MetroPlus UltraCare (HMO D-SNP) 2023
Our MetroPlus UltraCare Plan is a Medicaid Advantage Plus plan designed for people who are dual eligible for Medicare and full Medicaid and need long-term care services such as home care and personal care. This plan will cover most of your Medicare and Medicaid benefits, including long-term care or home and community-based services, plus Prescription Drug coverage. UltraCare members will also get a Primary Care Manager who will manage your everyday needs, identify health issues and customize your care plan, all to help you stay in your home for as long as possible. This plan offers as low as a $0 monthly plan premium for those that receive Extra Help paying for their prescription drug premium.
To be eligible for MetroPlus UltraCare (HMO D-SNP) you must:
Be 18 years or older
Live within the 5 boroughs of New York City
Have Medicare Part A and B coverage, or be enrolled in Medicare Part C coverage
Must have full Medicaid coverage
Need at least one of the following Community Based Long-Term Care Services for more than 120 days:
- Nursing Services in the home
- Therapies in the home
- Home Health Aide services
- Personal Care Services in the home
- Adult Day Health Care
- Private Duty Nursing; or
- Consumer Directed Personal Assistance Services
You pay $0 copay for all these services below and many more!
Primary Care Visits
Specialist Visits
Preventive Care
Long Term Care Benefits
Urgently Needed Services
Telehealth
Prescriptions
The Inflation Reduction Act (IRA): Changes to Your Drug Coverage
MetroPlusHealth Rewards Program
Free or Low-Cost Preventive Health Care Services
At MetroPlusHealth, we always want you to be at your best. That’s why we encourage you and your family to take advantage of preventive care services available to you at low or no cost. We’ve listed dozens of FREE preventive services here for adults, women and children that just may help you be your healthiest yet.
Plan Benefits
Fitness Reimbursement: up to $250 every six months for membership to qualifying exercise facilities
Plan Materials
A detailed explanation of your coverage, what we must do, your rights, and what you must do as a member of our plan.
A summary of changes to your benefits and costs for the next year. These changes take effect on January 1, 2023.
Low Income Subsidy is available under the Medicare Part D prescription drug program. Eligible beneficiaries who have limited income may qualify for a government program that helps pay for Medicare Part D prescription drug costs. If you receive “Extra Help” from Medicare, your monthly plan premium will be lower. The Low Income Subsidy (LIS) Premium Table shows you what your monthly premium will be if you get “Extra Help”.
Rights and Responsibilities Upon Disenrollment
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
