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NYS Essential Plan

Rehabs That Take NYS Essential Plan

The NYS Essential Plan is New York’s low-cost health coverage for residents whose income is above the Medicaid limit, offered through NY State of Health by participating insurers. Plans can include drug and alcohol treatment, with benefits varying by plan, network and level of care.New York facilities listed here name the Essential Plan on their own websites. Each Essential Plan member belongs to a specific insurer’s network, so the insurer on your card decides which centers are in network. Call the facility and that insurer before admission to ask about prior authorization, referrals and any small copays.

Rehab Centers Near You

Drug and Alcohol Rehab Centers That Accept NYS Essential Plan

Whitney M Young Jr Health Center Inc – Albany

10 Dewitt Street, Albany, NY, 12207

5.0★★★★★11

Joint Commission

DetoxIOPOutpatient+2

Accepts InsuranceAccepts MedicaidAccepts Medicare+2

Co-occurring DisordersMATMethadone+6

Whitney M Young Jr Health Center Inc is based at 10 Dewitt Street in Albany, New York. The facility is listed for intensive outpatient and outpatient care. Medication-assisted treatment is recorded, combining prescribing with regular clinical contact. Treatment is delivered without an overnight stay, around existing commitments. Telehealth is listed, so some contact can happen without traveling in. Trauma-specific provision is recorded here. The facility is federally registered and licensed by the New York State…

1.0 miLower Patroon Island6.9 miAlbany International AirportServes6 towns

Substances treated

Adderall Rehab · Alcohol MAT Friendly · Alcohol Medication Treatment · Alcohol Only Rehab · Alcohol Rehab · Beer Addiction Treatment · Binge Drinking Treatment · Carfentanil Rehab · Codeine Rehab · Concerta Rehab · +37 more

Levels of care

Aftercare and Continuing Care · Clonidine and Lofexidine Detox · Continuing Care · Detox by Substance · Detox Centers · Discharge Planning · Evening Treatment · Intensive Outpatient Program (IOP) · Online Rehab and Telehealth · Outpatient MAT Clinic · +4 more

Therapies

12 Step Rehab · Addiction Counseling · Brief Intervention · Cognitive Behavioral Therapy (CBT) · Counseling and Therapy · Couples Counseling · Evidence-Based Therapy · Family Therapy · Group Therapy · Individual Therapy · +3 more

Mental health

Co-Occurring Mental Health Conditions · Depression and Anxiety · Depression and Trauma · Mental Health Conditions · Mental Health Treatment · Trauma Treatment

Groups served

Adult Rehab · Couples Rehab · Early HIV Intervention · Hepatitis Support Services · HIV and Hepatitis Care · HIV Support Services · Men's Dual Diagnosis Rehab · Men's Medicare Rehab · Men's Outpatient Rehab · Men's Rehab · +11 more

Support services

Case Management · Community Outreach · Health and Wellness Support · Health Education · Peer Support · Practical Support · Recovery Support Services · Suicide Prevention Services · Waitlist Interim Services

Insurance accepted

Aetna · Anthem / Elevance Health · Capital District Physicians' Health Plan (CDPHP) · Carelon Behavioral Health · Cigna Healthcare · Delta Dental · Dentaquest · Emblem Health · Empire Blue Cross · Fidelis Care of New York · +14 more

Integrity Treatment Partners LLC – Baldwin

2250 Grand Avenue, Baldwin, NY, 11510

4.9★★★★★~~177~~

Joint Commission

DetoxIOPOutpatient+2

Accepts InsuranceAccepts MedicaidAccepts Medicare+4

Co-occurring DisordersMATTrauma-informed+9

The address on record is 2250 Grand Avenue in Baldwin, New York. According to the federal listing this provider runs intensive outpatient and outpatient care. Medication-assisted treatment is recorded, combining prescribing with regular clinical contact. Care is provided on an outpatient basis, so people continue living at home. Remote appointments appear on the record, useful where travel is difficult. Dedicated support is recorded for veterans and military families. Federal listing is via SAMHSA, and the…

2.3 miEast Meadow Pond8.9 miJohn F. Kennedy International AirportServes61 towns

Substances treated

Adderall Rehab · Alcohol Medication Treatment · Alcohol Only Rehab · Alcohol Rehab · Beer Addiction Treatment · Binge Drinking Treatment · Carfentanil Rehab · Chronic Pain and Substance Use · Codeine Rehab · Concerta Rehab · +36 more

Levels of care

Therapies

12 Step Rehab · Activity Therapy · Addiction Counseling · Anger Management · Brief Intervention · Cognitive Behavioral Therapy (CBT) · Cognitive Remediation Therapy · Contingency Management · Counseling and Therapy · Couples Counseling · +10 more

Mental health

Assertive Community Treatment (ACT) · Co-Occurring Mental Health Conditions · Crisis Intervention · Depression and Anxiety · Depression and Trauma · Family Education Programs · Illness Management and Recovery · Mental Health Conditions · Mental Health Crisis Services · Mental Health Treatment · +5 more

Groups served

Active Duty Military Dual Diagnosis Rehab · Active Duty Military Medicare Rehab · Active Duty Military Outpatient Rehab · Active Duty Military Rehab · Active Duty Military Suboxone · Active Duty Military Telehealth · Active Duty Military Trauma Rehab · Active Duty Military TRICARE Rehab · Adult Rehab · Couples Rehab · +65 more

Support services

Case Management · Chronic Illness Management · Community Outreach · Health and Wellness Support · Health Education · Hepatitis C Treatment · Housing and Employment Support · Housing Assistance · Intensive Case Management · Peer Support · +6 more

Insurance accepted

1199SEIU Benefit Fund · Aetna · BCBS (Blue Cross Blue Shield) · Cigna Healthcare · Emblem Health · Fidelis Care of New York · GEHA · GHI City of New York · Medicare · Molina Healthcare · +6 more

Erie County Medical Center Corporation – Buffalo (1285 Main Street)

1285 Main Street, Buffalo, NY, 14209

4.0★★★★☆3

Joint Commission

DetoxOutpatientTelehealth+1

Accepts InsuranceAccepts MedicaidAccepts Medicare+2

Co-occurring DisordersMATTrauma-informed+7

The site sits at 1285 Main Street in Buffalo, New York. On record, this provider offers intensive outpatient and outpatient care. Substance use and mental health conditions are both treated here. Treatment is delivered without an overnight stay, around existing commitments. Telehealth appointments are recorded as available, which widens what is reachable for anyone without transport. SAMHSA holds the federal registration and the New York State Office of Addiction Services and Supports the state license.

1.9 miLa Salle Park7.1 miBuffalo Niagara International AirportServes12 towns

Substances treated

Adderall Rehab · Alcohol Medication Treatment · Alcohol Only Rehab · Alcohol Rehab · Beer Addiction Treatment · Binge Drinking Treatment · Carfentanil Rehab · Codeine Rehab · Concerta Rehab · Dexedrine Rehab · +34 more

Levels of care

Aftercare and Continuing Care · Clonidine and Lofexidine Detox · Continuing Care · Detox by Substance · Detox Centers · Discharge Planning · Evening Treatment · Online Rehab and Telehealth · Outpatient MAT Clinic · Outpatient Rehab · +4 more

Therapies

12 Step Rehab · Addiction Counseling · Brief Intervention · Cognitive Behavioral Therapy (CBT) · Counseling and Therapy · Dialectical Behavior Therapy (DBT) · EMDR Therapy · Evidence-Based Therapy · Group Therapy · Individual Therapy · +4 more

Mental health

Co-Occurring Mental Health Conditions · Depression and Anxiety · Depression and PTSD · Depression and Trauma · Mental Health Conditions · Mental Health Treatment · Psychiatric Medication Management · PTSD Treatment · Serious Mental Illness Treatment · Trauma Treatment

Groups served

Adult Rehab · Court Ordered Rehab · Hepatitis Support Services · HIV and Hepatitis Care · HIV Support Services · Men's Dual Diagnosis Rehab · Men's Medicare Rehab · Men's Outpatient Rehab · Men's PTSD Rehab · Men's Rehab · +27 more

Support services

Community Outreach · Health and Wellness Support · Health Education · Housing and Employment Support · Housing Assistance · Peer Support · Practical Support · Recovery Support Services · Self Help Groups · Suicide Prevention Services · +2 more

Insurance accepted

Aetna · Center's Plan for Healthy Living · Cigna Healthcare · Emblem Health · Fidelis Care of New York · Healthplex · Highmark Health · Humana · Independent Health · Indian Health Service · +12 more

Northern Erie Clinical Services – Buffalo

2005 Sheridan Drive, Buffalo, NY, 14223

3.7★★★★☆3

Joint Commission

DetoxOutpatientTelehealth+1

Accepts InsuranceAccepts MedicaidAccepts Medicare+2

Co-occurring DisordersMATYoung adults+4

This location is registered at 2005 Sheridan Drive in Buffalo, New York. The facility is listed for intensive outpatient and outpatient care. The record shows medication-assisted treatment, so buprenorphine or methadone may be available. Treatment is delivered without an overnight stay, around existing commitments. Telehealth appointments are recorded as available, which widens what is reachable for anyone without transport. Dedicated support is recorded for veterans and military families. Federal listing is via SAMHSA, and the…

3.9 miPirates Island7.0 miBuffalo Niagara International AirportServes12 towns

Substances treated

Levels of care

Therapies

12 Step Rehab · Addiction Counseling · Brief Intervention · Cognitive Behavioral Therapy (CBT) · Counseling and Therapy · Evidence-Based Therapy · Group Therapy · Individual Therapy · Matrix Model Treatment · Motivational Interviewing · +1 more

Mental health

Co-Occurring Mental Health Conditions · Depression and Anxiety · Mental Health Conditions · Mental Health Treatment · Psychiatric Medication Management

Groups served

Adult Rehab · Court Ordered Rehab · DUI and DWI Programs · Hepatitis Support Services · HIV and Hepatitis Care · HIV Support Services · Men's Dual Diagnosis Rehab · Men's Outpatient Rehab · Men's Rehab · Men's Telehealth · +5 more

Support services

Insurance accepted

AthenaPsych LLC – Rochester

1299 Portland Avenue, Rochester, NY, 14621

3.7★★★★☆3

OutpatientTelehealth

Accepts InsuranceAccepts MedicaidAccepts Medicare

TeensSeniorsYoung adults+3

Spanish spoken

This provider is listed at 1299 Portland Avenue, Rochester, New York. Listed provision covers intensive outpatient and outpatient care. The listing covers both substance use and mental health treatment. Care is provided on an outpatient basis, so people continue living at home. Telehealth is listed, so some contact can happen without traveling in. The record notes group sessions alongside individual work. Both federal registration through SAMHSA and New York State Office of Addiction Services and…

3.6 miCobbs Hill6.6 miFrederick Douglass Greater Rochester International AirportServes3 towns

Substances treated

Adderall Rehab · Concerta Rehab · Dexedrine Rehab · Nicotine and Tobacco Treatment · Nicotine Replacement Therapy · Prescription Stimulant Rehab · Ritalin Rehab · Smoking Cessation Counseling · Smoking Cessation Medication · Vaping Cessation · +1 more

Levels of care

Evening Treatment · Non-12-Step Rehab · Online Rehab and Telehealth · Outpatient Rehab · Weekend Rehab

Therapies

Cognitive Behavioral Therapy (CBT) · Counseling and Therapy · Dialectical Behavior Therapy (DBT) · Evidence-Based Therapy · Family Therapy · Group Therapy · Individual Therapy

Mental health

Co-Occurring Mental Health Conditions · Crisis Intervention · Depression and Anxiety · Family Education Programs · Illness Management and Recovery · Mental Health Crisis Services · Mental Health Treatment · Psychosocial Rehabilitation

Groups served

Adult Rehab · Couples Rehab · Senior Outpatient Rehab · Senior Rehab · Senior Telehealth · Teen Dual Diagnosis Rehab · Teen Outpatient Rehab · Teen Rehab · Teen Telehealth · Young Adult Rehab

Support services

Peer Support · Recovery Support Services · Suicide Prevention Services

Languages

Spanish Speaking Rehab

Insurance accepted

1199SEIU Benefit Fund · Aetna · BCBS (Blue Cross Blue Shield) · Carelon Behavioral Health · Cigna Healthcare · Emblem Health · Excellus Blue Cross · Fidelis Care of New York · Humana · Medicare · +10 more

AthenaPsych LLC – New York

33 West 60th Street, New York, NY, 10023

3.8★★★★☆17

OutpatientTelehealth

Accepts InsuranceAccepts MedicaidAccepts Medicare

TeensSeniorsYoung adults+3

Spanish spokenDeaf and HoHChinese spoken+5

The address on record is 33 West 60th Street in New York, New York. On record, this provider offers intensive outpatient and outpatient care. Both addiction and mental health conditions appear on the record. This is outpatient provision, so daily life continues around the appointments. Video appointments are recorded as an option here. Group and family work are both recorded. Registration is federal, through SAMHSA; licensing is held with the New York State Office of…

1.9 miManhattan5.8 miLaGuardia AirportServes110 towns

Substances treated

Levels of care

Evening Treatment · Non-12-Step Rehab · Online Rehab and Telehealth · Outpatient Rehab · Weekend Rehab

Therapies

Activity Therapy · Cognitive Behavioral Therapy (CBT) · Counseling and Therapy · Dialectical Behavior Therapy (DBT) · Evidence-Based Therapy · Family Therapy · Group Therapy · Individual Therapy · Specialized Therapy

Mental health

Groups served

Support services

Case Management · Peer Support · Recovery Support Services · Suicide Prevention Services

Languages

Chinese Speaking Rehab · Creole Speaking Rehab · Deaf and Hard of Hearing Dual Diagnosis Rehab · Deaf and Hard of Hearing Rehab · French Speaking Rehab · Italian Speaking Rehab · Polish Speaking Rehab · Portuguese Speaking Rehab · Spanish Speaking Rehab

Insurance accepted

AthenaPsych LLC – Bronx

2825 3rd Avenue, Bronx, NY, 10455

3.5★★★★☆78

OutpatientTelehealth

Accepts InsuranceAccepts MedicaidAccepts Medicare

TeensSeniorsYoung adults+3

Spanish spokenDeaf and HoHChinese spoken+4

2825 3rd Avenue in Bronx, New York is the address held for this provider. According to the federal listing this provider runs intensive outpatient and outpatient care. This is recorded as treating co-occurring conditions rather than one in isolation. Provision is outpatient, so no overnight stay is involved. Remote appointments appear on the record, useful where travel is difficult. Group and family work are both recorded. SAMHSA holds the federal registration and the New York…

2.5 miHarlem River3.6 miLaGuardia AirportServes111 towns

Substances treated

Levels of care

Evening Treatment · Non-12-Step Rehab · Online Rehab and Telehealth · Outpatient Rehab · Weekend Rehab

Therapies

Cognitive Behavioral Therapy (CBT) · Counseling and Therapy · Dialectical Behavior Therapy (DBT) · Evidence-Based Therapy · Family Therapy · Group Therapy · Individual Therapy

Mental health

Groups served

Support services

Case Management · Peer Support · Recovery Support Services · Suicide Prevention Services

Languages

Chinese Speaking Rehab · Creole Speaking Rehab · Deaf and Hard of Hearing Dual Diagnosis Rehab · Deaf and Hard of Hearing Rehab · French Speaking Rehab · Polish Speaking Rehab · Portuguese Speaking Rehab · Spanish Speaking Rehab

Insurance accepted

Wtny Yng Wellness Recovery Center – Albany

500 Central Avenue, Albany, NY, 12206

3.1★★★☆☆45

Joint Commission

DetoxIOPOutpatient+2

Accepts InsuranceAccepts MedicaidAccepts Medicare+2

Co-occurring DisordersMATTrauma-informed+5

Wtny Yng Wellness Recovery Center operates from 500 Central Avenue in Albany, New York. According to the federal listing this provider runs intensive outpatient and outpatient care. Medication-assisted treatment appears on the record, pairing approved medication with counseling and review. Treatment runs on an outpatient footing, with people returning home between appointments. Telehealth is listed, so some contact can happen without traveling in. The listing notes provision for veterans and serving personnel. The provider appears…

6.4 miStarbuck Island5.6 miAlbany International AirportServes6 towns

Substances treated

Levels of care

Therapies

Mental health

Co-Occurring Mental Health Conditions · Depression and Anxiety · Depression and Trauma · Mental Health Conditions · Mental Health Treatment · Trauma Treatment

Groups served

Support services

Insurance accepted

Erie County Medical Center – Buffalo

462 Grider Street, Buffalo, NY, 14215

2.5★★★☆☆~~826~~

SAMHSA listed

PHPOutpatientTelehealth+1

Accepts InsuranceAccepts MedicaidAccepts Medicare+4

Trauma-informedVeteransTeens+6

Spanish spoken

Erie County Medical Center occupies 462 Grider Street in Buffalo, New York. Services on file are partial hospitalization, intensive outpatient and outpatient care. Mental health rather than substance use is what appears on this listing. Care is provided on an outpatient basis, so people continue living at home. Both federal registration through SAMHSA and New York State Office of Addiction Services and Supports licensing are on record.

3.6 miSquaw Island5.2 miBuffalo Niagara International AirportServes12 towns

Substances treated

Levels of care

Evening Treatment · Non-12-Step Rehab · Online Rehab and Telehealth · Outpatient Rehab · Partial Hospitalization Program (PHP) · Walk-In Rehab · Weekend Rehab

Therapies

Activity Therapy · Cognitive Behavioral Therapy (CBT) · Counseling and Therapy · Dialectical Behavior Therapy (DBT) · EMDR Therapy · Evidence-Based Therapy · Group Therapy · Individual Therapy · Specialized Therapy

Mental health

Co-Occurring Mental Health Conditions · Crisis Intervention · Depression and Anxiety · Depression and PTSD · Depression and Trauma · Family Education Programs · First Episode Psychosis · Mental Health Conditions · Mental Health Crisis Services · Mental Health Treatment · +6 more

Groups served

Adult Rehab · Court Ordered Medicare Rehab · Court Ordered Outpatient Rehab · Court Ordered Rehab · Court Referral Accepted · Rehab for Domestic Violence Survivors · Senior Outpatient Rehab · Senior PHP · Senior Rehab · Senior Telehealth · +10 more

Support services

Case Management · Peer Support · Recovery Support Services · Suicide Prevention Services

Languages

Spanish Speaking Rehab

Insurance accepted

NYC/HHC Harlem Hospital Center – New York (Ronald Brown Building)

Ronald Brown Building, New York, NY, 10030

Federally certified

OutpatientTelehealth

Accepts InsuranceAccepts MedicaidAccepts Medicare+5

Co-occurring DisordersTrauma-informedTeens+5

Spanish spoken

Records place NYC/HHC Harlem Hospital Center at Ronald Brown Building, New York, New York. What is recorded here is intensive outpatient and outpatient care. Substance use is treated alongside mental health rather than separately. Care is provided on an outpatient basis, so people continue living at home. Remote appointments appear on the record, useful where travel is difficult. Family involvement is listed as part of the provision. The provider appears in the federal treatment register,…

2.0 miManhattan4.3 miLaGuardia AirportServes112 towns

Substances treated

Levels of care

Evening Treatment · Non-12-Step Rehab · Online Rehab and Telehealth · Outpatient Rehab · Weekend Rehab

Therapies

Cognitive Behavioral Therapy (CBT) · Counseling and Therapy · Evidence-Based Therapy · Family Therapy · Group Therapy · Individual Therapy · Integrated Dual Disorder Treatment

Mental health

Co-Occurring Mental Health Conditions · Crisis Intervention · Depression and Anxiety · Depression and PTSD · Depression and Trauma · Family Education Programs · Illness Management and Recovery · Mental Health Conditions · Mental Health Crisis Services · Mental Health Treatment · +4 more

Groups served

Adult Rehab · Couples Rehab · Court Ordered Dual Diagnosis Rehab · Court Ordered Medicare Rehab · Court Ordered Outpatient Rehab · Court Ordered Rehab · Court Referral Accepted · Teen Dual Diagnosis Rehab · Teen Outpatient Rehab · Teen PTSD Rehab · +6 more

Support services

Case Management · Recovery Support Services · Suicide Prevention Services

Languages

Spanish Speaking Rehab

Insurance accepted

1199SEIU Benefit Fund · Aetna · Amida Care · Anthem / Elevance Health · Centerlight Health Plan · Cigna Healthcare · Medicare · Molina Healthcare · NYS Essential Plan · TRICARE

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Common questions

Answered from what is listed here.

What is the NYS Essential Plan?

The Essential Plan is New York State's $0-premium public health coverage for adults aged 19 to 64 whose income sits above the Medicaid limit. It operates as a federal Basic Health Program through NY State of Health, the state marketplace, and is delivered by private health plans under contract with the state.

Substance use disorder and mental health treatment are covered inpatient and outpatient, with no deductible and copays that vary only by tier.

State Insurance Rehabhttps://rehabseekers.com/insurance-accepted/state-insurance/

Is the Essential Plan the same as Medicaid?

No. The Essential Plan is a separate New York program for adults whose income is too high for Medicaid, up to 200% of the federal poverty level. Essential Plan 3 and 4 also cover lawfully present immigrants in the Medicaid income range who cannot get federally funded Medicaid.

Both run through NY State of Health, and a single application checks Medicaid, Child Health Plus, Essential Plan and Qualified Health Plan eligibility at the same time.

Medicaid Rehabhttps://rehabseekers.com/insurance-accepted/medicaid/

Does the Essential Plan cover rehab?

Yes, substance use disorder services appear under inpatient, outpatient and physician services in New York's 2026 benefit chart. New York-regulated plans must cover medically necessary hospital detoxification, inpatient rehabilitation and residential treatment, plus outpatient care in a facility or a provider's office.

Cost sharing follows your tier: Essential Plan 1 pays $15 per outpatient visit and $150 per admission, while Essential Plan 2, 3 and 4 pay nothing.

Inpatient Rehabhttps://rehabseekers.com/programs/inpatient/

Does the Essential Plan cover detox?

Yes, detoxification is a listed inpatient hospital benefit on every tier. In 2026 Essential Plan 1 members pay $150 per admission and Essential Plan 2, 3 and 4 members pay $0, with no deductible. The inpatient copay is waived for a readmission within 90 days for a related condition.

New York law bars state-regulated plans from requiring prior authorization for medically necessary in-network detoxification at an OASAS licensed or certified provider.

Detox Centershttps://rehabseekers.com/programs/detox-centers/

Does the Essential Plan cover inpatient or residential rehab?

Yes, inpatient substance use treatment is a covered benefit, and Independent Health's 2026 Essential Plan schedule states that inpatient substance use services include both hospital and residential settings. Essential Plan 1 charges $150 per admission, and Essential Plan 2, 3 and 4 charge $0.

The admission must be medically necessary and in network, judged with LOCADTR 3.0, the level-of-care tool New York requires for substance use decisions.

Residential Rehabhttps://rehabseekers.com/programs/residential/

Does the Essential Plan cover IOP or partial hospitalization?

Yes, partial hospitalization, intensive outpatient and medication-assisted treatment all sit under outpatient substance use services in Independent Health's 2026 Essential Plan schedule, at $15 per visit on Essential Plan 1 and $0 on Essential Plan 2, 3 and 4. No outpatient visit limit is stated for 2026.

Benefits are standardized by New York State, so read the schedule of benefits from the health plan named on your member card.

Intensive Outpatient Program (IOP)https://rehabseekers.com/programs/outpatient/iop/

Does the Essential Plan cover Suboxone or methadone?

Yes, New York OASAS requires plans with a prescription drug benefit to cover methadone, Suboxone and Subutex when medically necessary. State insurance rules also require immediate access, without prior authorization, to formulary substance use medications and naloxone. Each participating health plan publishes its own formulary.

Independent Health's 2026 Essential Plan schedule sets opioid treatment programs at $0 on every tier and requires no preauthorization for covered substance use medications.

Suboxone and Buprenorphinehttps://rehabseekers.com/medications/mat/buprenorphine/

How much does rehab cost with the Essential Plan?

$0 on Essential Plan 2, 3 and 4. There is no premium and no deductible on any tier in 2026. Essential Plan 1 members pay $150 per inpatient or detoxification admission and $15 per outpatient visit, with a $360 yearly out-of-pocket maximum.

Yearly out-of-pocket maximums are $200 on Essential Plan 2 and 3 and $0 on Essential Plan 4. American Indian and Alaska Native members pay no copays.

Low Cost Rehabhttps://rehabseekers.com/payment/low-cost/

Does the Essential Plan need prior authorization for rehab?

No, not for in-network treatment in New York. State law bars New York-regulated plans from requiring prior authorization for medically necessary in-network inpatient, residential, detoxification, outpatient and opioid treatment program services at OASAS licensed, certified or authorized providers. Out-of-network care still needs the health plan's approval.

Concurrent review is also barred for the first 28 days of inpatient or residential care if the provider notifies the plan within two business days of admission.

Medical Detoxhttps://rehabseekers.com/programs/detox-centers/medical-detox/

Does the Essential Plan cover out-of-network rehab?

Generally no. Every tier is HMO-style and in-network only, so a non-participating provider is not covered except in an emergency. Fidelis Care covers emergency services at any provider, and UnitedHealthcare reimburses out-of-network care only in specific circumstances with prior approval.

Out-of-network or out-of-state substance use admissions also face prior authorization and concurrent review, since New York's authorization ban applies only to in-network providers.

Private Insurance Acceptedhttps://rehabseekers.com/insurance-accepted/private-insurance-accepted/

Does the Essential Plan cover therapy and mental health?

Yes, mental health and behavioral healthcare are listed under inpatient, outpatient and physician services in New York's 2026 benefit chart, and MVP describes the Essential Plan as covering therapy, counseling and hospital care. Outpatient visits cost $15 on Essential Plan 1 and $0 on tiers 2, 3 and 4.

Mobile crisis services are $0 on every tier, and Anthem says its Essential Plan carries no behavioral health copays.

Counseling and Therapyhttps://rehabseekers.com/therapies/counseling-and-therapy/

Does the Essential Plan cover online therapy?

Yes, telehealth is covered, and cost sharing must be at least as favorable as for the same service in person under Independent Health's 2026 Essential Plan schedule. The vendor differs by health plan: Healthfirst offers Teladoc at $0 on all Essential Plans, MetroPlusHealth uses eVisit and MVP offers 24/7 virtual care.

Online Rehab and Telehealthhttps://rehabseekers.com/programs/online-rehab-and-telehealth/

Which health plans offer the Essential Plan?

Fourteen health plan brands appear on New York's 2026 Essential Plan contact list: Affinity by Molina Healthcare, Anthem Blue Cross and Blue Shield HP, CDPHP, EmblemHealth, Excellus BlueCross BlueShield, Fidelis Care, Healthfirst, Highmark, Independent Health, MetroPlus Health Plan, Molina Healthcare, MVP Health Care, UnitedHealthcare Community Plan and Univera Healthcare.

Availability differs by county, and the plan on your card owns the network, so its directory decides which treatment centers are in network.

State Insurance Rehabhttps://rehabseekers.com/insurance-accepted/state-insurance/

Who qualifies for the Essential Plan in 2026?

New York residents aged 19 to 64 who are lawfully present and not eligible for Medicaid, Child Health Plus or employer coverage, with annual income up to $31,920 for one person, $43,280 for two, $54,640 for three or $66,000 for four. Those limits equal 200% of the federal poverty level.

Enrollment runs all year with no open enrollment window, through NY State of Health at 1-855-355-5777. Anyone eligible for Medicare cannot enroll.

How do I find a rehab that takes the Essential Plan?

Start with the provider directory of the health plan named on your member card, since each participating plan runs its own network and the state publishes every directory link. You can also search the NYS Provider & Health Plan Look-Up by plan, provider or facility, then call the program to ask about network status.

New York's CHAMP helpline, 888-614-5400, assists with insurance obstacles to substance use or mental health care; the OASAS HOPEline is 1-877-8-HOPENY.

Private Insurance Acceptedhttps://rehabseekers.com/insurance-accepted/private-insurance-accepted/

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The NYS Essential Plan is New York State’s $0-premium public coverage program for adults aged 19–64 whose income is above the Medicaid line, administered by the New York State Department of Health and sold through NY State of Health. It is not an insurance company. Coverage is delivered by private health plans under contract with the state, so the insurer printed on the member card is the one that runs the network and pays the claim.

That split matters at the point of admission. Substance use treatment is a standardized state benefit with the same rules for every tier, but whether a particular program is in network is decided by Fidelis Care, Healthfirst, MVP, Excellus, UnitedHealthcare Community Plan or whichever of the participating plans issued the card. Availability also differs by county; NY State of Health publishes a plans-by-county search covering all 62 counties.

The program also changed on July 1, 2026, when New York ended its Section 1332 waiver and returned to Basic Health Program authority. The 200–250% FPL tier closed, about 450,000 New Yorkers lost eligibility, and roughly 1.3 million below 200% FPL kept coverage. This guide covers which levels of care are paid for, where prior authorization applies in New York, what each tier costs in 2026, how medication is handled, and how to find a program that takes the plan on your card.

Does the NYS Essential Plan Cover Drug and Alcohol Rehab?

Yes. The 2026 state benefit chart lists substance use disorder services under inpatient, outpatient and physician services, and detoxification under inpatient hospital services. All four tiers carry the same benefits and differ only in cost sharing. Every tier is HMO-style, so care has to be in network except in an emergency.

New York adds a floor underneath that chart. OASAS states that New York-regulated plans must cover, where medically necessary, hospital detoxification, inpatient care in a hospital, inpatient rehabilitation facility or residential treatment facility, and outpatient care delivered in a facility or a provider’s office. Independent Health names drug, alcohol and mental health treatment as covered on its Essential Plan page, and its 2026 schedule of benefits breaks the categories out by setting.

Which Essential Plan Tier Are You On?

Four tiers, one benefit package. Essential Plan 1 covers 150–200% FPL, Essential Plan 2 covers 138–150%, and Essential Plan 3 and 4 cover lawfully present immigrants in the Medicaid income range who cannot receive federally funded Medicaid. Essential Plan 1 is the only tier with copays for treatment. The Essential Plan 200–250 tier ended on June 30, 2026.

Medical Detox

Detoxification appears as an inpatient hospital benefit on the 2026 state chart, at $150 per admission on Essential Plan 1 and $0 on tiers 2, 3 and 4. Withdrawal from alcohol or benzodiazepines can produce seizures, and acute withdrawal belongs in an emergency department, which is covered at any provider regardless of network. Medical detox at a certified New York program is handled as inpatient care.

Residential and Inpatient

Inpatient substance use services include hospital and residential settings on Independent Health’s 2026 Essential Plan schedule, at the same $150 and $0 amounts as detox. The state chart does not break residential out as its own row, so a member heading into residential rehab should ask the health plan to state in writing how the admission will be classified and billed.

PHP, IOP and Outpatient

Partial hospitalization, intensive outpatient and medication-assisted treatment sit under outpatient substance use services on the 2026 Independent Health schedule, at $15 per visit on Essential Plan 1 and $0 on the other tiers. Neither the state chart nor that schedule states a visit limit for outpatient substance use or mental health care.

Does the Essential Plan Need Prior Authorization for Rehab?

For in-network care in New York, generally no. New York law bars state-regulated commercial and Medicaid plans from requiring prior authorization for medically necessary in-network inpatient, residential and detox services at OASAS licensed, certified or authorized providers, and for in-network outpatient clinic, outpatient rehabilitation and opioid treatment program services.

There is also a review holiday. Where the admitting program notifies the health plan within two business days, the plan cannot run concurrent review for the first 28 days of inpatient or residential treatment, or the first four weeks and up to 28 visits of outpatient treatment. Level-of-care decisions for treatment delivered in New York must use LOCADTR 3.0 or an alternative tool OASAS permits.

OASAS guidance is written for New York-regulated plans without naming the Essential Plan line by line, so the practical answer comes from each health plan. Fidelis Care states that in-network New York inpatient detox, inpatient rehabilitation and residential treatment are not subject to prior authorization across all its product lines, with the admitting program sending the OASAS notification form and LOCADTR within two business days and review resuming after day 28. Fidelis also requires prior authorization for adult inpatient mental health admissions.

Does the Essential Plan Cover Out-of-Network Rehab?

Generally no. Fidelis Care describes every Essential Plan as in-network only apart from emergency services, Independent Health’s 2026 schedule states that non-participating provider services are not covered except in an emergency, and UnitedHealthcare Community Plan reimburses out-of-network care only in specific circumstances with authorization arranged beforehand.

Going out of state. The prior authorization ban applies to in-network New York providers. An out-of-network or out-of-state program is a separate request to the health plan, with prior authorization and concurrent review both in play, so that conversation happens before the travel date rather than after it.

How Much Does Rehab Cost With the Essential Plan?

Very little. Every tier carries a $0 monthly premium and a $0 deductible in 2026. Essential Plan 1 charges $150 per inpatient or detox admission and $15 per outpatient substance use or mental health visit, with an annual out-of-pocket maximum of $360. Essential Plan 2 and 3 charge $0 with a $200 maximum, and Essential Plan 4 charges $0 throughout.

The inpatient facility copay is waived for a readmission within 90 days for the same or a related condition. Mobile crisis services are $0 on all tiers, and UnitedHealthcare added them for Essential Plan members on January 1, 2026 with no prior authorization. On Essential Plan 1 the other copays are $15 for primary care, $25 for a specialist or urgent care and $75 for an emergency room visit; tiers 2 to 4 pay nothing for each. MVP Health Care and other participating plans add 24/7 virtual care on top.

Typical US market rates before insurance
Level of care	Monthly	Daily
Medical detox (7–14 days)	$1,500 – $5,200 per week	$215 – $745
Residential inpatient	$6,200 – $26,000	$205 – $865
PHP	$7,200 – $14,000	$240 – $465
IOP	$2,700 – $9,200	$90 – $305
Outpatient	$1,300 – $5,200	$45 – $175

Those are the sums a program would bill without coverage. The gap between them and a $150 admission copay is the reason the network question outranks the price question on this plan, and why an out-of-network admission without authorization is the one expensive mistake available to an Essential Plan member.

Does the Essential Plan Cover Suboxone, Methadone and Other Addiction Medication?

Yes. OASAS states that New York-regulated plans with a prescription drug benefit must cover medications including methadone, Suboxone and Subutex where medically necessary. A 2019 Department of Financial Services circular letter requires immediate access without prior authorization to formulary medications for substance use disorder, including drugs for opioid withdrawal and stabilization, and to naloxone.

Where the Prescription Is Filled

Retail copays for a 30-day supply are $6, $15 and $30 by drug tier on Essential Plan 1, $1 or $3 on Essential Plan 2 and 3, and $0 on Essential Plan 4; a 90-day mail order supply costs 2.5 times retail. The state sets those tiers, but each participating health plan publishes its own formulary, so a Suboxone formulation is checked against that plan’s drug list rather than a statewide one. Independent Health’s 2026 schedule states that preauthorization is not required for a covered drug used to treat substance use disorder.

Opioid Treatment Programs

Medication dispensed inside a licensed opioid treatment program is a program service rather than a pharmacy fill, which is why it carries no drug copay. Independent Health’s 2026 schedule puts opioid treatment programs at $0 on every tier, including Essential Plan 1, and the in-network authorization ban covers them. A member starting at a methadone clinic confirms only that the clinic holds a contract with the health plan on the card.

Which Rehab Centers in New York Are In-Network With the Essential Plan?

A program is in network when it holds a contract with the specific health plan named on the member card, not with the Essential Plan as a whole, and when it is licensed, certified or otherwise authorized by OASAS. Network status is settled in that plan’s own provider directory or through the NYS Provider & Health Plan Look-Up run by the state.

New York has 1,100+ listed treatment programs, 1,061 of which accept Medicaid, concentrated in New York, NY, Bronx, NY, Brooklyn, NY and Buffalo, NY. Programs that accept the NYS Essential Plan are gathered on the NYS Essential Plan page, and the wider New York directory covers every county. Each listing shows the payments the program says it accepts, its licensing and accreditation, and how far it sits from the nearest airport, so a shortlist can be drawn before the call that settles network status. Counts updated October 2026.

How Do I Find a Rehab That Takes the Essential Plan?

Start with the health plan on the card rather than with the program. The state publishes each participating plan’s directory address in its 2026 Essential Plan contact list, and the NYS Provider & Health Plan Look-Up searches by plan, provider or facility. Because that data comes from the plans themselves, the state advises confirming with the provider before an admission date is set.

Member service numbers for 2026 include Fidelis Care 888-343-3547, Healthfirst 888-250-2220, MetroPlus Health Plan 855-809-4073, MVP Health Care 888-723-7967, Excellus 877-626-9298, Univera 877-687-6651, Independent Health 800-501-3439, CDPHP 866-692-3747, EmblemHealth 888-447-7703, Highmark 866-231-0847, Molina and Affinity by Molina 800-223-7242, Anthem 800-300-8181 and UnitedHealthcare Community Plan 866-265-1893. Behavioral health is handled by whichever plan is chosen: Optum Behavioral Health manages it for UnitedHealthcare on 1-844-206-1399, Anthem’s behavioral line is 844-483-0872, and Fidelis runs authorizations in-house. For eligibility and enrollment, NY State of Health answers on 1-855-355-5777, TTY 1-800-662-1220. Enrollment is open all year.

Is the Essential Plan the Same as Medicaid?

No. The Essential Plan is a Basic Health Program for New Yorkers whose income is above the Medicaid limit, up to $31,920 for a household of one and $66,000 for a household of four in 2026, plus lawfully present immigrants in the Medicaid income range who cannot receive federally funded Medicaid through Essential Plan 3 and 4. New York Medicaid managed care is a separate program, often sold by the same health plans. Medicare eligibility rules the Essential Plan out, since the age range stops at 64.

Before you call a program: have the tier and the health plan name from the card, ask whether the program is OASAS certified and contracted with that plan, and ask the admissions team to send the OASAS notification form and LOCADTR within two business days of admission. For a 24/7 conversation first, the OASAS HOPEline is 1-877-8-HOPENY, 988 handles crisis calls, and the CHAMP helpline on 888-614-5400 takes insurance obstacles to treatment.

References and Citations

New York State Department of Health / NY State of Health — Essential Plan benefit and cost-sharing chart for 2026, eligibility and income limits, plans-by-county tool and 2026 plan contact list.
NY State of Health — Section 1332 waiver termination and return to Basic Health Program authority effective July 1, 2026, with enrollment and transition figures.
New York State Office of Addiction Services and Supports — insurance coverage requirements for substance use services, prior authorization and concurrent review rules, and LOCADTR 3.0.
New York State Department of Financial Services — Circular Letter No. 13 (2019) on access to substance use disorder medications and naloxone.
Independent Health, Fidelis Care, UnitedHealthcare Community Plan, Anthem, MVP Health Care and MetroPlusHealth — 2026 Essential Plan schedules of benefits, member pages and behavioral health policies.
RehabSeekers directory listings and market rate research, United States, 2026. Ranges are indicative and vary by facility, length of stay and coverage.