The Essential Plan: A Health Care Success in NYS


From skyrocketing costs to lack of transparency, it’s easy to identify the problems plaguing today’s health care system. With all the negative news out there, it’s important to celebrate the positive. Here in New York, the Essential Plan has become a shining star and proven its ability to provide high-quality, affordable health care coverage to hundreds of thousands of vulnerable state residents.

Authorized as part of the Affordable Care Act, the Essential Plan (EP) is available to low-income New Yorkers who don’t qualify for Medicaid or Child Health Plus. New York is one of two states in the nation that took advantage of federal dollars to create what’s called a Basic Health Plan, which offers an affordable option for consumers earning below 200 percent of the federal poverty level (about $50,000 for a family of four). Here in New York, the Basic Health Plan is called the Essential Plan.

If you’re not familiar with the EP, here’s how it works.

The EP is available to New York residents between the ages of 19 – 64 who meet the below income requirements.

Depending on income levels, residents pay between $0-20 per person/month for coverage that includes the following benefits:

And best of all, the Essential Plan has no deductibles.

Since its launch in 2015, 730,000 New Yorkers have enrolled in the EP, which has played a major role in reducing the state’s uninsured rate from 10 to 5 percent. Despite that success, the program’s future was recently called into question when federal officials announced plans to cut funding for Basic Health Plans. Much to New York’s delight, that funding has since been restored, and CDPHP and other health plans will be offering the product in 2019.

While the future of federal funding for Basic Health Plans is uncertain, CDPHP applauds the efforts of state health officials for creating this valuable health care option, and encourages federal lawmakers to continue supporting this vital program.

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