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MetroPlus UltraCare (HMO D-SNP) 2024

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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

Medicaid, PIC, HARP, CHP:

NON-EMERGENCY TRANSPORTATION BENEFIT:

Your non-emergency transportation benefit is provided by Medical Answering Services (MAS). Need to schedule a ride?

Call 844-666-6270 or Schedule Online!

NationsBenefits

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

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.

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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

Our new Rewards Program is here! Click to learn more or to register.

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 833-965-1526 (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.

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

MPH Member Rewards Program Brochure

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

MPH Member Rewards Program Brochure

Comprehensive Formulary 
Provider / Pharmacy Directories

Kings (Brooklyn)/Richmond (Staten Island)

New York (Manhattan)

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.

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”.

Gym Reimbursement

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

Health Risk Assessment

HRA can be returned to:
ATTENTION: QM Health Risk Assessment Unit
MetroPlus Health Plan
50 Water Street, 7th Floor
​New York, NY 10004
or by completing our Contact form by clicking here.

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 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 833-965-1526 (TTY: 711), 24 hours a day, 7 days a week.

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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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

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.

Explore all MetroPlusHealth Plans

last updated: March 10, 2024

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