Is anyone on the NY Essentials plan & can your Rx’s be written by a NON-Medicaid doctor? Please help!

I was recently laid off & so I’m getting new insurance from the NYSOH marketplace.

I do not qualify for Medicaid bc I earned some income in 2024 before I was laid off.

But I will qualify for the Essentials plan.

There may be some confusion bc I vaguely remember hearing that the “essentials plan” is actually an umbrella term and there are an array of specific plans within that that you choose to use as your health insurance , with some Medicaid options and some non-Medicaid options that you can choose from.

(either way, I’d be signing up for a NON Medicaid version of the essentials plan if they offer both)

The “Medicaid” distinction is extremely important for me, bc if you have ANY medicaid plan in NY then ALL of your Rx’s need to be written by a Medicaid doctor or else your prescriptions won’t be covered by their pharmacy benefits (NYRX)…. And I have one Rx that I need every month from a doctor who is NOT a Medicaid Doctor. I cannot go without this medication and it will take months for me to switch to a Medicaid doctor for my issue (long story).

On the surface, it seems clear that it’s not Medicaid & everyone at the NYSOH exchange keeps telling me that the Essentials plan is NOT considered Medicaid,

but my pharmacist told me that if you have the essentials plan then your Rx’s nevertheless must be written by a Medicaid doctor bc they have to “run it through the system as Medicaid”. And it will automatically be rejected by the system if the prescribing doctor is not Medicaid covered.

So I don’t know who to believe and I’m really nervous bc if my pharmacist is correct, then I’m gonna be screwed when I go to fill my Rx since it will have been written by a non Medicaid doctor.

The one thing I would REALLY TRUST is If anyone here actually is ON the essential plan and IS able to get their Rx’s filled by a non/medicaid doctor. Does anyone here have any experience with this 🙏? ANY help would be greatly appreciated!!!

submitted by /u/gogo–yubari
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