GoldPrime 2025
The MetroPlusHealth GoldPrime Plan is a Marketplace health insurance option that gives New Yorkers premium coverage at an affordable price. With access to trusted doctors, hospitals, preventive care, prescriptions, and wellness programs, it offers the right balance of quality and value for individuals and families.
MetroPlusHealth offers a GoldPrime plan with an optional Young Adult rider to fit your needs. All GoldPrime plans include three Primary Care Physician (PCP) visits that are not subject to the deductible.*
The plan has an individual deductible of $675 and a max out of pocket of $8,400 depending on eligibility. It also has a family deductible of $1,350 and a max out of pocket of $16,800 depending on eligibility.
You can enroll with us in a MetroPlusHealth Marketplace plan directly by clicking here (“Off Exchange”) or through the NY State of Health (NYSOH), the Official Health Plan Marketplace (“Exchange”).
Check out our 2025 GoldPrime plans below. Interested in one? Think you might be eligible for a NYSOH premium subsidy? Call us at 1-855-809-4073 or contact us here. One of our representatives will contact you to review your plan options.
*For all standard plans with three PCP visits not subject to the deductible, the cost sharing co-pay is still applicable to the first three visits.
2025 GoldPrime*
* These charts are brief descriptions of benefits for the plan.
** Prescription Drug: Generic / Formulary Brand / Non-Formulary Brand Deductible must be met first before cost sharing begins. Family cost is multiplied by (2).
Premiums listed are example base rates for individuals. Rates may differ based according to family size, income level, and eligibility for tax credits. In accordance with Section 1303 of the Patient Protection and Affordable Care Act, at least $1.00 of the total premium amount owed per enrollee per month is a payment for coverage of non-Hyde abortion services.
How do I enroll?
Enrolling is hassle-free and easy as one, two, three! All you need is your:
- Proof of residency in the 5 boroughs of NYC
- Proof of immigration status
- Proof of relationship status for any dependents
Enroll online today. Or call us at 855-809-4073. A representative will contact you shortly to help you enroll.
Anytime I need to get any information about my plan or the doctors in the network I can honestly say the information is accurate and trustworthy. I am very happy with the customer service I have received anytime I call because the representative is friendly, caring, patient, and very knowledgeable.
Plan Materials
Certificate of Coverage
(includes Contract, Schedule of Benefits, Summary of Benefits and Coverages)
Summary of Benefits
Additional Member Resources
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
