New York Essential Plan (2024)

Looking for the federal government’s Medicaid website? Look here atMedicaid.gov.

UnitedHealthcare Dual Complete plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare.Benefits, features and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

Premium disclaimer

Dual Special Needs plans have a $0 premium for members with Extra Help (Low Income Subsidy).

Benefit disclaimer

Benefits, features, and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply.

Nurse Hotlinedisclaimer

This service should not be used for emergency or urgent care needs. In an emergency, call 911 or go to the nearest emergency room. The information provided through this service is for informational purposes only. The nurses cannot diagnose problems or recommend treatment and are not a substitute for your provider's care. Your health information is kept confidential in accordance with the law. The service is not an insurance program and may be discontinued at any time.Nurse Hotline not for use in emergencies, for informational purposes only.

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid plan)

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees.

UnitedHealthcare Connected® (Medicare-Medicaid plan)

UnitedHealthcare Connected® (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees.

UnitedHealthcare Connected® for One Care (Medicare-Medicaid plan)

UnitedHealthcare Connected® for One Care (Medicare-Medicaid plan) is a health plan that contracts withboth Medicare and MassHealth (Medicaid) to provide benefits of both programs to enrollees.

UnitedHealthcare Connected® general benefit disclaimer

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the member handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® member handbook.

UnitedHealthcare Senior Care Options (HMO SNP) plan

UnitedHealthcare Senior Care Options (SCO) is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare and does not have any other comprehensive health Insurance, except Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our Senior Care Options (SCO) program.

Star ratings disclaimer

Every year, Medicare evaluates plans based on a 5-Star rating system.The 5-Star rating applies to plan year 2024.

Important provider information

The choice is yours

We will provide you with information to help you make informed choices, such as physicians' and health care professionals' credentials. This information, however, is not an endorsem*nt of a particular physician or health care professional's suitability for your needs.

The providers available through this application may not necessarily reflect the full extent of UnitedHealthcare's network of contracted providers. There may be providers or certain specialties that are not included in this application that are part of our network. If you don't find the provider you are searching for, you may contact the provider directly to verify participation status with UnitedHealthcare's network, or contact Customer Care at the toll-free number shown on your UnitedHealthcare ID card. We also recommend that, prior to seeing any physician, including any specialists, you call the physician's office to verify their participation status and availability.

Some network providers may have been added or removed from our network after this directory was updated. We do not guarantee that each provider is still accepting new members.

Out-of-network/non-contracted providers are under no obligation to treat UnitedHealthcare plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services.

American Disabilities Act notice

In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 ("ADA"), UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

Referrals

Network providers help you and your covered family members get the care needed. Access to specialists may be coordinated by your primary care physician.

Paper directory requests

Paper copies of the network provider directory are available at no cost to members by calling the customer service number on the back of your ID card. Non-members may download and print search results from the online directory.

Inaccurate information

To report incorrect information, emailprovider_directory_invalid_issues@uhc.com. This email box is for members to report potential inaccuracies for demographic (address, phone, etc.) information in the online or paper directories. Reporting issues via this mail box will result in an outreach to the provider’s office to verify all directory demographic data, which can take approximately 30 days. Individuals can also report potential inaccuracies via phone. UnitedHealthcare Members should call the number on the back of their ID card, and non-UnitedHealthcare members can call1-888-638-6613/ TTY 711, or use your preferred relay service.

Declaration of disaster or emergency

If you’re affected by a disaster or emergency declaration by the President or a governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, there is certain additional support available to you.

  • Part A, Part B, and supplemental Part C plan benefits are to be provided at specified non-contracted facilities (note that Part A and Part B benefits must be obtained at Medicare certified facilities);
  • Where applicable, requirements for gatekeeper referrals are waived in full;
  • Plan-approved out-of-network cost-sharing to network cost-sharing amounts are temporarily reduced; and
  • The 30-day notification requirement to members is waived, as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the member.

If CMS hasn’t provided an end date for the disaster or emergency, plans will resume normal operation 30 days after the initial declaration.

New York Essential Plan (2024)

FAQs

What is the income limit for NY State essential plan? ›

Meet income eligibility requirements. (Examples: single adults earning up to $25,520; adults in family of four earning up to $52,400) Meet immigration status requirements. You can enroll in the Essential Plan any time of year. Apply online, over the phone, or in-person.

How do I prove my income for NY Essential Plan? ›

PROOF OF CURRENT INCOME, OR INCOME YOU MIGHT GET IN THE FUTURE LIKE UNEMPLOYMENT BENEFITS OR A LAWSUIT: You must provide a letter, written statement, or copy of check or stubs, from the employer, person or agency providing the income.

What is the maximum income to qualify for free health care in NY in 2024? ›

Eligibility and Cost
Family ContributionsMonthly Income by Family Size* (Effective for applications received on or after 2/18/2024)Each Additional Person, Add:
1
Free Insurance$2,787$996
$15 Per Child Per Month (Maximum of $45 per family)$3,138$1,121
$30 Per Child Per Month (Maximum of $90 per family)$3,765$1,345
3 more rows

Does NYS Essential Plan include dental? ›

The Essential Plan: Has no deductible, so the plan starts paying for your health care right away. Covers comprehensive benefits, including dental and vision, inpatient and outpatient hospital care, prescription drugs and more.

What's the highest income to qualify for Medicaid? ›

Who is eligible for California Medicaid?
Household Size*Maximum Income Level (Per Year)
1$20,030
2$27,186
3$34,341
4$41,496
4 more rows

What is considered low income for New York State? ›

A person of low income is one who is not a recipient of public assistance under the Social Services Law and whose income does not exceed (1) $6,500 or (2) such other sum not less than $6,500 nor more than $25,000 as may be provided by local law.

How do you prove sufficient income? ›

13 proof of income documents for homebuyers
  1. Paystubs. Paystub requests can vary by lender. ...
  2. Proof of income letter. ...
  3. Last year's tax return. ...
  4. Social Security proof of income letter. ...
  5. Annuity statement. ...
  6. Pension distribution statement. ...
  7. Court-ordered agreements. ...
  8. 1099 statement for self-employed.
Feb 23, 2024

How do I show proof that I have no income? ›

Any documents from state or federal benefit agency that show zero income. These can be eligibility notices for food stamps or Medicaid for instance. If zero income is due to the loss of a job, this can be proven by a termination letter or a notice of severance pay on your last paycheck stub.

What is the highest income to qualify for Obamacare? ›

Obamacare subsidy income limits for 2024
Household sizeMin. incomeTypical max. income
2$19,720$78,880
3$24,860$99,440
4$30,000$120,000
5$35,140$140,560
1 more row
Jan 2, 2024

How much do you need to make to get free health insurance in New York? ›

Income Requirements
Household SizeThe Least you Can Earn in 2024The Most you Can Earn in 2024
1$20,783$37,650
2$28,208$51,100
3$35,632$64,550
4$43,056$78,000
5 more rows

What is the Essential Plan 200-250 in New York? ›

The Essential Plan 200-250 includes a full range of benefits to support your health and wellness, including: FREE preventive care like checkups with your primary care provider and routine screenings. Dental and vision care with $0 copay. Hospital care.

Who qualifies for NY State of Health? ›

Qualified Health Plans are available through NY State of Health to individuals who are: New York State residents. Lawfully present in the U.S. Not eligible for Medicaid, the Essential Plan or Child Health Plus.

Is Fidelis Essential Plan 1 considered Medicaid? ›

The Essential Plan is for New Yorkers who do not qualify for Medicaid or Child Health Plus, but still need access to quality health care. Fidelis Care offers five income-based tiers of the Essential Plan – all with $0 premium.

What does essential insurance cover? ›

The Affordable Care Act requires non-grandfathered health insurance coverage in the individual and small group markets to cover essential health benefits (EHB), which include items and services in at least the following ten benefit categories: (1) ambulatory patient services; (2) emergency services; (3) hospitalization ...

Does New York state have free healthcare? ›

You may qualify for free or low-cost public health insurance based on your age and income. See the eligibility criteria for Medicaid, Child Health Plus, or the Essential Plan. If your income is too high for Medicaid, you could still get Medicaid through the Medicaid Excess Income Program.

What is the income limit for Fidelis in NY? ›

2024 Income Guidelines
Household SizeMaximum Yearly Income
1$37,650
2$51,100
3$64,550
4$78,000

Is there a dollar limit on essential health benefits? ›

Insurance companies can't set a dollar limit on what they spend on essential health benefits for your care during the entire time you're enrolled in that plan.

What is the income limit for NYS pension? ›

The current Section 212 earnings limit, determined by the state Legislature, is $35,000 per calendar year. The earnings limit has been temporarily suspended at times by New York State executive orders during the COVID-19 pandemic, which resulted in no earnings limit for pay earned: From March 27, 2020 through Dec.

What are the income guidelines for Medicaid expansion in NY? ›

Increased Income Limits for MSP

Starting January 1, 2023, the income eligibility limit for QMB increased from $1,133 to $1,677 for an individual and $1,546 to $2,268 for a couple. The income limit for QI will increase from $1,529 to $2,260 for an individual and $2,060 to $3,057 for a couple.

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