Smiling senior in New York consulting with a doctor about MetroPlusHealth Medicare UltraCare (HMO D-SNP) Plan benefits.

MetroPlus
UltraCare (HMO D-SNP)

Comprehensive care for individuals with
Medicare and full Medicaid, including
long-term care services.

The MetroPlus UltraCare Plan (HMO D-SNP) is a Medicare Advantage Dual Eligible Special Needs Plan designed for individuals who qualify for both Medicare and Medicaid, including long-term care services in NYC. Combining comprehensive medical coverage, prescription drug benefits, and coordinated care services, the MetroPlus UltraCare (HMO D-SNP) helps eligible New Yorkers access the healthcare they need while enjoying valuable extra benefits. With a trusted network of providers, personalized care management, and support focused on improving health outcomes, MetroPlus UltraCare (HMO D-SNP) makes it easier to navigate your healthcare journey and get the most from your Medicare and Medicaid benefits.

MetroPlus UltraCare Plan (HMO D-SNP) member meeting with a healthcare provider and receiving coordinated Medicare and Medicaid healthcare coverage.
The MetroPlus UltraCare Plan (HMO D-SNP) provides coordinated Medicare and Medicaid coverage, prescription drug benefits, and personalized support to help members stay healthy.

 

On this page:

Why Choose MetroPlus? | Benefits | Flex Card | InComm Guide | Member Rewards | Prescription Drug Benefits | Eligibility | Enrollment | Plan Materials | Disenrollment | View our 2026 MetroPlus UltraCare Plan (HMO D-SNP)

Why choose MetroPlusHealth?

$0 Copay Benefits with MetroPlus UltraCare (HMO D-SNP)

Wheelchair woman smiling in the room

 

All these services and more at ZERO COST to you:

  • Health Care Services:
    • Primary care visits
    • Urgent care visits
    • Specialist visits
    • 80 one-way trips (plan approved medical locations)
  • Fitness Benefits:
  • Up to $250 per every six months for gym membership
  • $780 quarterly flex card for:
  • Over-the-counter medications
  • Utility payments
  • Groceries and food
  • Other qualifying expenses
  • Pet supplies
  • Home Support:
    • Unlimited meal delivery to your home
    • Long-term care services
  • Wellness Support:
    • Fitness reimbursement: Up to $250 every 6 months
    • Post-hospital meals: 20 meals over 5 days

Extra benefits included with your plan:

  • $780 Flex Card quarterly for:
    • Over-the-counter medicines
    • Personal Emergency Response System
    • Bathroom safety devices
    • Chiropractic visits
    • Internet, phone, and cable service
    • Your electric and gas bills
    • Healthy Food and Pet Supplies
    • NEW! For 2027 – Rent assistance (through Visa Network)

Enjoy comprehensive coverage designed to support your independence and quality of life—with zero copays and zero hassle.

Disclaimer: Limitations may apply.

Quality Care When and Where You Need It

Access Top-Rated Health Care Providers in NYC

MetroPlus UltraCare Plan (HMO D-SNP) connects you with NYC’s finest healthcare network:

  • 34,000+ top doctors across the city
  • 40+ premiere hospitals including Mount Sinai, NYU Langone, and NY Health + Hospitals
  • 110+ urgent care locations including convenient CityMD sites

Perfect for families: Our health insurance for families covers everyone’s needs with one simple plan.
Care on your schedule: Access online doctor visits and virtual urgent care from home, work, or anywhere with our telemedicine health insurance coverage.

Other providers available in our network

Why Choose a New York-Only Health Care Plan?

Is a not-for-profit organization (prioritizing you, not profits)
Was created by New Yorkers, for New Yorkers
Proudly provides customer service from real people who live in NYC
Offers you 34,000+ providers across all five boroughs

National Health Care Chains

Prioritize their bottom line profits (not you)
Are based outside of NYC
Provide impersonal customer service
Offer uncertain provider networks

Your MetroPlusHealth *Flex Card: Healthy Eating Made Easier in 2027

One card, multiple benefits — now with $780 quarterly allowance!

Your MetroPlusHealth Flex Card now provides access to:

  • Over-the-counter medicines
  • Healthy food
  • Utility bill payments
  • NEW for 2027 – Rent assistance (through Visa Network)

Where to use your card:

  • Amazon
  • Walmart
  • CVS
  • Family Dollar
  • Duane Reade / Walgreens
  • Dollar General
  • AHOLD Brand Stores
  • And many other participating retailers

Find all participating locations via the link below: InComm My Benefits Portal

Need help with your Flex Card? Contact us:

  • Phone: 866.986.0356 (TTY: 711)
  • Hours: Monday–Friday, 8am–8pm Saturday, 9am–5pm and after-hours, at 800.442.2560.

Important: Your quarterly allowance of $780 does not roll over to the next quarter and unused balances expire at the end of each quarter or upon disenrollment.

How to Access Your InComm My Benefits: A Step-by-Step Guide

Learn how to manage all your benefits in one place:

  • Access your benefit information online
  • Check your available balance
  • Find participating retailers
  • Redeem your benefits easily
  • Use both the website and mobile app

Our step-by-step guide makes it simple to navigate the InComm My Benefits Center website and the OTC Network mobile application.

Prescription Drug Benefits

Find the medications you need at a price you can afford.

Coverage Information:

  • Review our formulary (list of covered drugs) in the Plan Benefits section below
  • With Extra Help, you may qualify for $0 copay prescriptions
  • We partner with CVS Caremark to provide your prescription coverage

Important Notes:

  • MetroPlusHealth may update the formulary during the year
  • You’ll receive notifications about changes that affect your medications
  • Your coverage level depends on your Extra Help qualification

Access Your Prescription Information:

  1. Visit your CVS Caremark account here.
  2. Use your MetroPlusHealth Member ID card to register or log in.
  3. View your complete prescription benefits and coverage details.

Need help? Contact our Member Services team for assistance with any prescription questions.

NEW MetroPlusHealth Rewards Program: MetroPlus UltraCare (HMO D-SNP)

Our exciting new Rewards Program is now available! Learn More or Register

Need Help with MetroPlus UltraCare Enrollment?

Contact us directly:

  • Call: 833.965.1526 (TTY: 711)
  • Hours: 7 days a week, 8:00am-8:00pm
  • Our representatives can answer all your questions.

Who can call:

  • You
  • Your family member
  • Your caregiver
  • Anyone who helps with your medical services

New to Long-Term Care Services?

Schedule a free evaluation with the New York Independent Assessor (NYIA):

  • Call: 1.855.222.8350
  • Hours: Monday-Friday, 8:30am-8:00pm Saturday, 10:00am-6:00pm

Our MetroPlus UltraCare Plan (HMO D-SNP) is specially designed for individuals who:

  • Have both Medicare and full Medicaid coverage
  • Need long-term care services
  • Require assistance with home care and personal care

Complete Coverage in One Plan:

  • Medicare benefits
  • Medicaid services
  • Long-term care support
  • Home and community-based services
  • Prescription drug coverage
  • Potential $0 monthly premium with Extra Help

Personalized Support

Your dedicated Primary Care Manager will:

  • Manage your everyday healthcare needs
  • Identify potential health issues early
  • Create a customized care plan
  • Help you remain at home independently for as long as possible

Enjoy comprehensive care with the support you need to maintain your independence and quality of life.

A mother and daughter embrace

MetroPlus UltraCare (HMO D-SNP) Eligibility Requirements

You qualify for this plan if you meet ALL of these criteria:

Basic Requirements:

  • Age 18 or older
  • Resident of one of New York City’s five boroughs
  • Have Medicare Parts A and B (or Part C) coverage
  • Have full Medicaid coverage

Health Assessment Requirements:

  • Qualify for nursing home level of care (determined by Uniform Assessment System or NYS-designated tool)
  • Be able to safely live at home or in the community, as determined by NYS criteria

Long-Term Care Needs:

You must need at least ONE of these services for more than 120 days:

  • Nursing services in the home
  • Home therapy services
  • Home health aide assistance
  • Personal care services
  • Adult day health care
  • Private duty nursing
  • Consumer-Directed Personal Assistance Services

 

Find out if you’re eligible today

We are available 6 days a week

Monday – Friday | 8am – 6pm (ET), Saturday | 9am – 5pm (ET)

How to Enroll in MetroPlus UltraCare Plan (HMO D-SNP) for 2027

Ready to enroll? It’s simple:

  • Call 833.965.1526 (TTY: 711).
  • Our representatives will guide you through enrollment by phone.
  • New benefits begin January 1, 2027.

Access Your Prescription Benefits:

  1. Visit caremark.com/wps/portal.
  2. Use your MetroPlusHealth Medicare Member ID card to register.
  3. Follow the step-by-step instructions on the Caremark website.

Medicare UltraCare Plan Materials

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, 2027.

Pharmacy Information

Formulary

Coming Soon

Comprehensive Formulary

Step Therapy Criteria

Prior Authorization

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”.

Directories

Provider / Pharmacy Directories

Coming Soon

Kings (Brooklyn)/Richmond (Staten Island)

New York (Manhattan)

Forms

NYS Standard Form to Designate a Representative to Assist with Health Insurance Authorizations, Complaints, Grievances, and Appeals

Coming Soon

Health Risk Assessment

Coming Soon

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.

Ending Your Membership: What You Need to Know

Important notes:

  • You can end your membership at any time.
  • Changes typically take effect on the first day of the month after we receive your request.
  • The process varies depending on your new coverage choice.

How to End Your Membership

Option 1: Join another plan

  • This automatically ends your MetroPlus coverage.

Option 2: Switch to Original Medicare

  • If you haven’t selected a separate Medicare prescription drug plan, you must request disenrollment by:
    • Submitting a written request
    • Completing our disenrollment form (Coming Soon)
    • Contacting Medicare directly at 1.800.MEDICARE (1.800.633.4227), available 24/7 (TTY users: 1.877.486.2048)

Questions? Call Member Services: 866-986-0356 (TTY: 711) – Monday to Friday, 8am to 8pm; Saturday, 9am to 5pm; and after-hours, at 800.442.2560.

Legal Information:

MetroPlus Health Plan, Inc. offers HMO and HMO D-SNP plans with contracts with Medicare and the New York State Medicaid program. Enrollment in MetroPlus Health Plan, Inc. depends on contract renewal.

MetroPlusHealth is not affiliated with, endorsed by, or otherwise related to the 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.

ATTENTION: Language assistance services and other aids, free of charge, are available to you. Call 1.866.986.0356 (TTY: 711).

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_MPHwebsite_M_2027 Approved 10012026 MKT26.119

last updated: September 15, 2026
MetroPlusHealth

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