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The Essential Plan is offered through UnitedHealthcare Community Plan. It's for lower income individuals in New York who meet the income or citizenship status requirements.

To find out if UnitedHealthcare Community Plan is offered in your county, please call 1-888-617-8979. A representative will contact you to schedule an appointment to help you apply.

Albany, Bronx, Broome, Cayuga, Chautauqua, Chemung, Chenango, Clinton, Columbia, Dutchess, Erie, Essex, Franklin, Fulton, Genesee, Greene, Jefferson, Kings, Lewis, Livingston, Madison, Monroe, Nassau, New York, Niagara, Oneida, Onondaga, Ontario, Orange, Orleans, Oswego, Queens, Rensselaer, Richmond, Rockland, Saratoga, Schenectady, Seneca, St. Lawrence, Suffolk, Tioga, Ulster, Warren, Wayne, Westchester, Wyoming, ken Yates.

UnitedHealthcare continues to partner with state and local public health departments, following guidance and protocols appropriate to our members that are provided by the U.S. Centers for Disease Control and Prevention (CDC), and state and local public health departments that are appropriate for our members. Please review the UnitedHealthcare Coronavirus (COVID-19) Information. To learn more, go to CDC.gov

COVID-19 NY State PPE Fee Guidance

The New York State Department of Financial Services (DFS) recently issued guidance stating that care providers should not charge members additional fees for items such as personal protective equipment (PPE). DFS expects New York care providers to refund any of these charges paid by the member that were more than the member’s financial responsibility on a claim. If you have questions, you may contact your provider or call the number on the back of your card for assistance with filing a complaint.

Dagiti Benepisio ken Paset ti Plano

Coverage Types

Essential Plan 1 Standard: Coverage for those ages 19-64 who earn 151-200% of the Federal Poverty Level. Includes Dental and Vision benefits.

Essential Plan 1 Native American/Alaskan: Coverage for those ages 19-64 who earn 151-200% of the Federal Poverty Level.  Designed for Native American or Alaskan Native Individuals. Includes Dental and Vision benefits.

Essential Plan 2 Standard: Coverage for those ages 19-64 who earn 139-150% of the Federal Poverty Level. Includes Dental and Vision benefits.

Essential Plan 2 Native American/Alaskan: Coverage for those ages 19-64 who earn 139-150% of the Federal Poverty Level. Designed for Native American or Alaskan Native Individuals. Includes Dental and Vision benefits.

Essential Plan 3: Coverage for those ages 21-64 who are "Legally Present" but not eligible for Medicaid, earning 100-138% of the Federal Poverty Level. Includes Dental and Vision benefits.

Essential Plan 4: Coverage for those ages 21-64 who are "Legally Present" but not eligible for Medicaid, earning less than 100% of the Federal Poverty Level. Includes Dental and Vision benefits.

Starting June 1, 2021, there will be no monthly premium for Essential Plan coverage and all Essential Plan enrollees will have dental and vision benefits with no premium or cost sharing for covered services.

Medical Services: Copays will apply for all Essential Plan 1 plan types.

Inpatient Hospital Services: Copays will apply for all Essential Plan plans.

Emergency Medical Services: Copays will apply for all Essential Health Plan plans.

Outpatient Hospital/Facility Services: Copays will apply for all Essential Plan plans.

Preventive and Primary Care Services: PCP/Specialist copay per visit (based on type of physician performing the service) will apply for all Essential Plan plans.

Physician /Professional Services: Copays will apply for all Essential Plan plans.

Prescription Drugs: Copays will apply for all Essential Plan plans.

* Copays may vary. Alaskan Natives and American Indian members are exempt from co-pays and co-insurance. Refer to Subscriber Contract in Member Information section for more details regarding copays and coinsurance.

Get the care you need to stay healthy – or to get better if you are injured or sick. Nga agraman ti:

  • Choice of Doctor. Use "Doctor Lookup" to see if your doctor is in our network or to find a new one.
  • Medicines. Prescription drugs are covered with a small copay.
  • Dental*. We cover cleanings, checkups and dental work.
  • Well Visits. Annual checkups can help keep you healthy.

* Dental benefits are available through purchase of Essential Plus plans or as a standard benefit in Essential Plan 3 and 4 plans; these benefits are not available for Essential Plan 1 and 2 Standard Plans.

If you have special health care needs, you can count on us. Our plan will provide the extra care and services needed. Dagiti benepisyo ket kairamanan ti:

  • Mental Health. Counseling and other treatments are covered.
  • Case Management. If you qualify, get personal help managing health conditions.
  • Asthma and COPD Care. Exams, testing and supplies are covered.

Make sure your sight, teeth, speech and hearing are at their best. Dagiti benepisyo ket kairamanan ti:

  • Vision. Covers eye exams and glasses.**
  • Dental. We cover cleanings, checkups and dental work.**
  • Hearing. Screenings and therapies, if needed, are provided.

Partial reimbursement ($400/200 every 6 months) for facility fees if member attains at least 50 visits.

Gym Reimbursement Forms: English | Espanol

Get the medical care and equipment you need to recover safely at home. Dagiti benepisyo ket kairamanan ti:

  • Care Coordinator. Someone to get you the services you need to recover safely.
  • Personal Care. Services to help you heal after illness or injury.
  • Equipment and Supplies. In-home medical and safety equipment are covered.
  • Nurse Visits. Care after surgery or illness to recover at home.

Mabalin a kasapulam nu dadduma ti kanayonan a tulong a mangusar ti plano ti salun-at mo. Kadagidiay a tiempo, mabalin a mangnamnama ka kadakami:

  • Member Services M-F 8:00am to 6:00pm EST. When you call Member Services you will be connected with a specially trained Advocate. They will help you get the most from your health plan. For example, your Advocate is equipped to answer your questions, resolve issues, help set up doctor appointments and directly connect you with services available to you.
  • Nutrition Coaching. Helpful advice to improve your diet.

Asthma and COPD Care

Individual care to help control asthma, allergies or COPD symptoms.

Do you or your child have trouble managing asthma, allergies or COPD symptoms? A nurse who specializes in breathing issues can really help. You'll get a customized treatment plan and medicine to:

  • Manage flare-ups.
  • Reduce symptoms.
  • Let you or your child stay active.

Ti Panagpili ti Doktor

You get a primary care physician (PCP), who is your main doctor. Usaren ti Panagbirok iti Doktor a tool tapno makitam no ti doktormo ket adda iti networkmi.

If you don't have a doctor or if your doctor is not in our network, we can help you find a new one close to you.

Ti PCPim ket iti kangrunaam nga doktor para:

  • Managlapped a taripato.
  • Panagagas no sika ket agsakit wenno nadunor.
  • Dagiti reperal kadagiti espesialista iti partikular a kondision.

Dental/Vision Care*

Dental Care*

Checkups are covered. Exams and cleanings every six months help keep teeth and gums strong and healthy. If there is a dental problem that needs to be fixed, that's covered as well.

Vision Care*

See life more clearly with routine eye exams and glasses, if needed. We also include:

  • Dagiti naireseta a lente.
  • Medicaid approved frames.
  • New eyeglasses every two years.

This benefit is offered by March Vision care.

Diabetic Supplies

If you have diabetes, you may need insulin, needles, wipes and glucose strips. Masakupan mi dagita ken dadduma pay.

Ti plano mi ket sakupen na pay dagiti serbisyo a mangtulong kenka a mangimaton ti diabetes mo, kairamanan ti:

  • Classes on keeping diabetes in control.
  • Panangikoordinar ti taripato ti doktor.
  • Nutrition and diet.

Natibker ken manayon a ramit-medikal

Ti salun-at mo ken kinatalged mo iti pagtaengan ket napateg.

Sakupen ti planomi dagiti medikal nga instrumento nga ibilin ti doktormo wenno ti mangimatmaton iti kasom. Mabalin a mairaman ditoy dagiti suplay kas koma iti:

  • Diabetic supplies.
  • Katre ti ospital.
  • Wheelchair wenno walker.

Taripato ti Panagdengngeg

Ti parikut ti panagdengngeg ket apektaran na ti inaldaw a biag mo iti nadum-duma a wagas. Ti plano mi ket kairamanan dagiti serbisyo ken suporta a makatulong a mangprotekta ti panagdengngeg.

Ti plano mi ket sakupen na:

  • Eksaminasion, terapi ken pannakaeksamen.
  • Hearing aid ken dagiti baterya.

Pannakaospital

Bayadan daytoy a plano ti amin a gastos mainaig iti pannakayospital, tapno makainana ken umimbag ka.

Mairaman iti masakupan ti seguro para iti pannaka-ospital ti:

  • Nursing care.
  • Kuarto ken makan.
  • Dagiti suplay ken makinarya.
  • Panagagas ken dagiti therapy.
  • Dagiti eksamen a diagnostic.

Ken kalpasan a rumuarka ti ospital, saaka nga agmaymaysa. Siguradoen mi nga adda ti follow-up a taripato tapno agtultuloy ka nga agimbag iti pagtaengam.

Dagiti Agas

Our plan covers prescription drugs and refills with a small copayment. Your copay is:

  Napateg a Plano
1 2 3 4
Generic $6 $1 $1 $0
Tier 2 $15 $3 $3 $0
Tier 3 $30 $3 $3 $0

Over-the-counter medicines with a written order from your doctor are available for a copayment for each medicine. And we make getting your medicine easy. You can fill your prescriptions at:

  • Local pharmacies.
  • Services that deliver right to your door.

Dagiti Serbisyo para ti Kameng

No dadduma mabalin a masapulmo ti bassit a tulong tapno maawatam dagiti pagpilian para iti pannakataripato ti salun-atmo. With us, you have someone you can call 24/7. Masungbatanmi dagiti saludsodmo iti simple ken kumpleto a wagas.

Mabalindaka pay a tulongan a mangsapulka iti/kadagiti:

  • Mangipapaay panaripato iti pagtaengan.
  • Dentists and vision providers.
  • Adult day health centers.

Mental Health*

Ti salun-at ti panunot ket kas kapateg ti salun-at a pisikal. Isu a sakupenmi dagitoy nga agpada.

Required care is 100% covered. Mairaman ditoy ti:

  • Therapy ti Tig-tignay.
  • Panagagas iti panagabuso ti droga.
  • Ag-agas.

* Copays will apply for Essential Plan 1.

Nurse Visit

Sometimes you may need continued care after you leave the hospital or urgent care.

If your health is at risk after a serious illness, surgery or injury, a nurse will visit you at home to:

  • Provide medical care for you.
  • Answer your questions and concerns.

Dagiti Serbisio iti Outpatient

Ti panagammmo nu ania iti parikut ken panagduktal iti daytoy ti nasapa ket nalabit a makaaramid ti dakkel a pagdumaan.

Ti plano mi ket sakupen na:

  • Dagiti Lab ken eksamen.
  • Dagiti X-rays, scans ken dadduma nga imaging.

Tulungandakanto a mangala iti impormasion a kasapulam tapno mapasayaat ti salun-atmo wenno tapno magun-odmo ti kasayaatan a kasasaad.

Residential Care

After a serious illness, surgery or injury, you may need extra nursing and therapy.

No kasapulan, sakupen ti planomi dagiti apagbiit a panagtalinaed iti sentro ti rehabilitasion no sadino a makapaimbagka. Mairaman dagiti sumaganad:

  • Serbisio a pannaripato iti pagtaengan.
  • 24-nga-oras a pannaripato ti nars.
  • Tulong kadagiti aktibidad ti inaldaw a panagbiag.
  • Speech, physical ken occupational therapy.

Taripato iti Temporaryo nga Institusyon (Respite Care).

Adda kadi kameng ti pamilyam wenno gagayyem a mangaywan kenka nu addaka iti pagtaengan?

Nu adda, kayat mi a suportaran ti trabaho da met a tumulong kenka. Isu a mangipapaay kami ti respite care tapno makainana met dagiti manartaripato kenka. Ti respite care ket mangidiaya kadagiti mangay-aywan ti waya a makabakasyon wenno makainana manipud kadagiti ay-ayaten da ti biag nga agsaksakit wenno addaan naisangsangayan a kasapulan a taripato.

Shots and Immunizations

Routine shots help keep you healthy.

Isu a sakupen ti planomi:

  • Dagiti mairekrekomendar nga indieksion ken bakuna.
  • Dagiti eksamen a diagnostic.

Dagiti Panagbisita ti Nakaradkad

Well visits with your doctor can help you stay healthy. Makatulong dagitoy a panagbisita tapno matakuatan a nasapa dagiti problema iti salun-at, tapno maagasan dagitoy.

Dagiti serbisyo ti panagsakbay ket kairamanan ti:

  • Panagpa-checkup para kadagiti nataengan ken ubbing.
  • Pannakataripato ti nasalun-at a maladaga.
  • Pannaripato para kadagiti babbai a masikog.
  • Kadawyan a bakuna ken pannakaeksamen.
  • Dagiti Mammogram.

Dagiti Pamuspusan ti Kameng

2020 & 2021 Subscriber Contracts

Kitaen Dagiti Sidadaan a Pagbasaran (aglukat iti modal a window)

To learn more about applying for health insurance, including Medicaid, Child Health Plus, Essential Plan, and Qualified Health Plans through NY State of Health, The Official Health Plan Marketplace, visit www.nystateofhealth.ny.gov or call  1-855-355-5777.

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