Medicare programs, MetroPlusHealth, comprehensive coverage, personalized care, tailored plans

Medicare 2025

Get all that traditional Medicare can offer—plus all the benefits that Medicare Managed Care provides.

Get all that traditional Medicare can offer — plus all the benefits that Medicare Managed Care provides.

If you are Medicare eligible and live in New York City, you may be eligible to join one of our plans. We offer quality, affordable care – and exciting new member extras designed with you in mind, as well. MetroPlusHealth is also the only plan backed by NYC Health + Hospitals, the largest municipal health system in the U.S.

Ready to enroll in a 2025 MetroPlusHealth Medicare plan? Call us at 833.965.1526 (TTY: 711). Our representatives can enroll you by phone! Or, want us to contact you? Fill out this form and one of our representatives will reach out to you.

To view our 2024 Medicare Plans
Learn more about which Medicare plan works best for you by reviewing the plan information below.

2025 MetroPlus Advantage Plan

MetroPlus Advantage Plan (HMO D-SNP) is a Dual-Eligible Special Needs Plan designed for those Medicare beneficiaries who live in New York City, are eligible for Medicare Parts A and B, and receive assistance from New York State Medicaid. Depending on your level of Medicaid eligibility, you may pay as low as $0 for covered services.

2025 MetroPlus Platinum Plan

MetroPlus Platinum Plan (HMO) is a plan designed for those Medicare beneficiaries who live in New York City and are eligible for Medicare Parts A and B. When you join our Platinum plan, you will receive your traditional Medicare benefits, plus the extra benefits offered by MetroPlusHealth. Medicare beneficiaries who may not qualify for Extra Help for Part D may like this plan.

2025 MetroPlus UltraCare Plan

MetroPlus UltraCare (HMO D-SNP) is a Medicaid Advantage Plus plan designed for people who are dual eligible for Medicare and full Medicaid, live in New York City, and need long-term care services such as home care and personal care. The plan covers most Medicare and Medicaid benefits, including long-term care or home and community-based services, plus Prescription Drug coverage. Premiums may be as low as $0 per month for those that receive Extra Help paying for their prescription drug premium.

MetroPlus Medicare also offers 24/7 access to a doctor—whenever and wherever you need it at no additional cost

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. Click here to learn more or to access care.

MetroPlusHealth has interpreter services to answer any questions you may have about our health or drug plan, at no additional cost. To get an interpreter, just call us at 866.986.0356 (TTY: 711), Monday to Friday, 8am to 8pm, and Saturday, 9am to 5pm. At other times, call our after-hours answering service at 800.442.2560. The call is free. Someone who speaks English and other languages can help you. This is a free service. Access our Multi Language Insert message in other languages here.

APPOINTMENT OF REPRESENTATIVE

Did you know?

You can ask someone to act on your behalf. If you want to, you can name another person to act for you as your “representative” to ask for an organization determination (coverage decision). There may be someone who is already legally authorized to act as your representative under State law. If you want a friend, relative, your doctor or other provider, or other person to be your representative, print out and complete this Appointment of Representative form in English or Spanish. The form must be signed by you and by the person who you would like to act on your behalf. You must send in or fax a copy of the signed form to 1-212-908-8701.

 

OUR 2025 MEDICARE PLANS AT A GLANCE
Platinum Plan BrochureEnglishEspañol中文
UltraCare Plan BrochureEnglishEspañol中文
Advantage Plan BrochureEnglishEspañol中文
Advantage/UltraCare Flex CardEnglishEspañol中文
Advantage Post Discharge MealsEnglishEspañol中文
Advantage/UltraCare Gym ReimbursementEnglishEspañol中文
Did you know?

If you are turning 65 within the next 3 months or you are 65 years of age or older, you may be entitled to additional medical benefits through the Medicare program. If you have Medicaid, you MUST apply for Medicare as a condition of continuous eligibility.

You can apply for Medicare by calling the Social Security Administration (SSA) at 1-800-772-1213 or by applying on-line at: ssa.gov/medicare/. You may be required to submit proof that you have applied for Medicare so please keep your award or denial letter from SSA or your online receipt from SSA.

Learn more here.

If you have more questions, please call our Member Services team at 833-965-1526 (TTY: 711).

PLEASE NOTE: CMS has new strategies to further help Medicare Part D plans prevent and combat opioid overuse, including additional safety alerts at the time of dispensing as a proactive step to engage both patients and prescribers about overdose risk and prevention. Click here to learn more.

MEDICARE PROVIDER/PHARMACY DIRECTORIES
The Bronx
Kings (Brooklyn) and Richmond (Staten Island)
New York (Manhattan)
Queens

Updated January 2025

ULTRACARE Provider/Pharmacy Directories
The Bronx
Kings (Brooklyn)/Richmond (Staten Island)
New York (Manhattan)
Queens

Updated January 2025

FORMULARY
Comprehensive Formulary
Step Therapy
Prior Authorization

Updated January 2025

2025 MEDICARE ENROLLMENT RESOURCES
Enrollment Request FormsEnglishEspañol中文
Short Enrollment FormsEnglishEspañol中文
Scope of AppointmentEnglishEspañol中文

IMPORTANT – All fully completed Medicare Forms in grid above should be sent to:

MetroPlus Health Plan
50 Water Street, 7th Floor
New York, NY 10004
Attn: Sales & Marketing Dept.

Request a Hard Copy of Provider/Pharmacy Directory/Evidence of Coverage

Members can create a new account or sign in to an existing account on their member portal and follow the instructions to request a hard copy directory.

If you want a Provider/Pharmacy Directory or Evidence of Coverage (EOC) mailed to you or if you need help finding a network provider/pharmacy, please call 866.986.0356 (TTY: 711), Monday to Friday, 8am to 8pm, and Saturday, 9am to 5pm. At other times, call our after-hours answering service at 800.442.2560. The call is free. You may also request the directory or EOC by filling out our Contact form. You can always access our online directory on our Provider Directory page or your EOC on the Get the Details page.

Additional Information
  • For more information about Medicare or for assistance with Medicare issues, click here.
  • Click here for important information regarding protecting your identity and your Medicare card.
  • Ombudsman Information at Medicare.gov
  • Looking to stay safe and active?  Click here to join virtual programming for older adults and caregivers.
  • Click here for resources for seniors from the New York City Department for the Aging.
  • Find a MetroPlusHealth representative in-person or at a virtual location that suits you. Visit MetroPlus Near You.
2025 STAR RATINGS
EnglishEspañol中文

*Medicare evaluates plans based on a 5-star rating system. Star ratings are calculated each year and may change from one year to the next.

  • MetroPlusHealth Medicare Multi-Language Interpreter Services (PDF)
  • View the MetroPlusHealth Privacy Notice
  • View the MetroPlusHealth Disaster Information Policy (PDF)

PREVENTIVE SERVICES RESOURCES
Preventive Health Care GuideEnglish Espanol (PDF)

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 no additional cost 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.

For more information and to sign up go to
nychealthandhospitals.org/mychart/

MetroPlus Health Plan, Inc. is an HMO, HMO D-SNP plan with a Medicare contract. MetroPlus Health Plan, Inc. has a contract with New York State Medicaid for MetroPlus 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-SNP). MetroPlusHealth is not affiliated with, endorsed by, or otherwise related to the federal government, CMS, HHS, and/or Medicare. Enrollment in MetroPlus Health Plan, Inc. depends on contract renewal.
MetroPlus Health Plan, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingü.stica. Llame al 866.986.0356 (TTY: 711).
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 866.986.0356 (TTY: 711).

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last updated: October 1, 2024

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