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Medicare Advantage Plan

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When you choose MetroPlus Advantage Plan (HMO-DSNP), you get one of the most complete health plans in New York City. If you are eligible for Medicare and Medicaid, you’ll receive all of your current benefits, plus much more.

To be eligible for our MetroPlus Advantage Plan (HMO-DSNP), you must have Medicare Part A, be enrolled in Medicare Part B, eligible for Medicaid or Medicare cost-sharing assistance under Medicaid, and live in New York City.

MetroPlus Advantage Plan (HMO-DSNP) provides all the benefits of Original Medicare PLUS:

  • Telehealth: Free 24/7 virtual access to doctors and therapists from your smart phone, tablet or computer

  • Routine Transportation: $0 copay for up to 14 one-way trips to health-related locations per year

  • Vision and Comprehensive Dental

  • Member Rewards Program: Earn points by keeping your health appointments and participating in wellness activities. Points can be exchanged for items from our exclusive catalog

  • Medications pre-packaged and delivered to you at no extra cost. Available through PillPack or CVS Pharmacy. Learn more below.

  • Healthy food vouchers: Qualifying members may get up to $64 per quarter ($256 per calendar year) in food vouchers for purchasing fresh, healthy fruits and vegetables from participating vendors. For a list of 2023 year-round food access sites across New York City, link coming soon.

  • Over the Counter (OTC) benefit: Members receive $375 per quarter ($1500 per calendar year) for purchase of OTC items (approved non-prescription drugs and health-related items). Learn more below.

How do I enroll?

Ready to enroll in a 2023 MetroPlus Advantage Plan (HMO-DSNP)? Call us at 1-866-986-0356 (TTY:711) now. Our representatives can enroll you by phone!

Please note new benefits below begins on January 1, 2023.

To access more information about your prescription drug benefits click here: https://www.caremark.com/wps/portal. You will be transferred to the CVS Caremark website. Use the information on your MetroPlusHealth Medicare Member ID card to register. Follow the step by step instructions located on the site.

Plus new for 2023:

  • Flex Card: Get a pre-paid $400 debit card annually to use toward home/bathroom safety devices and modifications, utilities, cable, and phone services. View our catalog in the Plan Benefits section below or go to members.nationsbenefits.com/metroplus to place your order.

  • Worldwide emergency room services

The Inflation Reduction Act (IRA): Changes to Your Drug Coverage

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.

Plan Benefits

Gym Reimbursement

Fitness Reimbursement: up to $250 every six months for membership to qualifying exercise facilities

Over The Counter (OTC) Catalog

Over the Counter (OTC) benefit, members receive $375 per quarter ($1500 per calendar year) for purchase of OTC items (approved non-prescription drugs and health-related items). Any unused balance will automatically expire at the end of each quarter or upon disenrollment from the plan. View our OTC catalog below, or go to cvs.com/otchs/metroplus to place your order. View this helpful video on how to order.

Prepackaged Pills 

Medications can be pre-packaged and delivered to you at no extra cost. Available through PillPack or CVS Pharmacy. Learn more below.

Plan Materials

MetroPlusHealth has updated the MetroPlus Advantage Plan (HMO-DSNP) Summary of Benefits, Evidence of Coverage, and Annual Notice of Changes for 2023 with 2023 Medicare Parts A & B deductibles and coinsurance amounts. Please review the updated documents for more information.

Evidence of Coverage (EOC)

A detailed explanation of your coverage, what we must do, your rights, and what you must do as a member of our plan.

Annual Notice of Change (ANOC)

A summary of changes to your benefits and costs for the next year. These changes take effect on January 1, 2023.

Low Income Subsidy (LIS) Premium Table

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”.

Ready to enroll in a 2023 MetroPlus Advantage Plan (HMO-DSNP)? Call us at 1-866-986-0356 (TTY:711) now. Our representatives can enroll you by phone!

Rights and Responsibilities Upon Disenrollment

Ending your membership in MetroPlusHealth Medicare plans may be voluntary (your own choice) or involuntary (not your own choice).

You can disenroll or change coverage during applicable enrollment periods. 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 this form (link 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 EOC.

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

MetroPlus Health Plan is a HMO, HMO SNP plan with a Medicare contract. MetroPlus Health Plan has a contract with New York State Medicaid for MetroPlus UltraCare (HMO-DSNP) and a Coordination of Benefits Agreement with the New York State Department of Health for the MetroPlus Advantage Plan (HMO-DSNP). Enrollment in MetroPlus Health Plan depends on contract renewal.

MetroPlus Health Plan 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 lingüística.  Llame al 1-866-986-0356 (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 1.866.986.0356 (TTY: 711).

H0423_MKT23_2181_M Accepted 10012022

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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.

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.

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: November 3, 2022

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