MetroPlus Health Plan Medicaid

Confused about Medicaid? This simple guide shows seniors how to qualify, protect assets, and avoid costly mistakes.

MetroPlus Health Plan Medicaid: What It Is, Who Qualifies, and What It Covers

New York City’s Medicaid managed care plan explained for seniors and low-income residents

MetroPlus Health Plan is a Medicaid managed care plan serving New York City residents. It is one of the largest and oldest Medicaid health plans in New York, operated by NYC Health + Hospitals — the city’s public hospital system. MetroPlus serves low-income adults, seniors, children, and people with disabilities who qualify for New York Medicaid and choose MetroPlus as their health plan.

If you’ve come across MetroPlus and aren’t sure whether it’s Medicaid, Medicare, or private insurance — this guide explains exactly what it is, who qualifies, and what it covers.

Is MetroPlus Medicaid?

Yes. MetroPlus Health Plan is a Medicaid managed care organization (MCO) — meaning it is a private health plan that contracts with New York State to deliver Medicaid benefits to eligible members. You must first qualify for New York Medicaid, then choose MetroPlus as your plan.

MetroPlus is not Medicare and is not private insurance. It is entirely Medicaid-based, which means there is no premium cost for eligible members.

Where Does MetroPlus Operate?

MetroPlus serves New York City residents across all five boroughs — Manhattan, Brooklyn, Queens, the Bronx, and Staten Island. Its provider network is heavily concentrated in NYC, with particular strength in hospitals and clinics operated by NYC Health + Hospitals. If you live outside New York City, MetroPlus is generally not available and you would need to look at other New York Medicaid managed care plans.

Who Qualifies for MetroPlus Medicaid?

To enroll in MetroPlus, you must first be approved for New York Medicaid. Eligibility is based on income, household size, age, and other factors:

Note: Income limits are updated annually. Apply through NY State of Health or your local Department of Social Services to confirm current eligibility.

What Does MetroPlus Medicaid Cover?

MetroPlus covers the full range of New York Medicaid benefits, including:

• Primary and preventive care — doctor visits, annual physicals, vaccinations, screenings
• Specialist visits — referrals to cardiologists, neurologists, orthopedic doctors, and more
• Prescription medications — covered through the MetroPlus formulary
• Hospital care — inpatient stays, outpatient procedures, emergency services
• Mental health and substance use services — therapy, psychiatric care, addiction treatment
• Dental and vision — routine exams, cleanings, eyeglasses
• Long-term care — nursing home care, in-home personal care, and community-based services for eligible seniors
• Non-emergency medical transportation — rides to and from medical appointments
• Maternity and newborn care — prenatal visits, labor and delivery, postpartum care

MetroPlus for Seniors: Key Benefits

For seniors in New York City, MetroPlus offers several advantages tied to its connection with NYC Health + Hospitals:

• Access to NYC Health + Hospitals network — one of the largest public hospital systems in the country, with facilities throughout all five boroughs
• Care coordination — dedicated care managers help seniors manage appointments, medications, and referrals
• Chronic disease management — structured programs for diabetes, heart disease, asthma, and other conditions
• Dual eligibility — seniors on both Medicare and Medicaid can use MetroPlus as their Medicaid plan, with Medicare paying first and MetroPlus covering remaining costs

How to Enroll in MetroPlus Medicaid

You cannot enroll directly with MetroPlus — you must first be approved for New York Medicaid, then select MetroPlus as your plan:

1. Apply for Medicaid — through NY State of Health online, by phone at 1-855-355-5777, or at your local Department of Social Services office
2. Get approved — once your application is reviewed and approved, you will be prompted to choose a managed care plan
3. Choose MetroPlus — select MetroPlus Health Plan as your Medicaid managed care organization
4. Receive your member materials — MetroPlus will send a welcome packet with your member ID card, provider directory, and benefit information
5. Start using your benefits — find an in-network provider through the MetroPlus directory at metroplus.org

What This Means for New York City Residents

If you live in New York City and qualify for Medicaid, MetroPlus Health Plan is one of the strongest managed care options available — particularly for seniors and low-income adults who rely on NYC Health + Hospitals facilities. Coverage is comprehensive, there is no premium, and care coordination services are available to help members navigate complex health needs.

The first step is confirming your Medicaid eligibility through NY State of Health. Once approved, choosing MetroPlus gives you access to a wide network of providers across all five boroughs at no cost.

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