MetroPlus UltraCare (HMO D-SNP) 2023

For information about your prescription drug benefits, please refer to the formulary to see which drugs are covered. You can find the formulary in the Plan Benefits section below. Depending on your level of Extra Help, you may only have to pay a $0 copay for your prescription drugs. Please note that MetroPlusHealth may add or remove drugs from our Medicare formulary during the year. You will receive notice when changes that may impact you are made. MetroPlusHealth has partnered with CVS Caremark to cover your prescription drugs. Click here to access your CVS Caremark account. You will be transferred to the CVS Caremark site. Use the information on your MetroPlusHealth Member ID card to register or login.

Effective 4/1/2023, coinsurance for certain Part B rebatable drugs will be reduced, if the drug’s price has increased at a rate faster than the rate of inflation.

Effective 7/1/2023, insulin covered under Part B (for example, insulin administered via a pump that qualifies as an item of durable medical equipment (DME)) will not exceed $35 total for a one month’s supply and the Medicare Part B deductible will not apply.

Important Message About What You Pay for Vaccines – Our plan covers most Part D vaccines at no cost to you, even if you haven’t paid your deductible. Call Member Services for more information.

Important Message About What You Pay for Insulin – You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible.

Register for the MetroPlus Member Rewards Program and earn rewards by keeping your health appointments and participating in wellness activities. Shop for healthy items you need with the rewards you earn!  Click here to see our member rewards program.

Have questions about enrolling in MetroPlus UltraCare (HMO D-SNP)?

You or your family/caregiver or another person who helps you get medical services may contact MetroPlusHealth by phone. Just call us to let us know that you are interested in learning more about the plan. Please call 1-866-986-0356 (TTY: 711). Our staff is available 7 days a week from 8:00 a.m. to 8:00 p.m.

If you are new to long term care services you can contact the the New York Independent Assessor (NYIA), at 1-855-222-8350 from Monday to Friday, 8:30 a.m-8 p.m., and Saturday, 10am-6pm to schedule a free evaluation.

Ending your membership in MetroPlusHealth Medicare plans may be voluntary (your own choice) or involuntary (not your own choice). You can end your membership in the plan at any time. The process for voluntarily ending your membership varies depending on what type of new coverage you are choosing. Your membership will usually end on the first of the month after we receive your request to change your plan.

How do you end your membership in our plan?

Usually, you end your membership by enrolling in another plan. However, if you want to switch from our plan to Original Medicare but you have not selected a separate Medicare prescription drug plan, you must ask to be disenrolled.

• You can make a request in writing to us or complete the form (Coming Soon) and mail it to us.
• Or, you can contact Medicare at 1-800-Medicare or 1-800-633-4227, 24 hours a day, 7 days a week, TTY users should call 1-877-486-2048. For more information, review your Evidence of Coverage.

If you have any questions, please call Member Services at 1-866-986-0356 (TTY: 711), 24 hours a day, 7 days a week.

MetroPlusHealth Plan is an HMO, HMO SNP plan with a Medicare contract. MetroPlusHealth Plan has a contract with New York State Medicaid for MetroPlusHealth UltraCare (HMO D-SNP) and a Coordination of Benefits Agreement with the New York State Department of Health for the MetroPlus Advantage Plan (HMO D-NSP). Enrollment in MetroPlusHealth Plan depends on contract renewal. MetroPlusHealth Plan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

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注意：如果您使用繁體中文，您可以免費獲得語言援助服 務。請致電1-866-986-0356 (TTY: 711).
H0423_MKT23_2181_M Accepted 10012022