Frequently Asked Questions
If you don’t qualify for Medicaid of the Child Health Plus plan, you may be eligible for MetroPlusHealth’s Essential Plan. You must live in New York State, be lawfully present in the U.S., be 19-64 years old and not have employer or other health coverage options. Additionally, you have to meet the Essential Plan’s annual income requirement. Those who are eligible for the Essential Plan will have access to tens of thousands of top-rated providers city wide, including 40+ premier hospitals and 110+ urgent care locations.
What does PPO stand for in health insurance?
In health insurance, PPO stands for Preferred Provider Organization. This is a type of plan that contracts with hospitals and doctors to create a network of providers. Plan members then pay less to use providers within that network.
What does deductible mean in health insurance?
A deductible is the amount you pay for covered health care services before your insurance takes over payment. For example, if you have a $1,000 deductible, you’ll have to pay for the first $1,000 of covered services yourself. However, some services like preventative care will be covered fully regardless of whether you’ve met your deductible or not.
How to deal with a gap in health coverage?
There are a few different options if you have a gap in health care coverage.
- COBRA: Taking advantage of COBRA lets you continue on your employer’s health plan for a limited time after leaving a job. However, you’ll have to pay both your premium and your former employer’s contribution, so it can be expensive.
- Affordable Care Act (ACA): If you’ve lost your coverage, you’re eligible for a special enrollment period. You can visit the ACA Marketplace and enroll in a plan, with cost typically dependent on your income.
- Medicaid/CHP: You and your dependents may qualify for Medicaid and/or Child Health Plus. Medicaid and Child Health Plus (CHP) are income-based government-funded health insurance options. Medicaid is designed for low-income individuals and families, while CHP is for children in families with incomes too high for Medicaid, but too low for private coverage.
How to get a new insurance card?
If you need a new insurance card, you should contact MetroPlusHealth directly. You can either log in to your online portal, call customer service at 866-496-6636, or ask your employer’s human resources department for guidance.
What are my self-employed health insurance options?
If you’re self-employed, you have a range of health insurance options. The best choice will depend on your personal circumstances. Some options include:
- Individual Plans on the New York State of Health Exchange: This could be a good affordable option if you’re just starting out. Depending on your income, you may qualify for subsidies to substantially lower your monthly payments, while still getting most essential health benefits.
- Spouse’s plan: If you have a married spouse with an employer-sponsored health insurance plan, ask about joining.
- Medicaid: Eligibility for Medicaid is income-based, but if you qualify you can receive low-cost or free health coverage.
- Medicare: If you are over 65 years old or have certain disabilities, you may qualify for Medicare.
- Private Insurance: You can buy individual private health insurance plans directly from insurance companies.
What are the options for medical insurance for parents?
If you’re a parent who needs medical insurance for your children, you may qualify to enroll them in Child Health Plus (CHP), which provides free or low-cost health coverage. Your children must be under 19 years old and a resident of New York.
What documents are needed to add a spouse to health insurance?
Marriage counts as a life event, allowing you to add a spouse to your health insurance within 60 days. However, you can also add them if they lose their own coverage.
If you decide to add a spouse to health insurance, there are a few documents you’ll likely need:
- Marriage certificate/license
- Your spouse’s social security number
- Your spouse’s government-issued ID
- Enrollment form provided by your employer or insurance
Some companies may also request proof of common residency and proof of financial interdependency. If your spouse recently lost their employer-sponsored coverage, they may need to provide additional documentation.
Marketplace & Essential Plans
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