Peace of mind with MetroPlusHealth's SilverPlus Plan comprehensive health coverage. 2025 SilverPlus health insurance NYC, affordable health coverage NYC, ACA SilverPlus plan 2025, Manhattan, Queens, Bronx, Brooklyn, Staten Island

SilverPlus 2025

Why choose MetroPlusHealth?

Quality Care When and Where You Need It

Access Top-Rated Healthcare Providers

MetroPlusHealth Essential Plan connects you with NYC’s finest healthcare network:

  • 34,000+ top doctors across the city
  • 40+ premiere hospitals including Mount Sinai, NYU Langone, and NY Health + Hospitals
  • 110+ urgent care locations including convenient CityMD sites

Perfect for families: Our health insurance for families covers everyone’s needs with one simple plan.
Care on your schedule: Access online doctor visits and virtual urgent care from home, work, or anywhere with our telemedicine health insurance coverage.

Why Choose a New York-Only Health Care Plan?

Is a not-for-profit organization (prioritizing you, not profits)
Was created by New Yorkers, for New Yorkers
Proudly provides customer service from real people who live in NYC
Offers you 34,000+ providers across all five boroughs

National Health Care Chains

Prioritize their bottom line profits (not you)
Are based outside of NYC
Provide impersonal customer service
Offer uncertain provider networks

MetroPlusHealth SilverPlus Plans

Customize your coverage to get the affordable healthcare you deserve.

Plan Costs

  • Individual: $0-$1,855 deductible | $1,075-$9,200 max out-of-pocket
  • Family: $0-$4,200 deductible | $2,000-$18,900 max out-of-pocket
  • American Indian/Alaska Native: $0 deductible | $0 max out-of-pocket (for eligible members)

How to Enroll

  1. Direct enrollment (“Off Exchange”) – Enroll directly through MetroPlusHealth
  2. NY State of Health (“Exchange”) – Apply through the Official Health Plan Marketplace

Interested in our 2025 SilverPlus plans?

You may qualify for NYSOH premium subsidies!

Contact us today:

Our friendly team of representatives will help you review all your plan options.

2025 SilverPlus*

S1

Standard
Premium$955.38
Deductible$2,100
Max Out of Pocket$9,200
PCP$30
Specialist$65
Prescription Drugs**$15 / $40 / $75
Adult Dental / VisionNo
Pediatric Dental / VisionYes
Mail Order RXYes
Exercise Facility ReimbursementYes

S3

Child-Only
Premium$410.39
Deductible$2,100
Max Out of Pocket$9,200
PCP$30
Specialist$65
Prescription Drugs**$15 / $40 / $75
Adult Dental / VisionNo
Pediatric Dental / VisionYes
Mail Order RXYes
Exercise Facility ReimbursementYes

S5 (ADULT)

AI / AN-Standard
Premium$995.38
Deductible$0
Max Out of Pocket$0
Max Out of Pocket$0
PCP0%
Specialist0%
Prescription Drugs**0%
Adult Dental / VisionNo
Pediatric Dental / VisionYes
Mail Order RXYes
Exercise Facility ReimbursementYes

S3-4 (CHILD)

AI / AN Standard
Premium$410.39
Deductible$0
Max Out of Pocket$0
PCP0%
Specialist0%
Prescription Drugs**0%
Adult Dental / VisionNo
Pediatric Dental / VisionYes
Mail Order RXYes
Exercise Facility ReimbursementYes


* 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).

 AI / AN – American Indian / Alaskan Native

2025 SilverPlus*

S1-1

Standard FPL 100 – 150%
Deductible$0
Max Out of Pocket$1,075
PCP$10
Specialist$20
Prescription Drugs**$6 / $15 / $30
Adult Dental / VisionNo
Pediatric Dental / VisionYes
Mail Order RXYes
Exercise Facility ReimbursementYes

S1-2

Standard FPL 150 – 350%
Deductible$350
Max Out of Pocket$3,050
PCP$15
Specialist$35
Prescription Drugs**$9 / $20 / $40
Adult Dental / VisionNo
Pediatric Dental / VisionYes
Mail Order RXYes
Exercise Facility ReimbursementYes

S1-3

Standard FPL 350 – 450%
Deductible$1,855
Max Out of Pocket$7,350
PCP$30
Specialist$50
Prescription Drugs**$10 / $35 / $70
Adult Dental / VisionNo
Pediatric Dental / VisionYes
Mail Order RXYes
Exercise Facility ReimbursementYes

* These charts are brief descriptions of benefits for plan.

** Prescription Drug: Generic / Formulary Brand / Non-Formulary Brand

◊ Deductible must be met first before cost sharing begins. Family cost is multiplied by (2)

□ FPL = Federal Poverty Level

2025 SilverPlus*

S3-1

Standard / Child-Only FPL 100-150%
Deductible$0
Max Out of Pocket$1,075
PCP$10
Specialist$20
Prescription Drugs**$6 / $15 / $30
Adult Dental / VisionNo
Pediatric Dental / VisionYes
Mail Order RXYes
Exercise Facility ReimbursementYes

S3-2

Standard / Child-Only FPL 150-200%
Deductible$350
Max Out of Pocket$3,050
PCP$15
Specialist$35
Prescription Drugs**$9 / $20 / $40
Adult Dental / VisionNo
Pediatric Dental / VisionYes
Mail Order RXYes
Exercise Facility ReimbursementYes

S3-3

Standard / Child-Only FPL 200-250%
Deductible$1,925
Max Out of Pocket$7,350
PCP$30
Specialist$50
Prescription Drugs**$10 / $35 / $70
Adult Dental / VisionNo
Pediatric Dental / VisionYes
Mail Order RXYes
Exercise Facility ReimbursementYes

* These charts are brief descriptions of benefits for plan.

** Prescription Drug: Generic / Formulary Brand / Non-Formulary Brand

◊ Deductible must be met first before cost sharing begins. Family cost is multiplied by (2).

□ FPL = Federal Poverty Level

Cost Sharing Reductions (CSR) Plans are available to people who have incomes between 100% and 250% of the Federal Poverty Level (FPL).

2022 Poverty Guidelines for 48 States and the District of Columbia (Excludes Alaska and Hawaii)

PERSONS IN FAMILY / HOUSEHOLD2021 POVERTY GUIDELINE
1$12,880 to $32,200
2$17,420 to $43,550
3$21,960 to $54,900
4$26,500 to $66,250
5$31,040 to $77,600
6$35,580 to $88,950
7$40,120 to $100,300
8$44,660 to $111,650

 

These rates may change annually.

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.

Find out if you’re eligible today

We are available 6 days a week

Monday – Friday | 8am – 6pm (ET), Saturday | 9am – 5pm (ET)

How to enroll

Signing up is simple! Here’s what you need:

  • Proof of residency (Must live in one of NYC’s 5 boroughs)
  • Immigration documents (If applicable)
  • Proof of relationship status (For health insurance for dependents in NY)

Need help? Call 855-809-4073 and a friendly representative will guide you through the process.

Ready to get covered?

View over a man's shoulder of the phone he is holding and the table he is sitting at with a computer, notebook, and coffee

Representative was very professional and helpful, showed empathy for my well being with no attitude …. Thank you….. 😊 👍👍

Betsy J.
Google Review

FPL or Federal Poverty Level is based on income and is used to determine cost assistance

CSR = Cost-sharing Reduction may lower out-of-pocket costs, based on income, for SilverPlus plans

Members and providers accessing MetroPlusHealth's online resource library
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.

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

Explore all MetroPlusHealth Plans

last updated: June 25, 2025
MetroPlusHealth
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