SilverPrime

MetroPlusHealth offers several different SilverPrime plans. Each plan adds additional levels of customization to fit your needs. All SilverPrime plans include three Primary Care Physician (PCP) visits that are not subject to the deductible*.

The plan has an individual deductible of $0 to $2,250 and a max out of pocket of $1,000 to $9,100 depending on eligibility. It also has a family deductible of $0 to $4,500 and a max out of pocket of $2,000 to $18,200 depending on eligibility.

You can enroll with us in a MetroPlusHealth Marketplace plan directly by clicking here (“Off Exchange”) or through the NY State of Health (NYSOH), the Official Health Plan Marketplace (“Exchange”).

Check out our 2023 SilverPrime plans below. Interested in one? Think you might be eligible for a NYSOH premium subsidy? Call us at 1-855-809-4073 or contact us here. One of our representatives will contact you to review your plan options.

Enrolling is hassle-free and easy as one, two, three! All you need is your:

1. Proof of residency in the 5 boroughs of NYC
2. Proof of immigration status
3. Proof of relationship status for any dependents

Click to enroll here.  Or call us at 1-855-809-4073. A representative will contact you shortly to help you enroll.

*For all standard plans with three PCP visits not subject to the deductible, the cost sharing co-pay is still applicable to the first three visits.

These rates may change annually.

Premiums listed are example base rates for individuals. Rates may differ based according to family size, income level, and eligibility for tax credits. In accordance with Section 1303 of the Patient Protection and Affordable Care Act, at least $1.00 of the total premium amount owed per enrollee per month is a payment for coverage of non-Hyde abortion services.

To learn more about the drugs covered by our Marketplace Plans, please visit the MetroPlusHealth Pharmacy page.

If you would like a hard copy of this Certificate of Coverage, you can submit a request online here. Please be sure to tell us which Certificate of Coverage – for example, GoldPlus G1 – you need.

To search our provider network for our Marketplace Plans, please visit the MetroPlusHealth Provider Directory page.

Non-Standard Plans offer additional benefits not included on the Standard Plans and allows members to purchase Adult Vision and Dental coverage.

FPL or Federal Poverty Level is based on income and is used to determine cost assistance

CSR = Cost-sharing Reduction may lower out-of-pocket costs, based on income, for SilverPrime plans

Recently, we sent you an announcement along with your new ID Card about our new partnership with DentaQuest, a dental vendor. Starting January 1, 2023, you can begin to use your new ID Card for all your health care needs, including dental services with DentaQuest. Remember to bring your new ID card when you visit your dentist.

Your oral health is important to us. Partnering with DentaQuest, we are able to bring their experience and passion for improving oral health care to you. Their dental network is 65% larger than what we have been offering, with more dentists and specialists available than before. Learn more about your new dental benefit here.

IMPORTANT INFORMATION: MONKEYPOX CASES ARE RISING IN NYC.

Monkeypox cases are rising in NYC. Learn more about Monkeypox, including prevention and treatment, here.