The Daily Dose
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:
- Free preventive care
- Outpatient services
- Emergency services
- Hospitalization
- Pregnancy, maternity, and newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitative and habilitative services
- Laboratory services
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.
John D. Bennett, MD, FACC, FACP About the Author
John D. Bennett, MD, FACC, FACP, is president and CEO of Capital District Physicians’ Health Plan, Inc. (CDPHP), an award-winning, physician aligned, not-for-profit health plan based in Albany, NY. Bennett has held the position since 2008 after serving more than 10 years as chair, vice chair, and board member for CDPHP. During his tenure, CDPHP has been ranked among the top-performing health plans in New York and the nation, most recently named #1 in Customer Satisfaction in the J.D. Power Member Health Plan Study 2021. Under his leadership, CDPHP has also become known as a model employer regionally and nationally, and was recently named among the top three Best Companies to Work for in New York by the Society for Human Resource Management, as well as Forbes Best-in-State Employers 2021. Prior to joining CDPHP, Bennett served as founding member and CEO of Prime Care Physicians, PLLC. During his tenure, he co-led a team of 25 cardiologists and helped grow the practice to a 100-physician multi-specialty group. Bennett is board certified by the National Board of Medical Examiners and the American Board of Internal Medicine, with subspecialties in internal medicine and cardiology. He earned his medical degree at SUNY-Downstate Medical Center, Brooklyn, and a Bachelor of Science degree at Rensselaer Polytechnic Institute. Bennett completed an internship and residency in internal medicine and a fellowship in cardiovascular disease at Albany Medical Center. He is a Fellow of the American College of Cardiology and the American College of Physicians. Bennett is currently board chair for the Center for Economic Growth, and vice chair for the Palace Theatre. Bennett also serves on the boards of the Capital Region Chamber, the New York eHealth Collaborative (NYeC), the Alliance of Community Health Plans (ACHP), America’s Health Insurance Plans (AHIP), Rensselaer Polytechnic Institute, and Russell Sage Colleges. Bennett is a member of the New York Public Health and Health Planning Council, where he helps shape decisions related to New York State's public health and health care delivery system. Well-known locally and nationally for advancing health care innovation, Bennett was recently named to Crain’s New York Business 2021 Notable in Health Care, as well as the Albany Business Review’s Power 50 list.
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Hi! This article is filled with answers to my ample questions. I am in the midst of starting a new blog and this article will be a bookmark for my future reference. Thanks for sharing this informative article.
John Bennett
Hello Josephine! I’m so glad you found the article helpful. Good luck on your blog and thanks again for the feedback!