MetroPlus Health Plan, Inc. is a prepaid health services plan that offers low or no-cost health insurance to eligible people living in Manhattan, Brooklyn, Queens and the Bronx through the following plans: Medicaid Managed Care, Child Health Plus, Family Health Plus, Medicaid HIV Special Needs Plan (SNP), Partnership in Care an HIV Special Needs Program through its network of participating providers. MetroPlus also offers MetroPlus Platinum Plan (HMO), a zero premium plan, for anyone eligible for Medicare; MetroPlus Advantage Plan (HMO SNP), for anyone who is eligible for Medicare and receives full or partial Medicaid benefits; MetroPlus Select Plan (HMO SNP), for anyone eligible for Medicare and receives full Medicaid benefits; and MetroPlus Medicare Partnership in Care Plan (HMO SNP), for people with HIV/AIDS eligible for Medicare with or without Medicaid. MetroPlus recently introduced MetroPlus Choice Plan (HMO) for anyone who is eligible for Medicare and already has creditable prescription drug coverage. MetroPlus offers MetroPlus Gold, a plan for New York City Health and Hospitals Corporation (HHC) employees, non-Medicare eligible retirees, their spouses or qualified domestic partners, and eligible dependents.
MetroPlus was rated the number one Medicaid Managed Care health plan in New York City for five out of the last six years based on indicators chosen by the New York State Department of Health (NYSDOH) and published in the Consumer’s Guide to Medicaid Managed Care in New York City. The 2010 guide, based in part on quality ratings submitted by the health plans and a NYSDOH member satisfaction survey, shows MetroPlus with a 82% percent overall rating, ranking it first among New York City’s eleven Medicaid Managed Care plans. The ratings are based on measures including plans’ preventive and well-care for adults and children, quality of care provided to members with illnesses and patient satisfaction with access and service. Currently MetroPlus has been ranked #1 in New York State based on Quality, Consumer Satisfaction Percentative Quality Indicators and Compliance.
MetroPlus emphasizes primary and preventive care. Benefits differ somewhat by program. Medicaid benefits include unlimited visits to a MetroPlus Primary Care Provider (PCP) chosen by the member; well-baby and well-child care; childhood immunizations; laboratory tests when ordered by the PCP; and maternity, including prenatal, delivery and post-partum care. Detailed benefit information is located at www.metroplus.org. Medicare benefits include all Original Medicare benefits (inpatient and outpatient hospital care as well as office-based services including preventive care), Prescription Drug Coverage (Part D) and added benefits that depend on the plan selected, such as routine podiatry visits, vision and hearing benefits. MetroPlus offers unlimited hospital care when prescribed by a MetroPlus provider and paperless referrals to specialists via the member’s PCP.
MetroPlus Care Management Programs help members with chronic conditions stay health and provide support to help them manage their illness. DiabetesCare and AsthmaPlus programs encourage members to partner with their PCPs to reduce complications from illnesses and lead healthier lives. MetroMom, a program for pregnant members, encourages early entry into prenatal care and offers members special privileges. Care Management is also available for members with SSI, Behavioral Health, Complex Medical or Transplant issues.
MetroPlus’ HIV SNP, Partnership in Care, has over 4,000 members, making it the largest HIV SNP in the U.S. Members select an HIV specialist as their PCP and benefit from care coordination by a team that assists with both medical and psychosocial issues including coordinating access to specialty providers and transportation to medical appointments. Partnership in Care can also coordinate linkages between the member and community-based organizations if the member has legal or housing issues.
MetroPlus Customer Services is available in 13 languages from Monday – Saturday, 8 am – 8 pm at 800-303-9626, TTY 800-881-2812 for the hearing impaired, and for calls after hours and during holidays, 800-442-2560. MetroPlus also has access to other languages through interpretation services. MetroPlus is committed to assuring access to quality comprehensive health care, health education and customer services to its culturally diverse membership.
Together with Plan providers, MetroPlus continually tries to improve member awareness of preventive services and assists members to receive these services. MetroPlus includes information on preventive care in its multilanguage member handbooks, also published in Braille. MetroPlus sends a quarterly newsletter to Medicaid, Child Health Plus and Family Health Plus members, published in six languages, and to MetroPlus Medicare members in English and Spanish. MetroPlus Gold members receive their own quarterly newsletter. The newsletters and other health information are available on the MetroPlus web site, www.metroplus.org. Members are encouraged to participate in developing MetroPlus policies and procedures through the Member Advisory Committee. MetroPlus has a Member Bill of Rights including information on advance directives, instructions about the care the member desires in the event that they are no longer able to make their own decisions.
The MetroPlus network includes over 12,000 PCP, specialist and other provider offices. In addition to hospital-based providers, MetroPlus members can also obtain primary and specialty care services at community-based doctor’s offices and neighborhood family care sites. Medicaid, Child Health Plus, Family Health Plus and MetroPlus Gold members can receive primary care and specialty services at HHC’s 11 hospitals and six Diagnostic & Treatment Centers, as well as from doctors at Lutheran Medical Center, Maimonides Medical Center, Peninsula Hospital and the hospitals of Continuum Health Partners, including Beth Israel Medical Center, St. Luke’s/Roosevelt Hospital and Long Island College Hospital. Specialty services are available at Mount Sinai Medical Center in Manhattan, Mount Sinai Hospital of Queens, NYU Medical Center-Tisch Center, NYU Medical Center-Rusk Institute, NYU Medical Center-Hospital for Joint Diseases, SUNY Downstate Medical Center and New York Eye and Ear Infirmary. MetroPlus Child Health Plus members and Gold members with the Prescription Drug Rider can obtain prescriptions at over 1600 pharmacies in the informedRx network.
MetroPlus Medicare members can also obtain primary and specialty care services at HHC facilities, community-based provider’s offices and from doctors at Lutheran Medical Center, Peninsula Medical Center and hospitals of Continuum Health Partners, including Beth Israel Medical Center, St. Luke’s/ Roosevelt Hospital, and Long Island College Hospital. Specialty services are also available at NYU Medical Center-Tisch Center, NYU Medical Center-Rusk Institute, NYU Medical Center-Hospital for Joint Diseases, SUNY Downstate Medical Center and New York Eye and Ear Infirmary. Medicare members can access their Part D pharmacy benefits at pharmacies in the informedRx network.
MetroPlus, which began operations in 1985, is certified under Section 4403-a of New York Public Health Law and is a wholly owned subsidiary of the New York City Health and Hospitals Corporation (HHC).
For more information, visit MetroPlus online at www.metroplus.org or call 800-475-6387.