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MetroPlusHealth offers several different SilverPrime plans. Each plan adds additional levels of customization to fit your needs. All SilverPrime plans include three Primary Care Physician (PCP) visits that are not subject to the deductible*.

The plan has an individual deductible of $0 to $2,250 and a max out of pocket of $1,000 to $9,100 depending on eligibility. It also has a family deductible of $0 to $4,500 and a max out of pocket of $2,000 to $18,200 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 2023 SilverPrime 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.

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

Click to enroll here.  Or call us at 1-855-809-4073. A representative will contact you shortly to help you enroll.

*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.

2023 SilverPrime*

PRODUCTSP2
Product TypeNon-Standard
Deductible$2,250
Max out of Pocket$9,100
PCP$35
Specialist$55
Prescription Drug**$15 / $40 / $80
Adult Dental / VisionYes
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).

2023 SilverPrime*

PRODUCTSP2-1SP2-2SP2-3
Product TypeNon-Standard FPL 100 – 150%Non-Standard FPL 150 – 200%Non-Standard FPL 200 – 250%
Deductible$0$400$2,175
Max out of Pocket$1,000$2,900$7,250
PCP$10$15$35
Specialist$20$35$55
Prescription Drug**$6 / $15 / $30$9 / $20 / $40$15 / $40 / $80
Adult Dental / VisionYesYesYes
Pediatric Dental / VisionYesYesYes
Mail Order RXYesYesYes
Exercise Facility ReimbursementYesYesYes

 

* 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)
□ 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$13,590 to $33,975
2$18,310 to $45,775
3$23,030 to $57,575
4$27,750 to $69,375
5$32,470 to $81,175
6$37,190 to $92,975
7$41,910 to $104,775
8$46,630 to $116,575

 

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.

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They’re very helpful and took care of me when I had an emergency 👍🏾👌🏾💯

Mateo V.
Google Review

Plan Materials

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

"Off Exchange"

Individual Non-Standard – SilverPrime SP2

"Exchange"

Individual Non-Standard – SilverPrime SP2

Individual Non-Standard – SilverPrime SP2-1

Individual Non-Standard – SilverPrime SP2-2

Individual Non-Standard – SilverPrime SP2-3

Summary of Benefits

"Off Exchange"

Individual Non-Standard – SilverPrime SP2

"Exchange"

Individual Non-Standard – SilverPrime SP2

Individual Non-Standard – SilverPrime SP2-1

Individual Non-Standard – SilverPrime SP2-2

Individual Non-Standard – SilverPrime SP2-3

Contracts

"Off Exchange"

Individual Non-Standard – SilverPrime SP2

"Exchange"

Individual Non-Standard – SilverPrime SP2

Individual Non-Standard – SilverPrime SP2-1

Individual Non-Standard – SilverPrime SP2-2

Individual Non-Standard – SilverPrime SP2-3

* 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.

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

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 SilverPrime plans

 

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 your 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.

Health Risk Assessment 

HRA can be returned to:
ATTENTION: QM Health Risk Assessment Unit
MetroPlus Health Plan
50 Water Street, 7th Floor
​New York, NY 10004
or by completing our Contact form by clicking here.

IMPORTANT INFORMATION: MONKEYPOX CASES ARE RISING IN NYC.

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

last updated: January 4, 2023

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