Essential Plan (EP)

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. 

Essential Plan benefits include:

• FREE preventive care like routine doctor exams and screenings 
• Dental and vision coverage 
• Inpatient and outpatient hospital care 
• Prescription drugs 
• Prenatal care, including free BabyCare program
• Lab tests, X-rays, and more
• Wellness Rewards program
• Fitness reimbursement

Adjusted Income Guidelines for Essential Plan in 2025

Who can apply for EP?

The Essential Plan is for individuals who meet certain income requirements. You can use the 2025 Income Guidelines chart to see if you may qualify.

The Essential Plan is a good option for young adults who no longer qualify for Child Health Plus. It’s also great for people who can’t get health coverage through their employer.

Open enrollment is available year-round.
If eligible, you can sign up today!

Low or No Costs

Fidelis Care offers five types of Essential Plans: Essential Plan 1, 2, 3, 4, and 200-250. Your income will determine which plan you are eligible for. 

Costs vary between tiers depending on your eligibility:

• Monthly premium is $0
• Office visits are $0 or $15 for a PCP, and $0 or $25 for a specialist.
• Inpatient hospital stays are $0 or $150. 
• There is no deductible for any of the plans.
• All plans offer in-network only coverage (except for emergency services which are covered at any provider). 
• Always check if your provider is in network before receiving care. Your costs will be higher if you receive care out of network.

Essential Plan members also have dental and vision coverage at no additional cost.

How to Enroll in an Essential Plan

Once you know the health coverage you qualify for, there are four ways you can enroll:

• Call 1-888-FIDELIS (TTY: 711)

• Find a Fidelis Care office near you.
  Make an appointment, or visit during regular business hours!

• Enroll Online via NY State of Health. 
  Visit NYSOH and click on "Start Enrollment."

• Select 'Get Started' in the next box to contact a certified representative.