Why choose MetroPlusHealth?

Quality Care When and Where You Need It

Access Top-Rated Healthcare Providers

MetroPlus Platinum Plan (HMO) connects you with NYC’s finest healthcare network:

  • 34,000+ top doctors across the city
  • 40+ premiere hospitals including Mount Sinai, NYU Langone, and NY Health + Hospitals
  • 110+ urgent care locations including convenient CityMD sites

Perfect for families: Our health insurance for families covers everyone’s needs with one simple plan.
Care on your schedule: Access online doctor visits and virtual urgent care from home, work, or anywhere with our telemedicine health insurance coverage.

Other providers available in our network

Why Choose a New York-Only Health Care Plan?

Is a not-for-profit organization (prioritizing you, not profits)
Was created by New Yorkers, for New Yorkers
Proudly provides customer service from real people who live in NYC
Offers you 34,000+ providers across all five boroughs

National Health Care Chains

Prioritize their bottom line profits (not you)
Are based outside of NYC
Provide impersonal customer service
Offer uncertain provider networks

Plan Materials

MetroPlusHealth has updated the MetroPlus Platinum Plan (HMO) Summary of Benefits, Evidence of Coverage, and Annual Notice of Changes for 2026 with 2026 Medicare Part A coinsurance amounts. Please review the updated documents for more information.

Evidence of Coverage (EOC) 

A detailed explanation of your coverage, what we must do, your rights, and what you must do as a member of our plan.

Annual Notice of Change (ANOC)

A summary of changes to your benefits and costs for the next year. These changes take effect on January 1, 2026.

MetroPlus Platinum Plan (HMO) provides all the benefits of Original Medicare PLUS:

  • Primary and urgent care visits: You pay $0.

  • Preventive Care: You pay $0.

  • Specialist Visits: $40 copay per visit

  • Urgently Needed Services: You pay $0.

  • Hearing Services: A new hearing aid every 3 years
    (limit up to $500)

  • Prescription Drug Coverage

  • Telehealth: No additionl cost, 24/7 virtual access to doctors and therapists with MetroPlusHealth Virtual Visit

  • Member Rewards: Member Rewards program where you earn rewards just by completing healthy activities.

    Disclaimer: Limitations may apply.

Get complete Medicare coverage plus extra benefits all in one plan.

MetroPlus Platinum Plan (HMO) provides traditional Medicare coverage with additional Medicare managed care benefits, quality, affordable healthcare designed specifically for New York City residents and is uniquely backed by NYC Health + Hospitals—the largest municipal health system in the U.S

Access your prescription benefits:

  • Visit the CVS Caremark website.
  • Register using your MetroPlusHealth Member ID card.
  • Follow the step-by-step instructions listed on the CVS Caremark website.

Pharmacy Information

Formulary

Comprehensive Formulary

Step Therapy Criteria

Prior Authorization

Low Income Subsidy (LIS) Premium Table

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”.

Directories

Medicare Provider / Pharmacy Directories    

Kings (Brooklyn) / Richmond (Staten Island)

New York (Manhattan)

Forms

NYS Standard Form to Designate a Representative to Assist with Health Insurance Authorizations, Complaints, Grievances, and Appeals
Health Risk Assessment

HRA can be returned to:
ATTENTION: QM Health Risk Assessment Unit
MetroPlus Health Plan
50 Water Street, 7th Floor
New York, NY 10004
or by completing our Contact form by clicking here.

Smiling seniors enjoying the at the park with family.

Who is eligible for MetroPlus Platinum Plan (HMO)?

  • Have Medicare Part A
  • Are enrolled in Medicare Part B
  • Live in New York City

Experience enhanced Medicare coverage designed to provide you with more benefits and greater peace of mind.

Simplify your healthcare journey with expanded Medicare coverage that offers more benefits with less hassle.

Find out if you’re eligible today

We are available 6 days a week

Monday – Friday | 8am – 6pm (ET), Saturday | 9am – 5pm (ET)

How to Enroll in MetroPlus Platinum Plan (HMO) for 2026:

  • Call 833.965.1526 (TTY: 711)
  • Speak with our helpful representatives to enroll by phone.
  • Start enjoying your comprehensive benefits.

Ending Your Membership: Understanding Your Disenrollment Rights

  • You can make changes to your plan during applicable enrollment periods.
  • Your membership typically ends on the first day of the month after we receive your request.

How to End Your Membership

Option 1: Join another plan

  • This automatically ends your MetroPlus coverage.

Option 2: Switch to Original Medicare

  • Submit a written request, complete the disenrollment form, and mail it to us.
  • Contact Medicare directly: 1.800.MEDICARE (1.800.633.4227)

Questions? Call Member Services: 833.965.1526 (TTY: 711), available 24/7

Legal Information:

MetroPlus Health Plan, Inc. offers HMO and HMO D-SNP plans with contracts with Medicare and New York State Medicaid. Enrollment in MetroPlus Health Plan, Inc. depends on contract renewal.

MetroPlusHealth is not affiliated with, endorsed by, or otherwise related to the federal government, CMS, HHS, and/or Medicare.

MetroPlus Health Plan, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingü.stica. Llame al  (TTY: 711).

注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電  (TTY: 711).

H0423_MPHwebsite_M_2026 Accepted 10012025

last updated: October 11, 2025
MetroPlusHealth
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