MetroPlus UltraCare (HMO D-SNP) 2025
Our MetroPlus UltraCare (HMO D-SNP) is a Medicaid Advantage Plus plan designed for people who are dual eligible for Medicare and full Medicaid and need long-term care services such as home care and personal care. This plan will cover most of your Medicare and Medicaid benefits, including long-term care or home and community-based services, plus Prescription Drug coverage. UltraCare members will also get a Primary Care Manager who will manage your everyday needs, identify health issues and customize your care plan, all to help you stay in your home for as long as possible. This plan offers as low as a $0 monthly plan premium for those that receive Extra Help paying for their prescription drug premium.
What’s New with your Flex Benefit for 2025!
You recently received a letter with important information about your Flex Card which is used to make over the counter purchases. We will soon be issuing a new card which you will receive in the mail by December 31st. You can begin using this card January 1st, 2025. This new card will allow you to enjoy the same amazing benefits that you currently use-$475 per quarter. THIS CARD WILL REPLACE YOUR CURRENT CARD. PLEASE MAKE SURE YOU USE THE FUNDS YOU HAVE NOW ON YOUR CARD BY December 31st, 2024, or you will lose the benefit amount on the old card. Please refer to your Annual Notice of Coverage for additional information or click “Learn More” to learn What’s New with your Flex Benefit for 2025!
To be eligible for MetroPlus UltraCare (HMO D-SNP) you must:
Be 18 years or older
Live within the 5 boroughs of New York City
Have Medicare Part A and B coverage, or be enrolled in Medicare Part C coverage
Be eligible for nursing home level of care (as of the time of enrollment) using the Uniform Assessment System (UAS) or other tool designated by SDOH (New York State)
Be capable, at the time of enrollment of returning to or remaining in your home and community without jeopardy to your health and safety, based upon criteria provided by SDOH (New York State)
Must have full Medicaid coverage
Need at least one of the following Community Based Long-Term Care Services for more than 120 days:
- Nursing Services in the home
- Therapies in the home
- Home Health Aide services
- Personal Care Services in the home
- Adult Day Health Care
- Private Duty Nursing; or
- Consumer Directed Personal Assistance Services
You pay $0 copay for all these services below and many more!
Primary and Urgent care
Specialist Visits
Up to $500 per year for gym membership
$475 per quarter flex card to use on OTC drugs, utilities, food, and more
Unlimited meals delivered to your homeLong-term care services
Long-term care services
Get Healthy Foods with the MetroPlusHealth Flex Card
Good news, we’ve made eating healthy easier in 2025! All your healthy foods, OTC drugs, and utilities benefits are now available on one card, and you get more of the benefits you need! Simply use your MetroPlusHealth Flex Card at participating grocers and pharmacies to purchase fruits, vegetables, and other healthy foods. You can spend up to $475 per quarter (no rollover to next quarter)*.
Some of the places you can use your benefits include CVS, Duane Reade, and Rite Aid. Visit the Member portal for a full list of retailers.
Talk to us about your Flex Card benefits!
Monday–Friday | 8 am–8 pm (ET)
Saturday | 9 am–5 pm (ET)
Call us at 866-986-0356 (TTY: 711)
*Unused balances will automatically expire at the end of each quarter or upon disenrollment from plan.
- Many retailers take the card, including CVS, Rite Aid, and Duane Reade
- Your card has $475 per quarter (no rollover to next quarter) to pay for healthy food, OTC drugs, utilities and more, all in one place
For a list of stores where you can use your flex card, click the button below.
Prescriptions
How do I enroll?
Ready to enroll in a 2025 MetroPlus UltraCare Plan? Call us at 833-965-1526 (TTY:711) now. Our representatives can enroll you by phone!
Please note new benefits above begin on January 1, 2025.
To access more information about your prescription drug benefits click here: https://www.caremark.com/wps/portal. You will be transferred to the CVS Caremark website. Use the information on your MetroPlusHealth Medicare Member ID card to register. Follow the step by step instructions located on the site.
How can I switch?
Switching to a MetroPlus UltraCare Plan is easy. Get in contact with our team and find answers to FAQs here.
MetroPlusHealth Rewards Program
Plan Materials
A detailed explanation of your coverage, what we must do, your rights, and what you must do as a member of our plan.
A summary of changes to your benefits and costs for the next year. These changes take effect on January 1, 2025.
Low Income Subsidy is available under the Medicare Part D prescription drug program. Eligible beneficiaries who have limited income may qualify for a government program that helps pay for Medicare Part D prescription drug costs. If you receive “Extra Help” from Medicare, your monthly plan premium will be lower. The Low Income Subsidy (LIS) Premium Table shows you what your monthly premium will be if you get “Extra Help”.
Fitness Reimbursement: up to $250 every six months for membership to qualifying exercise facilities
Rights and Responsibilities Upon Disenrollment
Access to a doctor—whenever and wherever you need it!
MetroPlusHealth Virtual Visit is the fast, easy way for our members to see a provider for common physical, mental, emotional, and behavioral health issues that are not emergencies. MetroPlusHealth Virtual Visit is available anytime, from anywhere in New York State, 24/7 – and in your language.
Know your rights and protections against surprise medical bills!
When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.
Are you receiving care at an NYC Health + Hospitals facility?
Manage Your Health Online With MyChart. Members who receive care at NYC Health + Hospital facilities now have access to MyChart. MyChart is a free secure portal you can use to manage your health information. MyChart allows you to:
- Message your primary care provider’s office
- Request refills of your prescription drugs
- Access your test results
- Schedule appointments
