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MetroPlus UltraCare (HMO D-SNP)

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Our MetroPlus UltraCare Plan 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


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.

The Inflation Reduction Act (IRA): Changes to Your Drug Coverage

Effective 4/1/2023, coinsurance for certain Part B rebatable drugs will be reduced, if the drug’s price has increased at a rate faster than the rate of inflation.

Effective 7/1/2023, insulin covered under Part B (for example, insulin administered via a pump that qualifies as an item of durable medical equipment (DME)) will not exceed $35 total for a one month’s supply and the Medicare Part B deductible will not apply.

Important Message About What You Pay for Vaccines – Our plan covers most Part D vaccines at no cost to you, even if you haven’t paid your deductible. Call Member Services for more information.

Important Message About What You Pay for Insulin – You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible.

MetroPlusHealth Rewards Program

Register for the MetroPlus Member Rewards Program and earn rewards by keeping your health appointments and participating in wellness activities. Shop for healthy items you need with the rewards you earn!  Click here to see our member rewards program.

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 1-866-986-0356 (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 Conflict Free Evaluation and Enrollment Center (CFEEC) 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.

Plan Benefits

Medical Reimbursement Form 
Frequently Asked Questions
Gym Reimbursement

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

Plan Materials

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, 2023.

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”.

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 1-866-986-0356 (TTY: 711), 24 hours a day, 7 days a week.

MetroPlusHealth Plan is an HMO, HMO SNP plan with a Medicare contract. MetroPlusHealth Plan has a contract with New York State Medicaid for MetroPlusHealth 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-NSP). Enrollment in MetroPlusHealth Plan depends on contract renewal. MetroPlusHealth Plan 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 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_MKT23_2181_M Accepted 10012022

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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.

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.


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

last updated: October 1, 2022

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