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Selecting a Plan

What makes MetroPlusHealth a good choice for a health insurance plan?

MetroPlusHealth offers a variety of high-quality, affordable health insurance plans that
fit your needs and budget.

MetroPlusHealth offers the following plans:

Essential Plans: These plans are designed to meet the minimum requirements of the
Affordable Care Act (ACA). They offer coverage for essential health benefits, such as
preventative care, prescription drugs, and emergency care.

Marketplace Plans: These plans are available through the Health Insurance
Marketplace. They offer a variety of coverage options, including different levels of
premiums, deductibles, and copays.

Medicaid Managed Care Plans: These plans are available to people who are eligible
for Medicaid. They offer a comprehensive set of benefits, including coverage for
doctor visits, prescription drugs, and long-term care.

Medicare Plans: These plans are available to people who are 65 years of age or older.
They offer a variety of coverage options, including different levels of premiums,
deductibles, and copays.

Child Health Plus: This plan is available to children under 19 who are not eligible for
Medicaid. It offers coverage for essential health benefits, such as preventative care,
prescription drugs, and emergency care.

Enhanced (HARP) Plan: This plan is available to Medicaid recipients 21 or older who
need additional resources for behavioral health. It offers coverage for behavioral health
services, such as therapy and medication.

Question:
How do I know if I have selected the right plan?

Answer:
Selecting the right plan can be overwhelming, but affordability, convenient access to care, and excellent customer service are all things to consider as you select your plan. Everyone is different, but if a plan has affordable premiums, a wide network of providers (including hospitals, doctors, and specialists), excellent customer service, convenient access to care, and programs to help you earn rewards and points, it might be the right plan for you.

MetroPlusHealth offers affordable premiums, over 34,000 providers, excellent customer service professionals, and programs that reward you for taking care of your health.

Signing up/ Enrolling in the Plan

Question:
How do I sign up for, or enroll in the plan?

Answer:
You can enroll in the MetroPlusHealth Essential Plan by phone, or in person.

Wherever you live in New York City, our Marketplace Facilitated Enrollers (FEs), navigators, brokers, and agents are available to help you complete your application in the NY State of Health Marketplace. Call us at 855-809-4073, TTY: 711, Monday through Friday, 8AM – 8PM, and Saturday, 9AM – 5PM to make an appointment.

 

Welcome Kit and ID Card

Question:
When will I receive my Welcome Kit and ID card?

Answer:
You should receive your welcome kit and ID mailed within the first 15 days of membership.

If you have not received your welcome kit and ID card within the first 15 days of membership, you can contact MetroPlusHealth customer service at 855-809-4073.

Term of Coverage

Question:
How long will I be covered by my insurance plan?

Answer:
It all depends!

If you are enrolled in the MetroPlusHealth Essential Plan, your coverage will last for 12 months. You can renew your coverage for an additional 12 months if you continue to meet the eligibility requirements.

Member Portal – Account Creation and Access

Question:
How do I create an account on the Member portal?

Answer:
Creating an account on the member portal is quick and easy. It is the best way to manage all of your plan benefits.

Go to “Members.Metroplus.org
Click on the “For members” tab
Click on the link that says “Member Portal”
Click “Create an Account”
Follow the prompts to create an account, and access your plan benefits, ID card, and more.

Question:
How do I access the Member Portal?

Answer:
If you already have an account, accessing the Member Portal is quick and easy.

Downloading the MetroPlusHealth App

Question:
Does MetroPlusHealth have a mobile app?

Answer:
MetroPlusHealth does have a mobile app. Downloading the app is a quick way to manage your health plan and benefits while you are on the move.

Want quick access to your plan benefits?
Download the MetroPlusHealth mobile app from Google Play (Android) or App Store (iOS).
Search for “MetroPlusHealth Member”
Get, or select Download
Open the app
Create an account to log on for the first time, or sign in with your userID and password
you have already created.
Begin accessing your plan information.

Question:
I created a Member Portal account on my desktop. Do I use the same userID and password for the mobile app?

Answer:
You would use the same userID and password for the desktop login, and the mobile app. The mobile app is essentially a different view of the member portal.

Benefits and Coverage

Question:
What are some of the Essential Plan benefit highlights?

Answer:
The Essential Plan benefit highlights include $0 preventative care. Urgent and emergent care are also plan benefits.

With no monthly premiums and no cost for dental and vision, our Essential Plans offer
all of the essential benefits you need: preventative care, emergency care, prescription
drugs, mental health, and more.

Plus, there’s no deductible, so the plan starts paying for your health care right away.
You get free preventative care like routine doctor exams and screenings to keep you
healthy.

Question:
What services does the Essential Plan offer?

Answer:
The Essential Plan offers a variety of services to help keep you on a path to feeling your best.

The Essential Plan offers preventative Services to keep you healthy, counseling, screenings, vaccines, chronic disease management, mental health and substance use disorder services, behavioral health treatment, counseling, psychotherapy, lab tests, outpatient care, trips to the emergency room, treatment in the hospital for inpatient care, prescription drugs, services and devices to help you recover if you are injured, or have a disability or chronic condition, physical and occupational therapy, speech language pathology, psychiatric rehabilitation.

Where to go for care

Question:
Where can I go for care?

Answer:
You can obtain care from a Primary Care Physician, via a Virtual Visit, from an Urgent Care Center, or in extreme situations, from an Emergency Room.

You can obtain care via the following methods:

Primary Care Physician (PCP)
Your primary care physician should be your main source of contact. See your PCP for your yearly wellness visit, vaccinations and referrals to specialists. Your wellness visit and vaccinations cost $0.
Find A PCP

Virtual Visit
Our program offers a choice to get care from board certified doctors. Use your phone or video chat on your computer. It is available 24/7 and has a $0 copay. Use for nonemergency issues such as allergy, sore throat, earache, nausea, vomiting and after hours care.
Access Virtual Visit Now

Urgent Care
Also known as a walk-in-clinic. Use for nonserious medical issues when your doctor is
not available. Visit an Urgent Care for colds/flu, fevers, cuts/sprains/strains, sore
throats.
Find an Urgent Care

Emergency Room
If you feel you are experiencing serious medical situations. Visit an Emergency Room if
you are experiencing a heart attack, stroke, difficulty breathing, broken bones, severe
allergic reaction or a sudden change in your health that is causing you concern.

Rewards and Perks

Question:
Is there a Rewards and Perks program?

Answer:
Yes.

MetroPlusHealth Member Rewards is a program that offers discounts on a variety of products and services to MetroPlusHealth members. The program is designed to help members save money on things they already buy, and to encourage them to live healthier lives.

Question:
How do I participate in the Rewards program?

Answer:
To participate in MetroPlusHealth Member Rewards, you must first enroll in the program.
You can do this by visiting the MetroPlusHealth website or by calling MetroPlusHealth
at 855-809-4073.

last updated: November 16, 2023

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