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MetroPlusHealth offers seven different BronzePlus plans. Each plan adds additional levels of customization to fit your needs.

The plan has an individual deductible of $4,700 and a max out of pocket of $8,700. The family deductible is $9,400 and a max out of pocket of $17,400.

The non-standard plan has an individual deductible of $4,700 and a max out of pocket of $8,650. The family deductible is $9,400 and a max out of pocket of $17,300.

This plan also has an American Indian / Alaska Native plan with a $0 deductible and $0 max out of pocket for those that qualify.

You can enroll with us in a MetroPlusHealth Marketplace plan through the NY State of Health (NYSOH), the Official Health Plan Marketplace (“Exchange”), or you can choose to enroll directly with us (“Off-Exchange”).

Check out our 2023 BronzePlus details 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.

2023 BronzePlus*

PRODUCTB1B2B3B5 (ADULT) / B3-4 (CHILD – ONLY)B6
Product TypeStandardNon-StandardChild-Only AI / AN Standard AI / NA Non-Standard
Premium$527.30$519.28$217.09$527.30 / $217.09$519.28
Deductible$4,700$4,700$4,700$0$0
Max out of Pocket$8,700$8,650$8,700$0$0
PCP$50$50$500%0%
Specialist$75$75$750%0%
Prescription Drug**$10 / $35 / $70$10 / $35 / $80$10 / $35 / $700%0%
Adult Dental / VisionNoYesNoNoYes
Pediatric Dental / VisionYesYesYesYesYes
Mail Order RXYesYesYesYesYes
Exercise Facility Reimb.YesYesYesYesYes

*These charts are brief descriptions of benefits for the plans.
**Prescription Drug: Generic / Formulary Brand / Non-Formulary Brand
◊ Deductible must be met first before cost sharing begins. Family cost is multiplied by (2).
□ AI / AN – American Indian / Alaskan Native
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:

  1. Proof of residency in the 5 boroughs of NYC
  2. Proof of immigration status
  3. 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.

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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

Plan Materials

Certificate of Coverage
(includes Contract, Schedule of Benefits, Summary of Benefits and Coverages)
"Off Exchange"

Individual Standard – BronzePlus B1

Individual Non-Standard – BronzePlus B2

Child-Only – BronzePlus B3

"Exchange"

Individual Standard – BronzePlus B1

Individual Non-Standard – BronzePlus B2

Child-Only – BronzePlus B3

American Indian / Child-Only – BronzePlus B3-4

American Indian Standard – BronzePlus B5

American Indian Non-Standard – BronzePlus B6

Summary of Benefits
"Off Exchange"

Individual Non-Standard – BronzePlus B2

American Indian / Child-Only – BronzePlus B3-4

American Indian Standard – BronzePlus B5

American Indian Non-Standard – BronzePlus B6

"Exchange"

Individual Non-Standard – BronzePlus B2

American Indian / Child-Only – BronzePlus B3-4

American Indian Standard – BronzePlus B5

American Indian Non-Standard – BronzePlus B6

Contracts
"Off Exchange"

Individual Standard – Age 26 – BronzePlus B1

Individual Standard – Age 29 – BronzePlus B1

Individual Non-Standard – Age 26 – BronzePlus B2

Individual Non-Standard – Age 29 – BronzePlus B2

"Exchange"

* Coming Soon

To learn more about the drugs covered by our Marketplace Plans, please visit the MetroPlusHealth Pharmacy page.

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 Certificate of Coverage – for example, GoldPlus G1 – you need.

To search our provider network for our Marketplace Plans, please visit the MetroPlusHealth Provider Directory page.

Child-Only Plans offer benefits to members who are under the age of 21 at the beginning of the year.

Non-Standard Plans offer additional benefits not included on the Standard Plans and allows members to purchase Adult Vision and Dental coverage.

Important Update

Pharmacy Network Change

Starting January 1, 2022, Walgreens and Duane Reade will no longer be in the pharmacy network for members of these plans:

  • Medicaid Managed Care (including Partnership in Care and HARP Plans)
  • Child Health Plus
  • Exchange / MarketPlace Plans

Where can I find a list of participating network pharmacies?

Members can find a list of network pharmacies or use our online provider search tool.

What do I do if I get my medications from Walgreens or Duane Reade?

Members who have an ongoing prescription including medications, certain supplies such as pen needles, test strips, continuous glucose monitors, and blood glucose test strips at a Walgreens or Duane Reade should call their health care providers to get a new prescription to be sent to a different pharmacy.

Who can I call if I have questions?

If you have any questions, please call the CVS Caremark® Customer Care Team at 1-(855) 656-0361 for Medicaid Managed Care and Child Health Plus members or 1-(855) 383-9426 for Exchange Plan members.

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MetroPlusHealth Virtual Visit

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:

  • Message your primary care provider’s office
  • Request refills of your prescription drugs
  • Access your test results
  • Schedule appointments
Preventive Services Resources

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.

IMPORTANT INFORMATION: MONKEYPOX CASES ARE RISING IN NYC.

Monkeypox cases are rising in NYC. Learn more about Monkeypox, including prevention and treatment, here.

Explore all MetroPlusHealth Plans

last updated: January 4, 2023

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