MetroPlusHealth members never pay a fee to renew Medicaid, Child Health Plus, or Essential Plan coverage. Contact us immediately if someone asks for money to renew. Learn how to protect yourself from health insurance scammers. Learn More
With no monthly premiums and no cost for dental and vision, our Essential Plans offer all of the essential benefits you need: preventative care, emergency care, prescription drugs, mental health, and more.
Plus, there’s no deductible, so the plan starts paying for your health care right away. You get free preventive care like routine doctor exams and screenings to keep you healthy. Check out our plans below.
Effective April 1, 2024
Great news. Starting April 1, more New Yorkers will qualify for the Essential Plan! Check out the grid below and see if you and your family qualify.
PEOPLE IN HOUSEHOLD
2024 MAXIMUM INCOME
1
$37,650
2
$51,100
3
$64,550
4
$78,000
Plan Features
$0
Monthly Premium
$0
Deductible
Eligibility
Monthly Premium
Deductible
Annual Checkup
Doctors & Specialists
$0 24/7 telehealth with MetroPlusHealth Virtual Visit
Hospital Visits
Adult Dental & Vision
Pediatric Dental & Vision
Hearing
Discount Drug Program
Prepackaged Medications
Fitness (Gym) Reimbursement
Wellness Benefit Reimbursement (online apps)
Qualified New Yorkers
$0
$0
$0
-
-
$200 every 6 mo. for member
-
How can I enroll?
Enrollment for the Essential Plans is open all year long. There are three ways you can enroll:
By Phone: Call MetroPlusHealth Member Services at 844.671.4660, TTY users: 711, Monday through Friday, 8 AM – 6 PM and Saturday, 9 AM – 5 PM.
In Person: Wherever you live in New York City, our Marketplace Facilitated Enrollers (FEs), navigators, brokers and agents are available to help you complete your application in the NY State of Health Marketplace. Call us at 844.671.4660, TTY: 711. Monday through Friday, 8 AM – 6 PM and Saturday, 9 AM – 5 PM to make an appointment.
Online: NY State of Health, the Official Health Plan Marketplace (aka “the Exchange”) lets you compare plans and premium rates. Visit nystateofhealth.ny.gov/.
For more information about the below mentioned preventive care benefits go to healthfinder.gov.
Outpatient care — the kind you get without being admitted to a hospital
Trips to the emergency room
Treatment in the hospital for inpatient care
Mental health and substance use disorder services: behavioral health treatment, counseling, and psychotherapy
Prescription drugs
Services and devices to help you recover if you are injured, or have a disability or chronic condition: physical and occupational therapy, speech-language pathology, psychiatric rehabilitation
Lab tests
Preventive services to keep you healthy: counseling, screenings, vaccines, managing a chronic disease
With all our plans you get:
$
0
Telehealth
Unlimited mental health
Urgent care
Immunization vaccines
$0 benefits depending on health plan eligibility.
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.
PEOPLE IN HOUSEHOLD
2024 MAXIMUM INCOME
1
$30,120
2
$40,880
3
$51,640
4
$62,400
Covered Immunization Vaccines*
Hepatitis A
Hepatitis B
Herpes
Zoster
Human Papillomavirus
Influenza (Flu Shot)
Measles, Mumps, Rubella
Meningococcal Pneumococcal
Tetanus, Diphtheria, Pertussis
Varicella
*For more information about the above mentioned immunizations go to vaccines.gov.
MetroPlusHealth has gathered a list of resources available to help New Yorkers get services such as childcare, food and nutrition, housing, and transportation. These resources are available for all our members. If you need help with any of these things, learn more here.
All MetroPlusHealth Essential Plan members have access to a mail order option for their medications. Access the mail order form here.
I have been with MetroPlusHealth for 10 years and am very satisfied with them being my health care provider. I get my questions answered from the professional, knowledgeable & caring agents every time. Everything I get with MetroPlusHealth I know doesn’t exist with other health care companies. I have inquired many times.
Evelyn D.
Google Review
Covered Preventive Care Services
For all adults:
For women:
Abdominal Aortic Aneurysm one-time screening (for men of specified age who have smoked)
Alcohol Misuse screening and counseling
Aspirin use (to prevent cardiovascular disease for men/women of certain ages)
Blood Pressure screening
Cholesterol screening (for adults of certain ages or at higher risk)
Depression screening
Diabetes screening
Diet counseling (for adults at higher risk for chronic disease)
HIV screening (ages 15-65, and other ages at increased risk)
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.
GREAT NEWS: STARTING JANUARY 1, 2023, METROPLUSHEALTH MEMBERS WILL RECEIVE THEIR DENTAL BENEFITS FROM DENTAQUEST.
Recently, we sent you an announcement along with your new ID Card about our new partnership with DentaQuest, a dental vendor. Starting January 1, 2023, you can begin to use your new ID Card for all your health care needs, including dental services with DentaQuest. Remember to bring your new ID card when you visit your dentist.
Your oral health is important to us. Partnering with DentaQuest, we are able to bring their experience and passion for improving oral health care to you. Their dental network is 65% larger than what we have been offering, with more dentists and specialists available than before. Learn more about your new dental benefit here.
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:
Learn about all of the free preventive services for adults, women and children. Preventive care includes immunizations, physical exams, lab tests and prescriptions. If you have any questions, call one of our Member Services Representatives. We’re here to help.
Our Certificate of Coverage explains the details of your Essential Plan coverage, including your benefits, the rules of the plan, and information about how to receive care. Here’s where to see the different certificates of all the different plans.
EP 1 and 2 members, please note, certificates are being updated to reflect the new $0 monthly premium and dental and vision benefits included at $0 cost. Revised certificates are coming soon.
If you would like a hard copy of this Certificate of Coverage, you can submit a request online here. Please be sure to tell us which plan Certificate of Coverage – for example, Essential Plan 2 Standard – you need.
2024 Certificate of Coverage (your member benefits handbook)
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