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MetroPlusHealth offers a variety of different SilverPlus plans. Each plan adds additional levels of customization to fit your needs.

The plan has an individual deductible of $0 – $1,750 and a max out of pocket of $1,000 – $9,100 (depending on eligibility). The plan has a family deductible of $0 – $3,500 and a max out of pocket of $2,000 – $18,200 (depending on eligibility).

This plan also has an American Indian / Alaska Native plan with a $0 deductible and $0 max out of pocket for those that qualify.

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 SilverPlus 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.

2023 SilverPlus*

PRODUCTS1S2S3S5 (ADULT) / S3-4 (CHILD)S6
Product TypeStandardNon-StandardChild-OnlyAI / AN-StandardAI / AN-Non-Standard
Premium$690.02$695$284.59$690.02/$284.59$695
Deductible$1,750$1,750$1,750$0$0
Max out of Pocket$9,100$9,100$8,500$0$0
PCP$30$30$300%0%
Specialist$65$65$650%0%
Prescription Drug**$15 / $40 / $75$15 / $40 / $75$15 / $40 / $750%0%
Adult Dental/VisionNoYesNoNoYes
Pediatric Dental / VisionYesYesYesYesYes
Mail Order RXYesYesYesYesYes
Exercise Facility ReimbursementYesYesYesYesYes

 


* These charts are brief descriptions of benefits for the plan.

** Prescription Drug: Generic / Formulary Brand / Non-Formulary Brand

 Deductible must be met first before cost sharing begins. Family cost is multiplied by (2).

 AI / AN – American Indian / Alaskan Native

2023 SilverPlus*

PRODUCTS1-1S1-2S1-3
Product TypeStandard FPL 100 – 150%Standard  FPL 150 – 200%Standard FPL 200 – 250%
Deductible$0$250$1,100
Max out of Pocket$1,000$2,200$6,500
PCP$10$15$30
Specialist$20$35$50
Prescription Drug**$6 / $15 / $30$9 / $20 / $40$10 / $35 / $70
Adult Dental / VisionNoNoNo
Pediatric Dental / VisionYesYesYes
Mail Order RXYesYesYes
Exercise Facility ReimbursementYesYesYes

 

* These charts are brief descriptions of benefits for plan.

** Prescription Drug: Generic / Formulary Brand / Non-Formulary Brand

◊ Deductible must be met first before cost sharing begins. Family cost is multiplied by (2)

□ FPL = Federal Poverty Level

2023 SilverPlus*

PRODUCTS2-1S2-2S2-3
Product TypeStandard FPL 100 – 150%Standard  FPL 150 – 200%Standard FPL 200 – 250%
Deductible$0$250$1,100
Max out of Pocket$1,000$2,200$6,500
PCP$10$15$30
Specialist$20$35$50
Prescription Drug**$6 / $15 / $30$9 / $20 / $40$10 / $35 / $70
Adult Dental / VisionNoNoNo
Pediatric Dental / VisionYesYesYes
Mail Order RXYesYesYes
Exercise Facility ReimbursementYesYesYes

 

* These charts are brief descriptions of benefits for plan.

** Prescription Drug: Generic / Formulary Brand / Non-Formulary Brand

◊Deductible must be met first before cost sharing begins. Family cost is multiplied by (2).

□FPL = Federal Poverty Level

2023 SilverPlus*

PRODUCTS3-1S3-2S3-3
Product TypeStandard / Child-Only  FPL 100-150%Standard / Child-Only  FPL 150-200%Standard / Child-Only  FPL 200-250%
Deductible$0$250$1,100
Max out of Pocket$1,000$2,200$6,500
PCP$10$15$30
Specialist$20$35$50
Prescription Drug**$6 / $15 / $30$9 / $20 / $40$10 / $35 / $70
Adult Dental / VisionNoNoNo
Pediatric Dental / VisionYesYesYes
Mail Order RXYesYesYes
Exercise Facility ReimbursementYesYesYes

 

* These charts are brief descriptions of benefits for plan.

** Prescription Drug: Generic / Formulary Brand / Non-Formulary Brand

◊ Deductible must be met first before cost sharing begins. Family cost is multiplied by (2).

□ FPL = Federal Poverty Level

Cost Sharing Reductions (CSR) Plans are available to people who have incomes between 100% and 250% of the Federal Poverty Level (FPL).

2022 Poverty Guidelines for 48 States and the District of Columbia (Excludes Alaska and Hawaii)

PERSONS IN FAMILY / HOUSEHOLD2021 POVERTY GUIDELINE
1$12,880 to $32,200
2$17,420 to $43,550
3$21,960 to $54,900
4$26,500 to $66,250
5$31,040 to $77,600
6$35,580 to $88,950
7$40,120 to $100,300
8$44,660 to $111,650

 

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.

How do I enroll?

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

Enroll online today. Or call us at 855-809-4073. A representative will contact you shortly to help you enroll.

View over a man's shoulder of the phone he is holding and the table he is sitting at with a computer, notebook, and coffee

Representative was very professional and helpful, showed empathy for my well being with no attitude …. Thank you….. 😊 👍👍

Betsy J.
Google Review

Plan Materials

Certificate of Coverage
(includes Contract, Schedule of Benefits, Summary of Benefits and Coverages)

"Off Exchange"

Individual Standard – SilverPlus S1

Individual Non-Standard – SilverPlus S2

Child-Only – SilverPlus S3

"Exchange"

Individual Standard – SilverPlus S1

Individual Standard – SilverPlus S1-1

Individual Standard – SilverPlus S1-2

Individual Standard – SilverPlus S1-3

Individual Non-Standard – SilverPlus S2

Individual Non-Standard – SilverPlus S2-1

Individual Non-Standard – SilverPlus S2-2

Individual Non-Standard – SilverPlus S2-3

Child-Only – SilverPlus S3

Child-Only – SilverPlus S3-1

Child-Only – SilverPlus S3-2

Child-Only – SilverPlus S3-3

American Indian Child-Only – SilverPlus S3-4

American Indian Standard – SilverPlus S5

American Indian Non-Standard – SilverPlus S6

Summary of Benefits

"Off Exchange"

Individual Non-Standard – SilverPlus S2

American Indian Child-Only – SilverPlus S3-4

American Indian Standard – SilverPlus S5

American Indian Non-Standard – SilverPlus S6

Contracts

"Off Exchange"

Individual Non-Standard – Age 26 – SilverPlus S2

Individual Non-Standard – Age 29 – SilverPlus S2

* Coming Soon

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.

Child-Only Plans offer benefits to members who are under the age of 21 at the beginning of the year.

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 SilverPlus plans

Important Update

Pharmacy Network Change

Starting January 1, 2022, Walgreens and Duane Reade will no longer be in the pharmacy network for members of these plans:

  • Medicaid Managed Care (including Partnership in Care and HARP Plans)
  • Child Health Plus
  • Exchange / MarketPlace Plans

Where can I find a list of participating network pharmacies?

Members can find a list of network pharmacies or use our online provider search tool.

What do I do if I get my medications from Walgreens or Duane Reade?

Members who have an ongoing prescription including medications, certain supplies such as pen needles, test strips, continuous glucose monitors, and blood glucose test strips at a Walgreens or Duane Reade should call their health care providers to get a new prescription to be sent to a different pharmacy.

Who can I call if I have questions?

If you have any questions, please call the CVS Caremark® Customer Care Team at 1-(855) 656-0361 for Medicaid Managed Care and Child Health Plus members or 1-(855) 383-9426 for Exchange Plan members.

View over a man's shoulder of the phone he is holding and the table he is sitting at with a computer, notebook, and coffee
MetroPlusHealth Virtual Visit

Access to your 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.

GREAT NEWS: STARTING JANUARY 1, 2023, METROPLUSHEALTH MEMBERS WILL RECEIVE THEIR DENTAL BENEFITS FROM DENTAQUEST.

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.

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.

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.

IMPORTANT INFORMATION: MONKEYPOX CASES ARE RISING IN NYC.

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

last updated: January 4, 2023

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