The Essential Plan is offered through UnitedHealthcare Community Plan. It's for lower income individuals in New York who meet the income or citizenship status requirements.
To find out if UnitedHealthcare Community Plan is offered in your county, please call 1-888-617-8979. A representative will contact you to schedule an appointment to help you apply.
Is this plan available in my county?Albany , Bronx , Broome , Cayuga , Chautauqua , Chemung , Chenango , Clinton , Columbia , Dutchess , Erie , Essex , Franklin , Fulton , Genesee , Greene , Jefferson , Kings , Lewis , Livingston , Madison , Monroe , Nassau , New York , Niagara , Oneida , Onondaga , Ontario , Orange , Orleans , Oswego , Queens , Rensselaer , Richmond , Rockland , Saratoga , Schenectady , Seneca , St. Lawrence , Suffolk , Tioga , Ulster , Warren , Wayne , Westchester , Wyoming , and Yates .
Clarification: Essential Plan Guidance related to cost sharing for the testing, diagnosis of, and vaccination for Monkeypox - August 19, 2022
Effective July 29, 2022, and for the duration of the declared disaster in the State of New York, Essential Plan issuers are required to cover cost-sharing for office or telemedicine visits related to testing, diagnosis, and treatment of Monkeypox.
While vaccines are in limited supply and awaiting broader approval, our understanding is that they are offered free of charge irrespective of insurance status. To the extent vaccines are offered through a provider, the visit should be covered without cost-sharing.
Additionally, this guidance applies to Essential Plans only. NY State of Health will monitor utilization and make rate adjustments, if necessary.
Search for doctors, hospitals and specialists.
Find medications covered by this plan.
Pill Bottle IconFind a pharmacy near you.
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Essential Plan 200-250 Standard: Coverage for those ages 19-64 who earn 201-250% of the Federal Poverty Level. Includes Dental and Vision benefits.
Essential Plan 200-250 Native American/Alaskan: Coverage for those ages 19-64 who earn 201-250% of the Federal Poverty Level. Designed for Native American or Alaskan Native Individuals. Includes Dental and Vision benefits.
Essential Plan 1 Standard: Coverage for those ages 19-64 who earn 151-200% of the Federal Poverty Level. Includes Dental and Vision benefits.
Essential Plan 1 Native American/Alaskan: Coverage for those ages 19-64 who earn 151-200% of the Federal Poverty Level. Designed for Native American or Alaskan Native Individuals. Includes Dental and Vision benefits.
Essential Plan 2 Standard: Coverage for those ages 19-64 who earn 139-150% of the Federal Poverty Level. Includes Dental and Vision benefits.
Essential Plan 2 Native American/Alaskan: Coverage for those ages 19-64 who earn 139-150% of the Federal Poverty Level. Designed for Native American or Alaskan Native Individuals. Includes Dental and Vision benefits.
Essential Plan 3: Coverage for those ages 21-64 who are "Legally Present" but not eligible for Medicaid, earning 100-138% of the Federal Poverty Level. Includes Dental and Vision benefits.
Essential Plan 4: Coverage for those ages 21-64 who are "Legally Present" but not eligible for Medicaid, earning less than 100% of the Federal Poverty Level. Includes Dental and Vision benefits.
Document Single IconStarting June 1, 2021, there will be no monthly premium for Essential Plan coverage and all Essential Plan enrollees will have dental and vision benefits with no premium or cost sharing for covered services.
Medical Services: Copays will apply for all Essential Plan 1 plan types.
Inpatient Hospital Services: Copays will apply for all Essential Plan plans.
Emergency Medical Services: Copays will apply for all Essential Health Plan plans.
Outpatient Hospital/Facility Services: Copays will apply for all Essential Plan plans.
Preventive and Primary Care Services: PCP/Specialist copay per visit (based on type of physician performing the service) will apply for all Essential Plan plans.
Physician /Professional Services: Copays will apply for all Essential Plan plans.
Prescription Drugs: Copays will apply for all Essential Plan plans.
* Copays may vary. Alaskan Natives and American Indian members are exempt from co-pays and co-insurance. Refer to Subscriber Contract in Member Information section for more details regarding copays and coinsurance.
Document Folder IconGet the care you need to stay healthy – or to get better if you are injured or sick. That includes:
* Dental benefits are available through purchase of Essential Plus plans or as a standard benefit in Essential Plan 3 and 4 plans; these benefits are not available for Essential Plan 1 and 2 Standard Plans.
Document Clipboard IconIf you have special health care needs, you can count on us. Our plan will provide the extra care and services needed. Benefits include:
Make sure your sight, teeth, speech and hearing are at their best. Benefits include:
Partial reimbursement ($400/200 every 6 months) for facility fees if member attains at least 50 visits.
Health Icon$75 credit every quarter to pay for healthy food and OTC products Learn more about this benefit
Get the medical care and equipment you need to recover safely at home. Benefits include:
Sometimes you might need a little extra help using your health plan. For those times, you can rely on:
Individual care to help control asthma, allergies or COPD symptoms.
Do you or your child have trouble managing asthma, allergies or COPD symptoms? A nurse who specializes in breathing issues can really help. You'll get a customized treatment plan and medicine to:
You get a primary care physician (PCP), who is your main doctor. Use the Doctor Lookup tool to see if your doctor is in our network.
If you don't have a doctor or if your doctor is not in our network, we can help you find a new one close to you.
Your PCP is your main doctor for:
Dental Care*
Checkups are covered. Exams and cleanings every six months help keep teeth and gums strong and healthy. If there is a dental problem that needs to be fixed, that's covered as well.
Vision Care*
See life more clearly with routine eye exams and glasses, if needed. We also include:
This benefit is offered by March Vision care.
Diabetes Monitoring IconIf you have diabetes, you may need insulin, needles, wipes and glucose strips. We cover all that and more.
Our plan also steps up with services to help you manage your diabetes, including:
Your health and safety at home are important.
Our plan covers medical equipment ordered by your doctor or case manager. This can include supplies like:
Trouble hearing can affect your everyday life in many ways. Our plan includes services and support to help protect your hearing.
Our plan covers:
This plan pays for all expenses related to a hospital stay, so you can rest and heal.
Hospitalization coverage includes:
And after you leave the hospital, you are not alone. We make sure you get follow-up care to continue healing at home.
Pill Bottle IconOur plan covers prescription drugs and refills with a small copayment. Your copay is:
| Essential Plan | ||||
| 1 | 2 | 3 | 4 | |
| Generic | $6 | $1 | $1 | $0 |
| Tier 2 | $15 | $3 | $3 | $0 |
| Tier 3 | $30 | $3 | $3 | $0 |
Over-the-counter medicines with a written order from your doctor are available for a copayment for each medicine. And we make getting your medicine easy. You can fill your prescriptions at:
Sometimes you might need a little help understanding your health care options. With us, you have someone you can call Monday – Friday 8 a.m. – 6 p.m. EST. We'll answer your questions simply and completely.
We can also help you find:
Mental health is as important as physical health. That's why we have coverage for both.
Required care is 100% covered. This includes:
* Copays will apply for Essential Plan 1.
Virtual Care IconSometimes you may need continued care after you leave the hospital or urgent care.
If your health is at risk after a serious illness, surgery or injury, a nurse will visit you at home to:
Knowing what's wrong and finding it early can make all the difference.
Our plan covers:
We'll help you get the information needed to help improve your health or be your best.
After a serious illness, surgery or injury, you may need extra nursing and therapy.
If needed, our plan covers short stays in a rehabilitation center where you can heal. Included are:
Do you have family members or friends who care for you at home?
If so, we want to support their hard work too. That's why we provide respite care to give your caregivers a rest. Respite care offers caregivers time away from their loved one who is ill or has special care needs.
Immunology IconRoutine shots help keep you healthy.
So, our plan covers:
Well visits with your doctor can help you stay healthy. These visits can catch health problems early, so they can be treated.
Preventive services include:
2023 & 2024 Subscriber Contracts
When you join as a new member, UnitedHealthcare wants you to become familiar with all the benefits and resources available to you as a member. This welcome letter provides a brief overview of the plan and what to expect as a UnitedHealthcare member.
As a member, we want to provide you with all the resources and information you need. This useful guide provides a quick resource for getting started, finding help, your benefits, how to connect, getting care and so much more.
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If you have questions about your health plan, please call us. Our toll-free Member Services number is 1-866-265-1893, TTY 711. We are open Monday through Friday, 8 am to 6 pm EST.
For a Mental Health or Substance Abuse Crisis dial the member services number then press 8.
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Every year, members enrolled in a New York State sponsored health insurance programs must renew their health care coverage. This process is called annual recertification or renewal of health care coverage.
Make sure to maintain your UnitedHealthcare Community Plan Coverage.
UnitedHealthcare cares about you. Our mission is to help people live healthier lives. To stay a UnitedHealthcare member, you have to renew your Medicaid coverage. Call us at 1-866-265-1893, TTY 711, or visit one of our office locations, and we will be happy to help you with questions about renewing your coverage
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There are many ways to choose a health care provider. It is important to find providers who are a good fit for you. Ideas include:
Wewant you to feel good about the quality of the providers you choose. Health care providers include:
Of course, you can also call your Member Services Advocate at 1-866-265-1893. We will help you make the choice that’s right for you.
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This is your secure member website. See your covered benefits, search for providers, view your member handbook and much more.
It’s designed for people on the go and includes many of the same features as the member website. Find it at the App Store or Google Play.
Getting to the doctor when you are healthy is important. We have guides to help you know what to expect at each well visit. You can also talk to your Member Services Advocate for support and information.
We also have helpful guides for most health problems and conditions. You can also talk to your Member Services Advocate for support and information.
Our educational materials can be found on myuhc.com/CommunityPlan .
You will find condition-specific and general health topics, including:
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For information on HIV and on HIV counseling, testing, referral, and partner notification (CTRPN) services including Perinatal HIV Prevention & Newborn Screening see the link to the NYSDOH web site below:
Additionally, the link below to the AIDS Institute will provide consumer information you might find helpful:
UnitedHealthcare Community Plan members are not responsible for payment for any covered services. Some services may have small co-payments, which can be waived if you cannot afford them.
You should not pay out-of-pocket upfront for any services. There are no out-of-network benefits except in a few cases. A surprise medical bill certification form may be required at those times. See your member handbook for times when you can go to an out-of-network provider. Reimbursement is not guaranteed.
If you have received a bill for covered services or need help fining a participating provider, please call us at 1-866-265-1893, TTY 711 for assistance.
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Clinical Practice Guidelines
UnitedHealthcare Community Plan has practice guidelines that help providers make healthcare decisions. These guidelines come from nationally recognized sources. UnitedHealthcare Community Plan has practice guidelines for preventive health and other health conditions.
Call our Member Services at 1-866-265-1893 (TTY: 711) to request a printed copy.
The quarterly newsletter is a great way to learn about our health plan and important health topics. Our HealthTalk newsletter is available online allowing you to read it whenever and wherever you want.
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Behavioral health is about how you feel and act. It is also called mental health. Your mental health is very important. The UnitedHealthcare Community Plan of New York includes mental health and substance use disorder services. You or your provider can call Optum Behavioral Health anytime for help at 1-844-206-1399.
Covered services include:
Quitting is hard, but we can help. Did you know that 20 minutes after you quit, your heart rate drops to a normal level? And within 24 hours after quitting the carbon monoxide level in your blood drops to normal.
Talk to your doctor about quitting. You know the bad health effects of smoking.
You know you need to quit. We support you while you quit with the help of coaches and supplies. The only thing you won't get from us is a lecture.Or call 1-800-QUIT-NOW (1-800-784-8669) to get free coaching, counseling and supplies to help you quit.
Being healthy is not always about your urgent medical needs. Sometimes you may need help connecting to resources out in the community. We call these social needs. These are things like housing, getting food every day or feeling safe. We can also help you with finishing your education. You can call your Member Services Advocate for more information. Or you can visit findhelp.org
We also offer special programs that include:
Advance directives are instructions you give about your future medical care in case there is a time you can’t speak or make decisions for yourself. They help your family and physician understand your wishes.
With advance directives, you can:
Advance directives are only used if you can’t speak for yourself. It does not take away your right to make a different choice if you later become able to speak for yourself.
You can make an advance directive by:
You can look at advance directive and health care proxy forms here:
UnitedHealthcare Community Plan provides member materials to you in a language or format that makes it easier for you to understand. Our provider network includes many doctors who are multilingual.
Our provider directory shows which languages doctors speak. Additionally, many of our Member Services Advocates speak multiple languages, so when you call they will be able to help you or connect you with our interpreter service which covers more than 170 languages.
If you have trouble hearing over the phone you can use a text telephone. This free service allows persons with hearing or speech disabilities to place and receive telephone calls. Call 711, give them the Member Services number, 1-866-265-1893, and they will connect you to us.
You can also get information in large print, Braille or audio files on a CD. We can also assist with interpreter services, including American Sign Language. To ask for help, please call us Monday through Friday, 8 am to 6 pm EST.
Our toll-free Member Services number is 1-866-265-1893, TTY: 711.
We have a Notice of Privacy Practices that tells you how health information about you may be used and shared. We are required by law to let you know that the Notice is available, and how you can get a copy of it. View a copy of our Notice of Privacy Practices
We want to hear from our members about any questions, complaints or concerns you may have. If you have a grievance, please call Member Services toll-free, at 1-866-265-1893, TTY 711.
If you are not happy with the response from your Member Services Advocate, Care Manager or Member Services, you may file a grievance. You may file a complaint or grievance against us (the health plan) or a provider with us at any time.
Members may file a grievance verbally with their Member Services Advocate from 8 am to 6 pm EST, Monday through Friday, at 1-866-265-1893, TTY 711. All members can file a grievance through this process.
You have other rights that include appeals and a State Fair Hearing. For detailed information about complaints and appeals, contact Member Services or view the Appeals and Grievances section of the Member Handbook.
Fraud, waste and abuse are serious problems. There can be penalties under law. To make a report, call the UHC Fraud Hotline at 1-844-359-7736. You can also call Member Services at 1-866-265-1893. We will not use your name in your report. You will not get in trouble for reporting this. We will look into the matter for you.
More information about fraud, waste or abuse, or to make a report online.
To learn more about applying for health insurance, including Medicaid, Child Health Plus, Essential Plan, and Qualified Health Plans through NY State of Health, The Official Health Plan Marketplace, visit www.nystateofhealth.ny.gov or call 1-855-355-5777.
The Essential Plan specialists can answer questions and help you enroll.
This plan is not currently available in the ZIP code entered.
Already a member?
Member Services: Monday - Friday from 8 a.m. - 6 p.m. Eastern Time
Benefits: Monday - Friday from 8 a.m. - 6 p.m. Eastern Time
You have access to our member-only website. Print ID cards and more.
The Essential Plan specialists can answer questions and help you enroll.
This plan is not currently available in the ZIP code entered.
Already a member?
Member Services: Monday - Friday from 8 a.m. - 6 p.m. Eastern Time
Benefits: Monday - Friday from 8 a.m. - 6 p.m. Eastern Time
You have access to our member-only website. Print ID cards and more.
It’s your health. It’s your choice.
Everyone deserves affordable health care, including you.
Working adults who don’t qualify for Medicaid may qualify for the Essential Plan. Check out the Essential Plan offered through the New York State of Health by UnitedHealthcare to see if you’re eligible.
We have the coverage, benefits and extras that can make a real difference in your life. All at either a low cost or no cost to you.
Sometimes, you might need a little extra help. If you aren’t eligible for Medicaid, the Essential Plan could be the right fit for you.
We also offer resources to help you make the most of your plan. Including:
Visit nystateofhealth.ny.gov dot gov for more information.
Helping you live a healthier life. We are here for you, New York. Remember to choose UnitedHealthcare Community Plan.
And get the plan that gets you more.
To learn more about UnitedHealthcare Community Plan and all plans offered in New York, visit UHCCommunityPlan dot com forward slash ny.
To learn more about applying for health insurance, including Medicaid, Child Health Plus, Essential Plan, and Qualified Health Plans through NY State of Health, The Official Health Plan Marketplace, visit nystateofhealth.ny.gov or call 1-855-355-5777. To find out if you qualify for Medicaid Managed Care or Child Health Plus offered by UnitedHealthcare Community Plan, please call 1-888-617-8979. UnitedHealthcare does not discriminate on the basis of race, color, national origin, sex, age or disability in health programs and activities. We provide free services to help you communicate with us. Such as, letters in other languages or large print. Or, you can ask for an interpreter. To ask for help, please call Member Services at 1-800-493-4647, TTY 711, 8 a.m. – 6 p.m., Monday – Friday ATTENTION: Language assistance services, free of charge, are available to you. Call 1-800-493-4647, TTY 711. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-493-4647, TTY 711. 注意：您可以免費獲得語言援助服務。請致電 1-800-493-4647, TTY 711 ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-800-493-4647 (телетайп: TTY 711).
Last Updated: 08.21.2024 at 10:19 PM CDT
Disclaimer information (scroll within this box to view)Looking for the federal government’s Medicaid website? Look here at Medicaid.gov.
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.
Dual Special Needs plans have a $0 premium for members with Extra Help (Low Income Subsidy).
Benefits, features, and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply.
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) 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) 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) is a health plan that contracts with both Medicare and MassHealth (Medicaid) to provide benefits of both programs to enrollees.
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 (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.
Every year, Medicare evaluates plans based on a 5-Star rating system. The 5-Star rating applies to plan year 2024.
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 endorsement 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.
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.
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 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.
To report incorrect information, email provider_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 call 1-888-638-6613 / TTY 711, or use your preferred relay service.
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.
If CMS hasn’t provided an end date for the disaster or emergency, plans will resume normal operation 30 days after the initial declaration.