MetroPlusHealth is also the only plan backed by NYC Health + Hospitals, the largest municipal health system in the U.S. Ready to enroll in a 2022 MetroPlusHealth Medicare plan? 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. Are you receiving care at an NYC Health + Hospitals facility? Members cancreate a new accountorsign into an existing account on their member portal and follow the instructions to request a hard copy directory. Low-cost plans for daycare workers in New York City. Depending on your level of Medicaid eligibility, you may pay as low as $0 for covered services. 1-866-693-4615 (TTY: 711), 24 hours a day, 7 days a week. You can use your rewards points to go shopping in theMetroPlusHealthRewards catalog. MetroPlusHealth is also the only plan backed by NYC Health + Hospitals, the largest municipal health system in the U.S. Ready to enroll in a 2022 MetroPlusHealth Medicare plan? MyChart is a free secure portal you can use to manage your health information. If you have any questions, please call Member Services at 1-866-986-0356 (TTY: 711), 24 hours a day, 7 days a week. For Medicaid recipients 21 or older who need additional resources for behavioral health. 50 Water Street, 7thFloor Visit, MetroPlusHealth Medicare Multi-Language Interpreter Services (, View the MetroPlusHealth Disaster Information Policy (. Find MetroPlusHealth offices, events, and local family care sites right near you. For more information and a list of medications, please visithere. MetroPlusHealth Plan has a contract with New York State Medicaid for MetroPlusHealth UltraCare (HMO-DSNP) and a Coordination of Benefits Agreement with the New York State Department of Health for the MetroPlus Advantage Plan (HMO-DNSP). When you join our Platinum plan, you will receive your traditional Medicare benefits, plus the extra benefits offered by MetroPlusHealth. MetroPlusHealth Virtual Visit is available anytime, from anywhere in New York State, 24/7 and in your language. If you want a Provider/Pharmacy Directory or Evidence of Coverage (EOC) mailed to you or if you need help finding a network provider/pharmacy, please call1-866-986-0356(TTY: 711). MetroPlusHealth has offered low-cost, quality health care for New Yorkers for more than 35 years. You or your family/caregiver or another person who helps you get medical services may contact MetroPlusHealth by phone. MetroPlus Health Plan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Check out our 2022 plans below. Menu. 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. Get inspired on our Blog, find answers to your questions in our FAQs, and explore our health library. Attn: Sales & Marketing Dept. METROPLUS HEALTH PLAN, INC. 2022 MEDICARE FORMULARY HPMS Approved Formulary File Submission ID: 00022265 , Version Number 1 6 H0423_MEM22_2609_C 0 823 2022 This formulary was updated on 0 9 /01/2022 METROPLUS ULTRACARE ( HMO-DSNP ) METROPLUS ADVANTAGE PLAN ( HMO-DSNP ) METROPLUS PLATINUM PLAN ( HMO ) H0423_MEM22_2609_C 08232022 09/01/2022 1 MetroPlusHealth members can access the Member Portal, find doctors, specialists, and pharmacies, and view member benefits. Find MetroPlusHealth offices, events, and local family care sites right near you. MetroPlus Health Plan 2022 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN 00022265, Version Number 13 This formulary was updated on 06/01/2022. MetroPlus Medicare Platinum Plan (HMO) is a plan designed for those Medicare beneficiaries who live in New York City and are eligible for Medicare Parts A and B. IMPORTANT NEWS: CULTURAL COMPETENCY TRAINING FOR OUR MEDICAID, PIC, AND HARP PROVIDERS Get inspired on our Blog, find answers to your questions in our FAQs, and explore our health library. In these cases, you shouldnt be charged more than your plans copayments, coinsurance and/or deductible. MetroPlus Health Plan has a contract with New York State Medicaid for MetroPlus UltraCare (HMO-DSNP) and a Coordination of Benefits Agreement with the New York State Department of Health for the MetroPlus Advantage Plan (HMO-DSNP). Our staff works with our Medicare members to ensure they have everything they need to manage their health and wellness. Find a plan that's right for you. MetroPlusHeath is proud to offer benefits and services that help you live a healthy life. Find MetroPlusHealth offices, events, and local family care sites right near you. MetroPlus Member Services: Monday through Saturday, 8 AM - 8 PM 1-800-303-9626, TTY: 711 For more information about Medicaid Managed Care, call New York Medicaid Choice at 1-800-505-5678. You can end your membership in the plan at any time. MetroPlusHealth Plan is an HMO, HMO SNP plan with a Medicare contract. Enrollment in MetroPlus Health Plan depends on contract renewal. Beginning January 1, 2022, as per CMS guidance, MetroPlusHealth will cover the COVID-19 Vaccine, approved boosters, along with its administration, without cost sharing for our Medicare and UltraCare (MAP) members. Or, you can contact Medicare at 1-800-Medicare or, Message your primary care providers office, Request refills of your prescription drugs. Message your primary care providers office. Live within the 5 boroughs of New York City, Have Medicare Part A, be enrolled in Medicare Part B, Need at least 120 days of Community Based Long-Term Care Services. Enter Your ZIP Code: Medicare Supplement FAQs Advertisement Add your drugs to see plans https://Q1Medicare.com/AddDrugs . Being healthy includes protecting your mental and emotional wellbeing, too. Best Available Evidence Think you might be eligible for one of our Essential Plan? A detailed explanation of your coverage, what we must do, your rights, and what you must do as a member of our plan. Effective March 22, 2022, prior authorization will not be required for medications used for the treatment of substance use disorder prescribed according to generally accepted national professional guidelines for the treatment of a substance use disorder. Fill out thisformand one of our representatives will reach out to you. We also pay for delivery-based services like Capsule and mail order medication through PillPack or CVS Pharmacy. 2022 Preferred Drug List PDL by Drug Class Effective 01/01/2022. March 31, 2022. please refer to the formulary to see which drugs are covered. This means you should not pay anything for your COVID-19 vaccines or booster shots starting January 1. Our representatives can enroll you by phone! PDF 681.91 KB - December 27, 2019. Contact Information. MetroPlusHealth 50 Water St, 7th Floor New York, NY 10004. MetroPlusHealth has offered low-cost, quality health care for New Yorkers for more than 35 years. To search providers based on your location, please explore our network directory: Want to know in advance what medications MetroPlusHealth will help pay for? Starting July 1, 2022, you can join a no-cost Medically Tailored Meals program that provides healthy meals straight to your home. Our representatives can enroll you by phone! For more recent information or other questions, please contact MetroPlus Health Plan Member Services at 1-866-986-0356 or, for TTY users, 711, 24 hours a day, 7 days a week, or visit www.metroplusmedicare.org. Click here for important information regarding protecting your identity and your Medicare card. If you have more questions, please call our Member Services team at1-866-986-0356(TTY: 711). Look it up in your plan formulary. See Plan information, Health Rewards, and Messages, Find someone in your neighborhood and in your language. Manage Your Health Online With MyChart. The Low Income Subsidy (LIS) Premium Table shows you what your monthly premium will be if you get Extra Help. Find a plan that's right for you. MyChart allows you to: For more information and to sign up go to nychealthandhospitals.org/mychart/. Prescriptions written outside of accepted guidelines may be subject to prior authorization. Join one of our Medicare plans, and in addition to your plan benefits, youll receive exclusive member extras. Part B Diabetes Monitoring Device and Supply Policy, Medicaid, SNP, HARP Nonenrolled Provider Override Guidance. To learn more, clickhereor call Medly at (929) 454-5090. MetroPlusHealth has offered low-cost, quality health care for New Yorkers for more than 35 years. 00022265, Version Number 8 This formulary was updated on01/01/2022. See Plan information, Health Rewards, and Messages, Find someone in your neighborhood and in your language. Enter Your ZIP Code: Medicare Supplement FAQs Advertisement Add your drugs to see plans https://Q1Medicare.com/AddDrugs Add your doctors to see plans The following resources are provided to assist those who are in need of more information about NYS Medicaid pharmacy benefits and Managed Care plans: Enrollment in Medicaid Managed Care is available at any local Department of Social Services. Enrollment in MetroPlusHealth Plan depends on contract renewal. Our 24/7 Customer Service Hotline will answer your call at other times and on holidays. 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. Find a plan that's right for you. MetroPlusHealth Virtual Visit is available anytime, from anywhere in New York State, 24/7 and in your language. Learn more. Ending your membership in MetroPlusHealth Medicare plans may be voluntary (your own choice) or involuntary (not your own choice). See Plan information, Health Rewards, and Messages, Find someone in your neighborhood and in your language. MyChart allows you to: Learn about all of the free preventive services for adults, women and children. . 1-866-986-0356 (TTY: 711). While I am incredibly grateful for my continual medicaid coverage through 2022 given federal mandate, quality general preventative care and mental health services on NYS medicaid feel virtually impossible to access, even if you've actually succeeded in making it to a scheduled appointment of any kind, services are abysmal. . The list includes: Medicare Part D drugs Some Medicaid covered prescription and over-the-counter drugs and items In general, we cover drugs if they are medically necessary. We are here Monday through Saturday from 8:00AM to 8:00PM. To learn more, click here or call Medly at (929) 454-5090. 2023 MetroPlus Advantage Plan (HMO D-SNP) in New York, New York Add your drugs to see plans Add doctors to see plans Medicare Supplements fill the gaps in your Original Medicare 1. For Medicaid recipients who meet certain income, resource, age, or disability requirements. Last updated - 4/26/2022 10:16:55 PM. Low Income Subsidy is available under the Medicare Part D prescription drug program. A formulary is a list of prescription drugs and therapies that an insurer has approved for its members. IMPORTANT NEWS for our Medicare & MAP Members: Beginning January 1, 2022, as per CMS guidance, MetroPlusHealth will cover the COVID-19 Vaccine, approved boosters, along with its administration,without cost sharingfor our Medicare and UltraCare (MAP)members. Find a MetroPlusHealth representative in-person or at a virtual location that suits you. MEDICATION ASSISTED TREATMENT (MAT) FORMULARY CHANGE NOTIFICATION FOR METROPLUSHEALTHMEDICAID MANAGED CARE, PARTNERSHIP IN CARE (PIC) HIV-SNP, AND ENHANCED (HARP) PLAN MEMBERS. If you are turning 65 within the next 3 months or you are 65 years of age or older, you may be entitled to additional medical benefits through the Medicare program. Medicare members can call us 24/7 at1-866-986-0356(TTY: 711). You can always access our online directory on ourProvider Directorypage or your EOC on the Get the Details page. Usually, you end your membership by enrolling in another plan. For information about your prescription drug benefits, please refer to the formulary to see which drugs are covered. 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. Looking to get your medications sent to you pre-packaged? *Medicare evaluates plans based on a 5-star rating system. MetroPlusHealth, New York City's high-quality and affordable health plan, today announced the start of the open enrollment period for its Gold Health Plan, exclusively for all New York City (NYC) employees, non-Medicare eligible retirees, their spouses or qualified domestic partners, and eligible dependents. The SBC shows you how you and the plan would share the cost for covered health care services. Explore MetroPlusCoverage thats right for you. Premiums and Benefits MetroPlus Advantage Plan (HMO -DSNP) What you should know Monthly Plan Premium You pay $0 or up to $42.40, depending Learn more about Monkeypox, including prevention and treatment,here. Medicaid Promoting Interoperability Program Rural Hospital Tax Credit State Directed Payment Programs X Providers Provider Types . Request a Hard Copy of Provider/Pharmacy Directory/Evidence of Coverage. PDL by Drug Name Effective 01/01/2022. H0423_MEM22_2597_M Accepted 09222021 MetroPlus Health Plan is a HMO, HMO SNP plan with a Medicare contract. 2501 Mail Service Center Raleigh, NC 27699-2501 NC Medicaid Contact Center Phone: 888-245-0179. MetroPlusHealth members can access the Member Portal, find doctors, specialists, and pharmacies, and view member benefits. Monday-Friday 8 a.m. to 5 p.m. MetroPlusHealth has partnered with Medly Pharmacy to offer these services and more! Want a pharmacy that you can text? For New Yorkers living with HIV/AIDS and other select groups. 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. Our MetroPlusUltraCare 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. MEDICARE ADVANTAGE | SEE IF YOU ARE ELIGIBLE, MEDICARE PLATINUM | SEE IF YOU ARE ELIGIBLE, Grievance, Coverage Determination and Appeals, Kings (Brooklyn) and Richmond (Staten Island), Kings (Brooklyn)/Richmond (Staten Island), For more information about Medicare or for assistance with Medicare issues,click. How do you end your membership in our plan? You can find the formularyin the Plan Benefits section below. This plan offers as low as a $0 monthly plan premium for those that receive Extra Help paying for their prescription drug premium. 2022 Information 2023 Information List of Drugs (Formulary) Our List of Drugs (Formulary) shows the drugs we cover. Download Acrobat Reader, a PDF viewer. $0 premiums for all who qualify, and no deductible, so it pays for your care right away. The plan covers most Medicare and Medicaid benefits, including long-term care or home and community-based services, plus Prescription Drug coverage. For more information about Child Health Plus and Medicaid, call New York Health Options at 1-800-541-2831. Please note that MetroPlusHealth may add or remove drugs from our Medicare formulary during the year. MetroPlusHealth Gold Plan Materials . You may be required to submit proof that you have applied for Medicare so please keep your award or denial letter from SSA or your online receipt from SSA. A summary of changes to your benefits and costs for the next year . MEDICATION ASSISTED TREATMENT (MAT) FORMULARY CHANGE NOTIFICATION FOR METROPLUSHEALTH MEDICAID MANAGED CARE, PARTNERSHIP IN CARE (PIC) HIV-SNP, AND ENHANCED (HARP) PLAN MEMBERS MetroPlusHealth has partnered with CVS Caremark to cover your prescription drugs. Star ratings are calculated each year and may change from one year to the next. Depending on your level of Extra Help, you may only have to pay a $0 copay for your prescription drugs. MetroPlus UltraCare (HMO-DSNP)is a Medicaid Advantage Plus plan designed for people who are dual eligible for Medicare and full Medicaid, live in New York City, and need long-term care services such as home care and personal care. Finding a pharmacy that is covered by MetroPlusHealth is easy. If you receive Extra Help from Medicare, your monthly plan premium will be lower. For children under 19 who are not eligible for Medicaid and have little or no health insurance. Get inspired on our Blog, find answers to your questions in our FAQs, and explore our health library. the 2022 Evidence of Coverage for MetroPlus Advantage Plan (HMODSNP). Clickhere to learn more. ATENCIN: si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. You will receive notice when changes thatmay impact you are made. 2022 Medicare Advantage Plan Benefit Details for the MetroPlus Platinum Plan (HMO) - H0423-004- Top Add your drugs to see plans Add doctors to see plans Medicare Supplements fill the gaps in your Original Medicare 1. Learn more about which Medicare plan works best for you by reviewing the plan information below. Or, want us to contact you? Metroplus, or . Just call us to let us know that you are interested in learning more about the plan. on our 2022 formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 2022 coverage year except as described above . Note to existing members: Thismulary for has changed since last year. Kings (Brooklyn)/Richmond (Staten Island). Call us at 1-855-809-4073 or contact us here. You will be transferred to the CVS Caremark site. 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. Just call1-800-303-9626(TTY:711). Find MetroPlusHealth offices, events, and local family care sites right near you. A summary of changes to your benefits and costs for the next year. low-cost health plan available to all New York City employees and others. IMPORTANT All fully completed Medicare Forms in grid above should be sent to: MetroPlus Health Plan MetroPlusHealth has offered low-cost, quality health care for New Yorkers for more than 35 years. Request refills of your prescription drugs. Talk To Us About Any Questions or Concerns. Your plan benefits page can explain in more detail. Llame al1.866.986.0356(TTY: 711). Call us at1-866-986-0356 (TTY: 711)now. MetroPlusHealth has offered low-cost, quality health care for New Yorkers for more than 35 years. A plan for New Yorkers who have or are eligible for Medicaid. Click below for formulary, prior authorization, step therapy criteria, mail order enrollment, and other Medicare Part D prescription drug benefits provided by Wellcare By Fidelis Care's Medicare and Dual Advantage plans. Clickhereto access your CVS Caremark account. Learn more about Monkeypox, including prevention and treatment,here. For more information, please call Member Services at 1-866-986-0356 (TTY: 711), 24 hours a day, 7 days a week. Talk To Us About Any Questions or Concerns. You may also request the directory or EOC by filling out ourContactform. PLEASE NOTE:CMS has new strategies to further help Medicare Part D plans prevent and combat opioid overuse, including additional safety alerts at the time of dispensing as a proactive step to engage both patients and prescribers about overdose risk and prevention. Interested in one? Call us at 1-866-986-0356 (TTY: 711) now. See Plan information, Health Rewards, and Messages, Find someone in your neighborhood and in your language. Or, want us to contact you? Just call1-800-303-9626(TTY:711). Our Member Services team is always here to help. Explore Qualified Health Plans (QHP) through the NY State of Health, The Official Health Plan Marketplace. Please call 1-866-986-0356 (TTY: 711). $0 premiums, deductibles, and co-insurance. Were here to help. We will generally cover anything listed in our formulary as long as the drug is medically necessary, the prescription is filled at a MetroPlusHealth network pharmacy, and other plan rules are followed. ATENCIN: si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. You can apply for Medicaid in any one of the following ways: Write, phone, or go to your local department of social services. MEDICATION ASSISTED TREATMENT (MAT) FORMULARY CHANGE NOTIFICATION FOR METROPLUSHEALTH MEDICAID MANAGED CARE, PARTNERSHIP IN CARE (PIC) HIV-SNP, AND ENHANCED (HARP) PLAN MEMBERS 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 get free preventive care like routine doctor exams and screenings to keep you healthy. PDL by Drug Class Effective 02/01/2022. MetroPlus Plans . Llame al 1-866-986-0356 (TTY: 711). Monkeypox cases are rising in NYC. If you are Medicare eligible and live in New York City, you may be eligible to join one of our plans. See Plan information, Health Rewards, and Messages, Find someone in your neighborhood and in your language. Share this page: Facebook; Twitter; Email; Back to top. Plus, there's no deductible, so the plan starts paying for your health care right away.

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