Essential Plan 200-250 Discontinuation
Check your coverage options
We are here to help you
If you are an existing Essential Plan 200-250 member, you may have recently received a notice about changes New York State is making to the Essential Plan due to new federal rules taking effect on July 1, 2026. As a result, Essential Plan 200-250 will no longer be offered and will end on June 30, 2026.
We know this news may be hard to hear. You may feel worried or unsure about what to do next. If you have depended on this coverage, this change can feel stressful.
You are not alone. We are here to help you understand what is changing and what options you may have.
What is changing?
If you are enrolled in Essential Plan 200–250
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Your Essential Plan coverage will end on June 30, 2026
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This change is due to a change in federal law
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This change affects people across New York state
If you are pregnant or were pregnant in the last 12 months
You may be able to:
NY State of Health will decide what you qualify for based on your immigration status. We can help explain what this means for you.
Learn about your options
Everyone’s situation is different. Based on your income and family size, you may be able to get:
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A Qualified Health Plan (QHP) through NY State of Health with possible financial help
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Medicaid, including pregnancy or postpartum coverage
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Health insurance through your job if your employer offers it
There is no requirement to enroll in a plan with us. We are here to help you understand your choices so you can decide what is best for you.
For help understanding what CDPHP coverage might be available, start here.
What to do before June 30, 2026
What to do after June 30, 2026
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You will have 60 days after your coverage ends to sign up for new coverage.
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If you miss that time, the next chance to enroll is Open Enrollment starting November 1, 2026.
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You may be able to enroll sooner if you have a life change, like pregnancy or getting married or divorced.
We are here for you when you are ready to talk
You do not have to go through this alone. Our team can help you:
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Understand letters from NY State of Health
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Know important dates and deadlines
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See if you qualify for financial assistance to lower your monthly premium
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Enroll in a new plan
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Answer questions about pregnancy, Medicaid or other plans
Call: 1-888-519-3358 (TTY 711)
We know this is a difficult change. We care about helping you understand what comes next. When you are ready, we are here to answer questions, explain your options, and support you in any way we can.
Answers to common questions
Why is my EP coverage ending mid year?
New York State is making changes to the Essential Plan because of new federal rules that go into effect July, 1, 2026. As a result, some members will move to a Qualified Health Plan (QHP) starting July 1. The state has asked insurers to help make this transition as easy as possible.
Will I have a deductible when I move to a QHP?
Yes, but it will be pro-rated and reduced for 2026. When you switch to a Qualified Health Plan (QHP) in July, your deductible and out of pocket maximum will be pro-rated so you only pay the portion that applies to July–December — not a full calendar year amount.
That means your cost sharing limits reset, but to smaller, half year amounts.
I already paid toward my out-of-pocket maximum this year. Do I lose that progress?
Not necessarily. If you stay with the same insurance company, the state is asking insurers to transfer the amounts you’ve already paid from your current EP plan to your new QHP.
That means the money you’ve already put toward your out-of-pocket maximum can count toward your new plan. This helps make sure you don’t start from scratch, especially if you’re in the middle of treatment.
Why does this carryover only happen if I stay with the same insurer?
Each insurance company uses its own internal systems to track what you’ve already paid toward your out-of-pocket maximum. Because these systems are different and don’t “talk” to each other, it’s only possible to transfer your progress if both your EP plan and your new QHP are with the same company.
Will moving from EP to a QHP raise premiums or costs for other members?
No. The state has confirmed that members coming from the Essential Plan do not create risk issues for QHP.
Will my benefits change?
Yes, QHPs differ from the Essential Plan, but you will still have comprehensive health and vision coverage, with the exception of dental. CDPHP non-standard QHPs include coverage for adult vision exams and eyewear. Standard QHPs do not include dental or vision coverage. Your deductible and out-of-pocket limit will be adjusted for the half year.
What if I’m in the middle of treatment?
If you stay with the same insurer, the amounts you’ve already paid toward your out-of-pocket maximum can be carried over to your new QHP. This is designed to help protect you, so you’re not suddenly asked to start over on your cost sharing while you’re actively getting treatment.
FAQs for Pregnant Members
What happens to pregnant members or members with an EP Postpartum Save Date (PPSD)?
A PPSD refers to the period of time after childbirth during which a woman’s health and well-being are monitored and supported. Typically, the postpartum period lasts for six to eight weeks. NYSOH will keep certain individuals in EP temporarily due to PPSD.
NYSOH will maintain EP eligibility through the end of the EP PPSD for impacted members who have an active EP PPSD with a due date that is within 6 months, even if they become over-income for EP. Eligible members continue to have the option to move to Medicaid.
What happens if a member is pregnant and their EDC (Estimated Date of Confinement) is within 6 months?
The system will move the individual into EP1 through the end of the EP PPSD.
What happens if a member is not pregnant but still has EP PPSD?
The system will move the individual into EP1 through the end of the EP PPSD.
What happens if a member is pregnant and their EDC is more than 6 months away?
NYSOH will move these pregnant individuals (all EP levels) into Medicaid.
Will cost sharing continue to be waived for members who are pregnant/in their post-partum period and remain in EP, once the transition back to BHP is completed? The same question applies to those members who have diabetes.
Yes, cost sharing will continue to be waived for pregnant/postpartum members who remain in EP. Cost sharing will also continue to be waived for members who have diabetes, and who remain enrolled in EP.