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MetroPlus UltraCare (HMO D-SNP) 2024
Our MetroPlus UltraCare (HMO D-SNP) 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
Get Healthy Foods with the MetroPlusHealth Flex Card
Good news, we’ve made eating healthy easier in 2024! All your healthy foods, OTC drugs, and utilities benefits are now available on one card, and you get more of the benefits you need! Simply use your MetroPlusHealth Flex Card at participating grocers and pharmacies to purchase fruits, vegetables, and other healthy foods. You can spend up to $155 each month*.
Some of the places you can use your benefits include CVS, Duane Reade, and Rite Aid. Visit the Member portal for a full list of retailers.
Talk to us about your Flex Card benefits!
Monday–Friday | 8 am–8 pm (ET)
Saturday | 9 am–5 pm (ET)
Call us at 866-986-0356 (TTY: 711)
*Unused balances will automatically expire at the end of each month or upon disenrollment from plan.
- Health bucks are going away in 2024, but the flex card allows you to still purchase healthy foods
- Many retailers take the card, including CVS, Rite Aid, and Duane Reade
- Your card had $155 of benefits per month to pay for healthy food, OTC drugs, utilities and more, all in one place
For a list of stores where you can use your flex card, click the button below.
Prescriptions
How do I enroll?
Ready to enroll in a 2024 MetroPlus UltraCare Plan? Call us at 833-965-1526 (TTY:711) now. Our representatives can enroll you by phone!
Please note new benefits above begin on January 1, 2024.
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.
How can I switch?
Switching to a MetroPlus UltraCare Plan is easy. Get in contact with our team and find answers to FAQs here.
MetroPlusHealth Rewards Program
YOUR MEMBER HANDBOOK HAS BEEN CHANGED TO INCLUDE MORE SERVICES
Dental Services - MAP
Starting January 31, 2024, MetroPlusHealth will be covering crowns and root canals in certain circumstances so that you can keep more of your natural teeth.
Mobile Crisis Telephonic Triage Response Service - Medicare
Starting March 1, 2024, MetroPlusHealth will cover the Mobile Crisis Telephonic Triage and Response service for members under the age of 21. This service is already available to members 21 years of age and older.
Plan Benefits
MPH Member Rewards Program Brochure - Coming Soon
Flex Card
Gym Reimbursement
Fitness Reimbursement: up to $250 every six months for membership to qualifying exercise facilities
Plan Materials
NYS Standard Form to Designate a Representative to Assist with Health Insurance Authorizations, Complaints, Grievances, and Appeals
MPH Member Rewards Program Brochure - Coming Soon
Comprehensive Formulary
Flex Card
Provider / Pharmacy Directories
Summary of Benefits (SB)
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, 2024.
Handbook
Member Guide - Coming Soon
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”.
Member Reimbursement Form & FAQs
Gym Reimbursement
Fitness Reimbursement: up to $250 every six months for membership to qualifying exercise facilities
Health Risk Assessment
Rights and Responsibilities Upon Disenrollment
MetroPlusHealth Virtual Visit
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
Preventive Services Resources
Explore all MetroPlusHealth Plans
last updated: March 1, 2024
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