New York Essential Plan benefits

As an Anthem Blue Cross and Blue Shield HP Essential Plan member in New York, you get many benefits with little to no costs or copays.

Who’s eligible for Essential Plan in NY?

 

You or your child(ren) may be eligible for the Essential Plan through Anthem if you:

 

 Are between the ages of 19 and 64.

 

 Live in the Bronx, Brooklyn (Kings), Manhattan (New York), Queens, Staten Island (Richmond), Delaware, Dutchess, Nassau, Orange, Putnam, Rockland, Suffolk, Sullivan, Ulster, or Westchester County.

 

 Are not eligible for Medicaid or Child Health Plus.

 

 Are not eligible for minimum essential coverage.

 

You do not have to be a citizen or legal resident to qualify for the Essential Plan. Participation in this program will not affect any future immigration status.

More choices to customize your coverage

 

With an Anthem Essential Plan, you'll have access to a wide range of services in New York. There are four versions of the Essential Plan. Some benefits may vary based on your plan.

What you get with Anthem

Doctor visits

Hospital stays

Prescriptions

There are no copays for covered medical services, including:

  • Primary care provider (PCP) visits
  • Immunizations and wellness visits
  • Specialist visits
  • Urgent care
  • Emergency care
  • Lab and X-ray services
  • Pregnancy services
  • Family planning
  • Hospital care
  • Physical therapy
  • Behavioral health care

 

Check your member handbook for a full list of benefits in your plan.

 

Find care 

Dental benefits are provided through LIBERTY Dental. If your plan includes dental services, you can get coverage for:

  • Teeth cleaning twice a year
  • Oral exams
  • X-rays
  • Extractions
  • Fillings
  • Emergency care
  • Dentures (removable or partial)
  • Orthodontics

 

Check your member handbook for a full list of dental benefits in your plan. To find or change your dentist, call LIBERTY Dental at 833-276-0847, or visit their website.

 

Find a dentist 

If your plan includes vision services, you can get coverage for:

  • One eye exam every two years
  • Prescription glasses every two years

 

Check your member handbook for a full list of vision benefits in your plan.

 

Provider Directory - Vision Plan  

Your benefits include coverage for a wide range of prescription drugs and, for Essential Plan 3 and 4 members, over-the-counter (OTC) drugs. We work with CarelonRx to provide these benefits. Your plan may have prescription copays. Check your handbook for information about copays.

 

Visit the pharmacy page to find a pharmacy near you and check if your medicine is on the Preferred Drug List (PDL).

 

Go to Pharmacy page 

Our Treatment Cost Calculator can give you an estimate of your out-of-pocket costs for many common services. Use this tool to:

  • Get an estimate for common treatments and services.
  • Compare the costs of one or more providers.
  • Print or save estimates.
  • Review past treatment cost calculations.

 

How to use it:

  1. Log in and go to the Treatment Cost Calculator.
  2. Select the member.
  3. Select the treatment.
  4. Select your provider (skip if no provider).
  5. Review, print, and/or save your estimate.

New York never sleeps, and neither do we. Get 24-hour phone advice from a registered nurse anytime, day or night.

 

Call 800-300-8181 (TTY 711).

Not yet a member? Choose Anthem.

We can help you apply. Call 844-430-1699 (TTY 711), or visit us in person. Find a Community Service Center near you.

Enroll

Already a member? We’re glad you chose Anthem.

 

We want you to understand your benefits and receive the best possible care. Here are some resources to help.

The member handbook: Everything you need to know

 

Your member handbook is your go-to guide for health services. It contains complete benefit information about your plan. Read it to find out about:

 

 How to use your benefits.

 

 How to choose your PCP.

 

 How to get help if your doctor’s office is closed.

 

 How to reach Member Services if you have questions.

 

 Your rights and responsibilities as an Anthem member.

Need a handbook mailed to you?

You can request a handbook via live chat with Member Services.