The Fidelis Care Blog

NY State of Health has notified health plans and members of Essential Plan 200-250 (also known as Essential Plan 5) that plan coverage will end. The last day of coverage is June 30, 2026. Your patients’ coverage remains the same through that date.

This change is due to anticipated cutbacks in federal funding, according to NY State of Health. It only affects people whose income is between 200% and 250% of federal poverty level. Your patients in Essential Plan 1–Essential Plan 4 are not impacted.

Impacted individuals received a letter on April 1 from NY State of Health outlining the timeline for the end of Essential Plan 200-250 and next steps for them to stay covered. NY State of Health will use these patients’ NY State of Health account information and data from federal and state sources to determine the coverage available to them. Patients will receive a follow-up letter by May 15 from NY State of Health with that information. 

How you can help

• Remind your patients with Essential Plan 200-250 coverage to update their NY State of Health accounts to reflect changes in income, household size, and contact information.
  • Depending on a loss of income, patients may qualify for a different EP or Medicaid plan.
  • Pregnant patients will be eligible for EP1 or Medicaid Managed Care depending on their due date.
  • Other patients will qualify for Qualified Health Plans (Marketplace).
• Report the pregnancy of patients in Essential Plan 200-250 to NY State of Health to ensure their transition of care.
• If your patients have questions, please have them call Fidelis Care at 1-888-FIDELIS (1-888-343-3547). Fidelis Care members can also visit one of our Community Offices or StreetSide vehicles for assistance.

NY State of Health has notified health plans and members of Essential Plan 200-250 (also known as Essential Plan 5) that plan coverage will end. The last day of coverage is June 30, 2026. Your patients’ coverage remains the same through that date.

This change is due to anticipated cutbacks in federal funding, according to NY State of Health. It only affects people whose income is between 200% and 250% of federal poverty level. Your patients in Essential Plan 1–Essential Plan 4 are not impacted.

Impacted individuals received a letter on April 1 from NY State of Health outlining the timeline for the end of Essential Plan 200-250 and next steps for them to stay covered. NY State of Health will use these patients’ NY State of Health account information and data from federal and state sources to determine the coverage available to them. Patients will receive a follow-up letter by May 15 from NY State of Health with that information. 

How you can help

• Remind your patients with Essential Plan 200-250 coverage to update their NY State of Health accounts to reflect changes in income, household size, and contact information.
  • Depending on a loss of income, patients may qualify for a different EP or Medicaid plan.
  • Pregnant patients will be eligible for EP1 or Medicaid Managed Care depending on their due date.
  • Other patients will qualify for Qualified Health Plans (Marketplace).
• Report the pregnancy of patients in Essential Plan 200-250 to NY State of Health to ensure their transition of care.
• If your patients have questions, please have them call Fidelis Care at 1-888-FIDELIS (1-888-343-3547). Fidelis Care members can also visit one of our Community Offices or StreetSide vehicles for assistance.