab options.
- Top hospital systems, including NewYork-Presbyterian, Mount Sinai, NYU Langone Health, Hospital for Special Surgery, NYC Health + Hospitals, Northwell Health, Memorial Sloan Kettering Cancer Center, Catholic Health, and more.
Plus, AdvantageCare Physicians††, a leading primary and specialty care practice serving New York City and Long Island, is in network for EmblemHealth members, making it simple to find trusted, in-network doctors and specialists.
The Essential Plan offers in-network coverage only, except in the case of a medical emergency.
†This information is as of July 2025.
††AdvantageCare Physicians is an EmblemHealth company.
The Essential Plan and Medicaid are different low-cost health insurance plans available in New York and offered through EmblemHealth. While both offer similar benefits and $0 monthly premiums, they have different eligibility requirements. If you qualify for Medicaid, you are not eligible for the Essential Plan.
Call us at 866-230-1071 (TTY: 711) and we can help you determine your eligibility based on your situation.
All Essential Plan variants offer the same core benefits such as doctor visits, prescription drugs, hospital care, and dental and vision coverage for $0 monthly premiums. Depending on which variant you qualify for, there may be differences in the amount of cost sharing for certain services or additional benefits you are eligible for.
Call us at 866-230-1071 (TTY: 711) and our team can help you understand which Essential Plan you may qualify for.
Yes, we can help you renew your coverage. When it’s time to renew, you will be contacted by NY State of Health and EmblemHealth with information on what you’ll need to do.
Be sure to renew on time to keep the coverage you rely on — and the extra support EmblemHealth provides:
- Up to $500 per year to spend on eligible health-related items and healthy foods with your EmblemHealth over-the-counter (OTC) card.
- Dental coverage through DentaQuest with a robust network of dental providers.
- Vision, urgent care visits, and preventive care like annual physicals, immunizations, and screenings.
- Access to local care with convenient appointments at AdvantageCare Physicians.48,000+ in-network health professionals in the New York metropolitan area.
- And more.
For help renewing your plan, call us at 888-432-8026 (TTY: 711) or visit our renewing coverage page. We’re here to answer any questions you may have and assist you every step of the way.
EmblemHealth's Essential Plan is provided by Health Insurance Plan of Greater New York (HIP), an EmblemHealth company.
*For those who qualify.
**Includes primary care, nonemergency care, mental health services, and dermatology. Restrictions apply. For primary care, members must be 18 or older; for mental health services, you must be age 13 or older. Not all services are available 24/7.