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Essential Plan Expansion – April 1, 2024

Published on March 24, 2024 by Michelle Berney

Effective April 1, 2024, the income limit for the Essential Plan (EP) will be increasing from 200% to 250% of the Federal Poverty Level (FPL).  This new, expanded, coverage will be known as “EP 200-250.”

Individuals with incomes between 200-250% of the FPL, who were previously eligible for both Cost Sharing Reductions and the Premium Tax Credit for purchasing a Qualified Health Plan (QHP), will be re-determined for Essential Plan coverage.  NYS expects to transition 70,000 individuals from QHP to EPP 200-250.  For those being transitioned from QHP to EP, if their QHP insurer offers EP coverage, they will transition to the Essential Plan product offered by that same insurer.  If not, they can select a plan or will be automatically assigned to a plan.  Individuals who do not want Essential Plan coverage can go back to QHP, but they will not be able to benefit from any premium tax credits or cost-sharing reductions and will therefore have to pay the full cost of coverage and cost-sharing.

An additional 20,000 uninsured individuals will likely be eligible for Essential Plan 200-250.  Beginning April 1, these individuals can apply through the NY State of Health/Marketplace or with the assistance of a Navigator. Coverage can be effective in the month of enrollment, as long as a plan is selected in that month. If no plan is selected within 10 days of being determined eligible, the individual will be automatically assigned to a plan and coverage can be effective in that month.

Reminders regarding Essential Plan coverage:

  • Applications are accepted at any time of the year. 

  • Enrollees have 12 months of continuous coverage.

  • Enrollees can change their plan at any time of the year.

  • Essential Plan is offered with no premium, no deductible, and no cost sharing for preventive services.

So let’s reach out to those who do not have coverage and tell them the good news!

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