The Essential Plan

Plans with access to essential health benefits like doctor visits, lab tests, prescription drugs, hospitalization, urgent care, emergency care, vision, dental, and more—all for a $0 monthly plan premium. These plans are for qualified individuals ages 19–64.

Plan Highlights:

No-cost annual checkups
Hospital, emergency room, and urgent care visits
Lab tests and X-rays
Prescription drug coverage
Maternity coverage
No-cost dental and vision coverage^*
24/7 access to care with telemedicine (Teladoc)^**
Physical, occupational, and speech therapy
Annual gym membership reimbursement^†

2023
2022

Tier

Essential Plan 1

Summary of Benefits and Coverage (PDF)

Eligible Age

19 to 64

Eligible Service Areas

Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), on Long Island, and in Westchester, Orange, Rockland, and Sullivan counties

Other Eligibility Requirements

Income between $20,385 and $27,180^††

Dental Cleanings

$0 copay

Vision Exams

$0 copay

Telemedicine ()

$0 copay

Costs & Benefits

Essential Plan 1

(Individual)

$2,000

Your Annual Checkup

$0 copay

$15 copay

$25 copay

Retail Health Clinic

$25 copay

Urgent Care

$25 copay

Emergency Room

$75 copay

Ambulance

$75 copay

Surgeon

$50 copay

$150 copay per admission

Prescriptions

(Tier 1)

$6 copay

(Tier 2)

$15 copay

(Tier 3)

$30 copay

(Tier 1)

$15 copay

English

Eligibility for Medicaid Plans

These plans are for low-income families, and for individuals under the age of 65, with the following household income

Medicaid Managed Care
Household Size	Maximum Household Income
1	$18,755
2	$25,268
3	$31,782
4	$38,295
5	$44,809
6	$51,323
7	$57,836
8	$64,350

Tier

Essential Plan 2

Summary of Benefits and Coverage (PDF)

Eligible Age

19 to 64

Eligible Service Areas

Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), on Long Island, and in Westchester, Orange, Rockland, and Sullivan counties

Other Eligibility Requirements

Income between $18,755 and $20,385^††

Dental Cleanings

$0 copay

Vision Exams

$0 copay

Telemedicine ()

$0 copay

Costs & Benefits

Essential Plan 2

(Individual)

$200

Your Annual Checkup

$0 copay

Retail Health Clinic

$0 copay

Urgent Care

$0 copay

Emergency Room

$0 copay

Ambulance

$0 copay

Surgeon

$0 copay

$0 copay per admission

Prescriptions

(Tier 1)

$1 copay

(Tier 2)

$3 copay

(Tier 3)

$3 copay

(Tier 1)

$2.50 copay

English

Eligibility for Medicaid Plans

These plans are for low-income families, and for individuals under the age of 65, with the following household income

Medicaid Managed Care
Household Size	Maximum Household Income
1	$18,755
2	$25,268
3	$31,782
4	$38,295
5	$44,809
6	$51,323
7	$57,836
8	$64,350

Tier

Essential Plan 3

Summary of Benefits and Coverage (PDF)

Eligible Age

21 to 64

Eligible Service Areas

Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), on Long Island, and in Westchester, Orange, Rockland, and Sullivan counties

Other Eligibility Requirements

Income between $13,590 and $18,755^††

Requires legal U.S. residency for less than five years. Learn more about your legal status here.

Dental Cleanings

$0 copay

Vision Exams

$0 copay

Telemedicine ()

$0 copay

Costs & Benefits

Essential Plan 3

(Individual)

$200

For Covered Prescription Drugs, there will be a $50 copay maximum out of pocket per calendar quarter.

Your Annual Checkup

$0 copay

Retail Health Clinic

$0 copay

Urgent Care

$0 copay

Emergency Room

$0 copay

Ambulance

$0 copay

Surgeon

$0 copay

$0 copay per admission

Prescriptions

(Tier 1)

$1 copay

(Tier 2)

$3 copay

(Tier 3)

$3 copay

(Tier 1)

$2.50 copay

English

Eligibility for Medicaid Plans

These plans are for low-income families, and for individuals under the age of 65, with the following household income

Medicaid Managed Care
Household Size	Maximum Household Income
1	$18,755
2	$25,268
3	$31,782
4	$38,295
5	$44,809
6	$51,323
7	$57,836
8	$64,350

Tier

Essential Plan 4

Summary of Benefits and Coverage (PDF)

Eligible Age

21 to 64

Eligible Service Areas

Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), on Long Island, and in Westchester, Orange, Rockland, and Sullivan counties

Other Eligibility Requirements

Income less than $13,590^††

Requires legal U.S. residency for less than five years. Learn more about your legal status here.

Dental Cleanings

$0 copay

Vision Exams

$0 copay

Telemedicine ()

$0 copay

Costs & Benefits

Essential Plan 4

(Individual)

Your Annual Checkup

$0 copay

Retail Health Clinic

$0 copay

Urgent Care

$0 copay

Emergency Room

$0 copay

Ambulance

$0 copay

Surgeon

$0 copay

$0 copay per admission

Prescriptions

(Tier 1)

$0 copay

(Tier 2)

$0 copay

(Tier 3)

$0 copay

(Tier 1)

$0 copay

English

Eligibility for Medicaid Plans

These plans are for low-income families, and for individuals under the age of 65, with the following household income

Medicaid Managed Care
Household Size	Maximum Household Income
1	$18,755
2	$25,268
3	$31,782
4	$38,295
5	$44,809
6	$51,323
7	$57,836
8	$64,350

Tier

Essential Plan 1

Summary of Benefits and Coverage (PDF)

Eligible Age

19 to 64

Eligible Service Areas

Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), on Long Island, and in Westchester, Orange, Rockland, and Sullivan counties

Other Eligibility Requirements

Income between $20,385 and $27,180^††

Dental Cleanings

$0 copay

Vision Exams

$0 copay

Telemedicine ()

$0 copay

Costs & Benefits

Essential Plan 1

(Individual)

$2,000

Your Annual Checkup

$0 copay

$15 copay

$25 copay

Retail Health Clinic

$25 copay

Urgent Care

$25 copay

Emergency Room

$75 copay

Ambulance

$75 copay

Surgeon

$50 copay

$150 copay per admission

Prescriptions

(Tier 1)

$6 copay

(Tier 2)

$15 copay

(Tier 3)

$30 copay

(Tier 1)

$15 copay

English

Eligibility for Medicaid Plans

These plans are for low-income families, and for individuals under the age of 65, with the following household income

Medicaid Managed Care
Household Size	Maximum Household Income
1	$18,755
2	$25,268
3	$31,782
4	$38,295
5	$44,809
6	$51,323
7	$57,836
8	$64,350

Tier

Essential Plan 2

Summary of Benefits and Coverage (PDF)

Eligible Age

19 to 64

Eligible Service Areas

Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), on Long Island, and in Westchester, Orange, Rockland, and Sullivan counties

Other Eligibility Requirements

Income between $18,755 and $20,385^††

Dental Cleanings

$0 copay

Vision Exams

$0 copay

Telemedicine ()

$0 copay

Costs & Benefits

Essential Plan 2

(Individual)

$200

Your Annual Checkup

$0 copay

Retail Health Clinic

$0 copay

Urgent Care

$0 copay

Emergency Room

$0 copay

Ambulance

$0 copay

Surgeon

$0 copay

$0 copay per admission

Prescriptions

(Tier 1)

$1 copay

(Tier 2)

$3 copay

(Tier 3)

$3 copay

(Tier 1)

$2.50 copay

English

Eligibility for Medicaid Plans

These plans are for low-income families, and for individuals under the age of 65, with the following household income

Medicaid Managed Care
Household Size	Maximum Household Income
1	$18,755
2	$25,268
3	$31,782
4	$38,295
5	$44,809
6	$51,323
7	$57,836
8	$64,350

Tier

Essential Plan 3

Summary of Benefits and Coverage (PDF)

Eligible Age

21 to 64

Eligible Service Areas

Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), on Long Island, and in Westchester, Orange, Rockland, and Sullivan counties

Other Eligibility Requirements

Income between $13,590 and $18,755^††

Requires legal U.S. residency for less than five years. Learn more about your legal status here.

Dental Cleanings

$0 copay

Vision Exams

$0 copay

Telemedicine ()

$0 copay

Costs & Benefits

Essential Plan 3

(Individual)

$200

For Covered Prescription Drugs, there will be a $50 copay maximum out of pocket per calendar quarter.

Your Annual Checkup

$0 copay

Retail Health Clinic

$0 copay

Urgent Care

$0 copay

Emergency Room

$0 copay

Ambulance

$0 copay

Surgeon

$0 copay

$0 copay per admission

Prescriptions

(Tier 1)

$1 copay

(Tier 2)

$3 copay

(Tier 3)

$3 copay

(Tier 1)

$2.50 copay

English

Eligibility for Medicaid Plans

These plans are for low-income families, and for individuals under the age of 65, with the following household income

Medicaid Managed Care
Household Size	Maximum Household Income
1	$18,755
2	$25,268
3	$31,782
4	$38,295
5	$44,809
6	$51,323
7	$57,836
8	$64,350

Tier

Essential Plan 4

Summary of Benefits and Coverage (PDF)

Eligible Age

21 to 64

Eligible Service Areas

Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), on Long Island, and in Westchester, Orange, Rockland, and Sullivan counties

Other Eligibility Requirements

Income less than $13,590^††

Requires legal U.S. residency for less than five years. Learn more about your legal status here.

Dental Cleanings

$0 copay

Vision Exams

$0 copay

Telemedicine ()

$0 copay

Costs & Benefits

Essential Plan 4

(Individual)

Your Annual Checkup

$0 copay

Retail Health Clinic

$0 copay

Urgent Care

$0 copay

Emergency Room

$0 copay

Ambulance

$0 copay

Surgeon

$0 copay

$0 copay per admission

Prescriptions

(Tier 1)

$0 copay

(Tier 2)

$0 copay

(Tier 3)

$0 copay

(Tier 1)

$0 copay

English

Eligibility for Medicaid Plans

These plans are for low-income families, and for individuals under the age of 65, with the following household income

Medicaid Managed Care
Household Size	Maximum Household Income
1	$18,755
2	$25,268
3	$31,782
4	$38,295
5	$44,809
6	$51,323
7	$57,836
8	$64,350

^*Dental services must be medically necessary to be covered; limitations apply.

^**Telemedicine isn’t a replacement for your primary care provider (PCP). Your PCP should always be your first choice for care (both in-person and virtual visits).

^†Up to $200 per reward period. There are two reward periods—January through June, and July through December.

^††Based on 2021 earnings. The income ranges shown are for individuals only. The income ranges may increase based on the eligible members in your household. To learn more, talk to a Healthfirst representative.

The benefit information provided is a brief summary, not a complete description, of benefits. For more information, contact the plan.

Coverage is provided by Healthfirst PHSP, Inc. Plans contain exclusions and limitations.

Additional Benefits

24/7 Access to Telemedicine with Teladoc^*

Talk to a doctor any time—for a $0 copay. Connect with board-certified doctors through video chat or phone for prescriptions, help diagnosing and treating non-emergency conditions, and more. Access to dermatologists is also available.

^*Telemedicine isn’t a replacement for your primary care provider (PCP). Your PCP should always be your first choice for care (both in-person and virtual visits).
Active & Fit Direct

Healthfirst makes working out affordable too! For just $25/month, you get a standard membership to a fitness center in your area. Premium fitness center options are available for an additional fee. Track your activity, monitor your progress, achieve your fitness goals, and so much more! Visit activeandfitdirect.com to learn more.
ExerciseRewards™ Program

Physical activity is one of the simplest ways to stay healthy, and Healthfirst makes it even more rewarding! With the Active&Fit ExerciseRewards™ program, you can earn $200 every six months if you visit a qualifying fitness center at least 50 days during the same six-month reward period. Contact ExerciseRewards at 1-877-810-2746 to learn more about qualifying fitness centers.

Additional Benefits

24/7 Access to Telemedicine with Teladoc^*

24/7 Access to Telemedicine with Teladoc^*
Talk to a doctor any time—for a $0 copay. Connect with board-certified doctors through video chat or phone for prescriptions, help diagnosing and treating non-emergency conditions, and more. Access to dermatologists is also available.

^*Telemedicine isn’t a replacement for your primary care provider (PCP). Your PCP should always be your first choice for care (both in-person and virtual visits).
Active & Fit Direct

Active & Fit Direct
Healthfirst makes working out affordable too! For just $25/month, you get a standard membership to a fitness center in your area. Premium fitness center options are available for an additional fee. Track your activity, monitor your progress, achieve your fitness goals, and so much more! Visit activeandfitdirect.com to learn more.
ExerciseRewards™ Program

ExerciseRewards™ Program
Physical activity is one of the simplest ways to stay healthy, and Healthfirst makes it even more rewarding! With the Active&Fit ExerciseRewards™ program, you can earn $200 every six months if you visit a qualifying fitness center at least 50 days during the same six-month reward period. Contact ExerciseRewards at 1-877-810-2746 to learn more about qualifying fitness centers.

Frequently Asked
Questions

See All

Who is eligible to enroll?

We have plans for all ages, needs, and income levels. To see which Healthfirst plans are right for you, please use our plan recommendation tool or contact us.
Why should I choose Healthfirst?

Healthfirst is a not-for-profit community organization sponsored by some of the most prestigious and nationally recognized hospitals and medical centers in New York. With more than a million members and growing, Healthfirst has been serving communities in New York City for more than 25 years. With access to thousands of doctors and specialists, you’re sure to find the service you need nearby. Each of our community offices is fully staffed with representatives who can answer questions—in many different languages—about our health insurance plans and programs, whether you’re a member or not.
How can I enroll?

The easiest way to enroll in a Healthfirst plan is to contact us. Our sales reps can guide you to the best plan for you and ease the enrollment process.

To learn more about our Healthfirst plans or find the one that’s right for you, use our plan recommendation tool.

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Support When You Need It

We’re happy to answer your questions.

Learn about enrollment

1-844-488-1486

Monday to Saturday, 8am–8pm

TTY English: 1-888-542-3821

TTY Español: 1-888-867-4132

Member Services

1-888-250-2220

Monday to Saturday, 8am–8pm

TTY English: 1-888-542-3821

TTY Español: 1-888-867-4132

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Request a callback and we’ll get back to you within one business day.

You can also visit our Virtual Community Office to connect with a local Healthfirst representative or to find a community office near you.

You can also go to the NY State of Health’s website to view your choices, or call the NY State of Health customer service center at 1-855-355-5777.

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Need help choosing a plan?

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The Essential Plan

Plan Highlights:

Additional Benefits

24/7 Access to Telemedicine with Teladoc^*

Active & Fit Direct

ExerciseRewards™ Program

Additional Benefits

24/7 Access to Telemedicine with Teladoc^*

Active & Fit Direct

ExerciseRewards™ Program

Frequently Asked
Questions

Support When You Need It

1-844-488-1486

1-888-250-2220

Can’t talk right now?

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The Essential Plan

Plan Highlights:

Plans

Eligibility for Medicaid Plans

Eligibility for Medicaid Plans

Eligibility for Medicaid Plans

Eligibility for Medicaid Plans

Eligibility for Medicaid Plans

Eligibility for Medicaid Plans

Eligibility for Medicaid Plans

Eligibility for Medicaid Plans

Additional Benefits

24/7 Access to Telemedicine with Teladoc*

Active & Fit Direct

ExerciseRewards™ Program

Additional Benefits

24/7 Access to Telemedicine with Teladoc*

Active & Fit Direct

ExerciseRewards™ Program

Frequently Asked Questions

Support When You Need It

1-844-488-1486

1-888-250-2220

Can’t talk right now?

We look forward to helping you!

You are now navigating away from the Healthfirst website.

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24/7 Access to Telemedicine with Teladoc^*

24/7 Access to Telemedicine with Teladoc^*

Frequently Asked
Questions