New York ACA Essential Plan

[jpdx]

Any New Yorkers here?

I am not one, but I am trying to assist a family member who lives in NY sign up for ACA health insurance. Is the Essential Plan any good, and how does it compare to regular qualified health plans on the exchange? Are the provider networks the same or are they more limited like Medicaid? I noticed there were a limited number of plans and each appeared to be an HMO; I could not find any PPO options.

[Dollar Slice]

I haven't been on the Essential Plan, but I've been on some ACA plans and Medicaid in NY, and as far as I can tell the ACA and Medicaid networks are pretty much the same (and they're all limited). Unfortunately a lot of doctors won't be in network if you're on an ACA plan. But the coverage is great and you'll pay very little out of pocket.

I really only have a problem with the network when I'm looking for specialists, though. When I had a health problem mid-pandemic I was able to get a telehealth appointment at 10PM on a Sunday, a new primary care doctor (appt within two days) and a new gynecologist (next day appt), an ultrasound, blood work, etc. etc. all right away. I had a colonoscopy/endoscopy scheduled within 10 days when I needed one. It's just when I need to find a neurologist with a certain subspecialty that I have a hard time finding a good one who takes my insurance. You may have to do some hunting or wait a while for an appointment.

[jim555]

NY Medicaid MCOs and Essential Plan are basically the same.  EP doesn't usually cover dental and vision, but for 2021 and 2022 the EP does.  Sometimes a Provider will move plans and you need to jump to the new plan if you want to keep seeing them.

[jim555]

Gov. Hochul proposed increasing the Essential Plan up to 250% FPL from 200% FPL for next year.