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Insurance FAQs

Member FAQs

What if I miss an enrollment period?

Call us at 1-866-986-0356 (TTY users: 711), 24 hours a day, 7 days a week to speak with a representative for help.  You can also call Medicare directly at 1-800-MEDICARE or 1-800-633-4227. TTY users: 1-877-486-2048. Explain your circumstances to a representative. It may be possible to switch plans at other times, depending on your situation.

What is MetroPlus Health Plan’s Contact Info?

MetroPlus Health Plan
50 Water Street, 7th Floor
​New York, NY 10004
Phone: 1-866-986-0356, TTY users: 711
24 hours a day, 7 days a week
Fax: 1-212-908-8601

Do I need my physical ID card to see a doctor or access services?

  • We recommend carrying your physical ID card however you can still obtain services with your MetroPlusHealth ID number.
  • You can also get a virtual ID card through your member portal at (members.metroplus.org).

When will I get my physical ID card?

If you are a MedicaidSNP or HARP member:

  • You will receive your MetroPlusHealth ID card within the first 15 days of membership.

If you are a Qualified Health PlanEssential Plan or Child Health Plus member:

  • If you pay a premium
    • If you make your payment before the start of your membership you will receive your card within the first 15 days of membership.
    • If you make your payment during the first 10 calendar days of the month after your eligibility start date, you will receive your card 15 days after your payment is received.
  • If you don’t pay a premium (only applicable to Essential Plan and Child Health Plus)
    •  You will receive your card within the first 15 days of membership

You may also receive a new card when you initiate a PCP change by contacting our Member Services Department or request one from your member portal (members.metroplus.org)

How do I get my Member ID?

  • Your Member ID will be available to you via a physical card that will be mailed and virtually through your member portal (members.metroplus.org).
  • If you are a new member and don’t have your member ID yet, please contact MetroPlusHealth Customer Service at 1-800-303-9626.
  • You can also email us at [email protected]. If you email to receive your member ID, we will need to schedule a call back to verify your identity for security purposes.

Plan FAQs

Who is eligible for the Essential Plan?

Essential Plans are open to those who don’t qualify for Medicaid or the MetroPlusHealth Child Health Plus plan. Eligibility also depends on your income, and the size of your household.

Who is eligible for Managed Medicaid Care?

MetroPlusHealth Medicaid Managed Care is our plan for people eligible for Medicaid, a government assistance program. You may qualify for Medicaid if you have high medical bills, receive Supplemental Security Income (SSI), or meet certain income, resource, age or disability requirements.

Who is eligible for Child Health Plus?

The Child Health Plus plan provides protection for the little ones—everything from check-ups to dental care, from the MetroPlusHealth citywide list of providers. It’s available for all children under age 19, who live in New York City and don’t qualify for Medicaid.

Pharmacy FAQs

How can I get my prescriptions?

Our members can go to any CVS Caremark in-network pharmacy to fill prescriptions. The MetroPlus PillPack program allows members to get multiple medications pre-packaged and sent to your home for no additional cost. To sign up, you can contact PillPack directly at 855-745-5725.

Visit our Find a Pharmacy page to learn more.

How can I get a 90-day supply of my medicine?

You can fill a 90-day supply of your approved maintenance medications at any in-network pharmacy of your choice. You can also get them mailed right to your home if your pharmacy offers delivery service or through one of our mail-order pharmacy partners such as CVS Caremark. For more information or assistance in setting up home delivery service, please contact the MetroPlus Health Plan Customer Service number on your member ID card or your local pharmacy.

What if I need an emergency supply of medication?

During this public health crisis, MetroPlusHealth will allow for a short-term supply for most essential medications even if you are not due for a refill at any in-network pharmacy.

Can I have my medicine delivered to my door on the same day?

We have partnered with CVS Retail Pharmacies to offer same-day delivery for your medications. During this state of emergency, all delivery fees will be waived. Please contact your local CVS retail pharmacy to find out more information on how to access this benefit.

MetroPlusHealth has participating pharmacies all across New York City.

What if I have other questions about my pharmacy benefits?

Visit our Find a Pharmacy page for more information about your pharmacy benefits.

Medicare FAQs

Who is eligible for Medicare?

  • People who are 65 or older
  • People under 65 with certain disabilities
  • People with End-Stage Renal Disease (permanent kidney failure)

Do I need to sign up for Medicare before I turn 65?

Some people are automatically enrolled in Original Medicare (Part A and Part B) and other people have to sign up for it. In most cases, if you’re turning 65 and will be getting benefits from Social Security or the Railroad Retirement Board (RBB) at least 4 months before you turn 65, you will automatically get Medicare Part A and Part B starting the first day of the month you turn 65. If you’re under 65 and have a disability, you’ll automatically get Medicare Part A and Part B after you get disability benefits from Social Security or certain disability benefits from the RRB for 24 months. You don’t need to sign up if you automatically get Medicare Part A and Part B. You will get your Medicare card in the mail three months before your 65th birthday or 25th month of disability.

When can I join or switch my Medicare plan?

You can join or switch plans during certain times of the year. Since your health and finances may change from year to year, it’s smart to review your health care needs every year to see if you need to change to a plan that works better for your current needs. You can join or switch plans during the following times:

  • Initial Enrollment Period: You can enroll three months before you turn 65 (or 25th month of disability), during your birthday month (or 25th month of disability) and up to three months after your birthday (or 25th of disability).
  • Medicare Annual Enrollment Period (October 15-December 7): During this period, you can enroll in or switch plans, including adding or dropping prescription drug coverage or switch from a Medicare Advantage Plan back to Original Medicare. Your new coverage will start on January 1 of the following year.
  • Special Election Period: If you qualify for Medicaid, “Extra Help” or meet other special circumstances, you may be eligible for this period. If you are eligible, you can add new coverage or make changes to your current coverage depending on your situation.
  • Medicare Advantage Open Enrollment Period (January 1-March 31): During this time, you have a one-time opportunity to switch from one Medicare Advantage plan to a different one. You can also drop your current plan and return to Original Medicare with the option to purchase a stand-alone Medicare Part D Prescription Drug Plan.


last updated: August 3, 2022

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