Frequently Asked Questions

Here are answers to some of the most commonly asked questions about MVP’s free and low cost health insurance options.

Medicaid Managed Care

  • Who can enroll in Medicaid Managed Care?

    Medicaid Managed Care is a health insurance program for children and adults who are:

    • Adults not eligible for Medicare (under age 65) and people of any age who are blind, disabled or have other special circumstances
    • Children under age 19
    • Residents of the State of New York
    • Qualified for Medicaid based on income and family size
    • U.S. citizens, or have documented immigration status

    Eligibility for Medicaid is based on several factors. These may include family size, income and where you live. In some cases, student or parental status may be considered as well. The maximum income levels may vary depending on the county you live in. Pregnant women, children and disabled persons with medical bills may also qualify.

    If you live in Albany, Columbia, Dutchess, Genesee, Greene, Jefferson, Lewis, Livingston, Monroe, Oneida, Ontario, Orange, Putnam, Rensselaer, Saratoga, Schenectady, Sullivan, Rockland, Ulster, Warren, Washington or Westchester counties:

    Medicaid Coverage MapCall MVP Health Care to Learn More

    • 1-800-825-5687 
    • Monday – Friday from 8:30 am to 5 pm Eastern Time

    If you live in a county that is not listed above, please contact the New York State Department of Health to learn more about the Medicaid options in your area.


  • What are the income limits for Medicaid Managed Care?

    Use our MVP plan finder to see what you might qualify for.


  • What benefits are covered by Medicaid Managed Care?

    Medicaid Managed Care Member Guide

    Medicaid Managed Care is a program that includes participating doctors, health centers and hospitals in our service area. There are no premiums to pay on a monthly basis with Medicaid. However, co-pays may apply when you receive health services.

    MVP covers you with:

    • No limit on needed visits to your doctor (Primary Care Physician)—Covered in full
    • Maternity and baby care—Covered in full
    • Non-urgent emergency room—Covered in full
    • Eye exams and eyeglasses—Covered in full with some limits
    • Many specialists to choose from—Covered in full
    • Lab tests—Covered in full
    • X-rays—Covered in full
    • Hearing services—Covered in full
    • Physical, occupational and speech therapy—Covered in full with visit limits
    • Mental health/alcohol and substance use disorder treatment—Covered in full
    • Condition Health and Case Management Programs to help you live well with ongoing illnesses like diabetes and asthma—Free
    • Little FootprintsSM prenatal program to take care of new moms—Free
    • Family planning and reproductive health services—Covered in full
    • HIV testing and counseling—as part of a family planning visit—Covered in full
    • Over the Counter (OTC) drugs—Covered with a co-payment
    • Medical Supplies—Covered in full
    • Dental service—Covered
    • Prescription Drugs:
    • Can be filled at any participating Medicaid pharmacy, if your doctor orders them—Covered with a co-payment
    • Brand Name Drugs—$3.00
    • Preferred Brand Name Drugs*—$1.00
    • Generic Drugs—$1.00
    • OTCs—$0.50
    • Medical Supplies—No co-payment
    • Hearing Aid Batteries—No co-payment
    • Enteral Formula—No co-payment
    • Diabetic Supplies—No co-payment
    • Behavioral Health Benefits (PDF)

    Note: This summary of benefits is only an overview of plan provisions. While every effort has been made to ensure that this summary accurately reflects the provisions of each plan, it is the plan contract that governs the operations of individual plans and payment of all benefits.


  • How do I apply for Medicaid Managed Care?

    If you think you qualify, even if you’re not sure, get started with the enrollment process online now. Families can enroll in Medicaid Managed Care at any time during the year. We’re here to help you find the right plan for you and your family.

    Get started now online.

    If you live in Albany, Columbia, Dutchess, Genesee, Greene, Jefferson, Lewis, Livingston, Monroe, Oneida, Ontario, Orange, Putnam*, Rensselaer, Saratoga, Schenectady, Sullivan, Rockland, Ulster, Warren, Washington or Westchester counties:

    Medicaid Coverage MapCall MVP Health Care to Learn More

    • 1-800-825-5687 
    • Monday – Friday from 8:30 am to 5 pm Eastern Time

    If you live in a county that is not listed above, please contact the New York State Department of Health to learn more about the Medicaid options in your area.

    *Essential Plan not available in Putnam county.


Child Health Plus

  • Who can enroll in Child Health Plus?

    Child Health Plus is a health insurance program for children in families who are:

    • Under the age of 19 years old
    • Not covered by private health insurance, such as employer-based health insurance*
    • Not eligible for Medicaid
    • Qualified for CHPlus based on income level
    • New York residents, whether or not they are documented U.S. residents

    If you live in Albany, Columbia, Dutchess, Genesee, Greene, Jefferson, Lewis, Livingston, Monroe, Oneida, Ontario, Orange, Putnam, Rensselaer, Saratoga, Schenectady, Sullivan, Rockland, Ulster, Warren, Washington or Westchester counties:

    Medicaid Coverage MapCall MVP Health Care to Learn More

    • 1-800-825-5687 
    • Monday – Friday from 8:30 am to 5 pm Eastern Time

    If you live in a county that is not listed above, please contact the New York State Department of Health to learn more about the Child Health Plus options in your area.

    *Some children who had employer-based health insurance may be subject to a waiting period of no more than 90 days before they can be enrolled in CHPlus. This will depend on your household income and the reason your children lost employer-based coverage.


  • What are the income limits for Child Health Plus?

    The income limits vary depending upon the family size. Reference the below to see if you may be eligible for Child Health Plus:

     


  • What benefits are covered by Child Health Plus?

    Child Health Plus Subscriber Contract

    Your child will have access to a range of health care services under Child Health Plus. Some families pay a monthly premium for coverage. However, there are no co-pays for services. That means you don’t have to pay anything for the care your child receives through the plan.

    With MVP, you have a range of options for primary and specialty care from participating doctors and health centers. We have many doctors, health centers and hospitals in our service area that are ready to help you. We also offer dental care, eye care and other services designed to help your child’s health.

    Child Health Plus benefits include:

    • No limit on needed visits to your doctor (Primary Care Physician)—Covered in full
    • Maternity and baby care—Covered in full
    • Non-urgent emergency room—Covered in full
    • Eye exams and eyeglasses—Covered in full with some limits
    • Many specialists to choose from—Covered in full
    • Lab tests—Covered in full
    • X-rays—Covered in full
    • Hearing services—Covered in full
    • Physical, occupational and speech therapy—Covered in full (short term therapy)
    • Mental health/alcohol and substance use disorder treatment—Covered in full
    • Condition Health and Case Management Programs to help you live well with ongoing illnesses like diabetes and asthma—Free
    • Little FootprintsSM prenatal program to take care of new moms—Free
    • Family planning and reproductive health services—Covered in full
    • HIV testing and counseling—as part of a family planning visit—Covered in full
    • Over the Counter (OTC) drugs—Covered in full
    • Medical Supplies—Limited coverage
    • Dental service—Covered
    • Prescription Drugs:
    • Can be filled at any participating Medicaid pharmacy, if your doctor orders them—Covered in full
    • Brand Name Drugs—No co-payment
    • Preferred Brand Name Drugs*—No co-payment
    • Generic Drugs—No co-payment
    • OTCs—No co-payment
    • Medical Supplies—No co-payment
    • Hearing Aid Batteries—No co-payment
    • Enteral Formula—No co-payment
    • Diabetic Supplies—No co-payment

    Note: This summary of benefits is only an overview of plan provisions. While every effort has been made to ensure that this summary accurately reflects the provisions of each plan, it is the plan contract that governs the operations of individual plans and payment of all benefits.


  • How do I apply for Child Health Plus?

    Families can enroll in Child Health Plus at any time during the year. Get ready to enroll by gathering documents regarding your household income and the age(s) of your children:

    Proof of current income. For example:

    • Paycheck stubs or records of earnings
    • Veterans’ benefits, unemployment benefits, Social Security, Workers’ Compensation, child support/alimony

    Proof of child’s age, address and identity. Any of the following:

    • Birth certificate
    • Driver’s license or state ID card with photo
    • ID card issued by a federal, state or local government
    • School ID card with a photo (may also show date of birth)
    • Certificate of Degree of Indian blood or other Native American/Alaska Native tribal document with photo
    • Verified school, nursery or daycare records (for children under 16, may also show date of birth)
    • Clinic, doctor or hospital records (for children under 16)

    We’re here to help you find the right plan for you and your family. If you think you qualify, even if you’re not sure, get started with the enrollment process online now.

    Get started now online

    If you live in Albany, Columbia, Dutchess, Genesee, Greene, Jefferson, Lewis, Livingston, Monroe, Oneida, Ontario, Orange, Putnam*, Rensselaer, Saratoga, Schenectady, Sullivan, Rockland, Ulster, Warren, Washington or Westchester counties:

    Medicaid Coverage MapCall MVP Health Care to Learn More

    • 1-800-825-5687 
    • Monday – Friday from 8:30 am to 5 pm Eastern Time

    If you live in a county that is not listed above, please contact the New York State Department of Health to learn more about the Child Health Plus options in your area.

    *Essential Plan not available in Putnam county.


Essential Health Plans

  • Who can enroll in New York’s Essential Plan?

    MVP’s Essential Plan is available through the New York State of HealthTM Marketplace to eligible individuals in Albany, Columbia, Dutchess, Genesee, Greene, Jefferson, Lewis, Livingston, Monroe, Oneida, Ontario, Orange, Putnam, Rensselaer, Saratoga, Schenectady, Sullivan, Rockland, Ulster, Warren, Washington or Westchester counties. Individuals must fall within specific income guidelines, are ineligible for Medicaid, and do not have access to affordable employer coverage. There are other eligibility criteria that apply.


  • What are the income limits for Essential Plans?

    Essential Plans are only available through New York State of HealthTM and eligibility is determined by the state. $0 premium EP3 and EP4 plans available to income-qualifying lawfully-present Aliessa Immigrants, including green card holders, immigrants fleeing persecution and others. Eligibility is based upon annual projected income and the Federal Poverty Level (FPL).

    Household Size Household Income
    1 $16,395–$17,820 $17,821–$23,760
    2 $22,108–$24,030 $24,031–$32,040
    3 $27,821–$30,240 $30,241–$40,320
    4 $33,534–$36,450 $36,451–$48,600
    You may qualify for: Essential Plan 2 $0/month Essential Plan 1 $20/month

    *effective 9/2017


  • What benefits are covered by New York’s Essential Plans?

    NY Essential plans offer the same services covered by other plans:

    • Doctor visits, including specialists
    • Tests ordered by your doctor
    • Prescription drugs


  • How do I apply for an Essential Plan?

    Call 1-800-TALK-MVP to speak with one of our health insurance specialists or fill out a request form for a call back.