Medicare Platinum Plan 2019


MetroPlus Medicare Platinum Plan (HMO) provides all the benefits of Original Medicare PLUS

To be eligible for MetroPlus Medicare Platinum Plan (HMO), you must be eligible for Medicare Parts A and B; reside in the Bronx, Brooklyn, Manhattan, Staten Island, or Queens; and not have End-Stage Renal Disease (ESRD). 

MetroPlus Medicare Platinum Plan (HMO) provides all the benefits of Original Medicare PLUS:
  • Monthly Plan Premium: You pay $253.50. (Members must continue to pay their Medicare Part B premium) 
  • Doctors Visits: You pay nothing.
  • Specialist visits: You pay $40 co-pay per visit. 
  • Preventive Care: You pay nothing.
  • Emergency Care: $75 co-pay. Cost is waived if you are admitted within 3 days.
  • Urgently Needed Services: You pay nothing.
New for MetroPlus Medicare members! Multiple medications pre-packaged for free. Available through PillPack or CVS Pharmacy. Learn more! 

To access more information about your prescription drug benefits click here:

CVS-Caremark - MetroPlus Prescription Drug Provider.

You will be transferred to the CVS Caremark site. Use the information on your Medicare Member ID card to register. Follow the step by step instructions located on the site.

Platinum Plan Summary of Benefits (SB)
English Español 中文 


Platinum Plan Evidence of Coverage (EOC)
English Español 中文 

A detailed explanation of your coverage, what we must do, your rights, and what you must do as a member of our plan

Updated Quality Improvement Organization Contact Information
English Español 中文 

Updated contact information for Livanta, New York's Quality Improvement Organization.

Platinum Plan Annual Notice of Change (ANOC)
English Español 中文 

A summary of changes to your benefits and costs for the next year. These changes take effect on January 1, 2019.


Low Income Subsidy

Low Income Subsidy is available under the Medicare Part D prescription drug program. If you receive extra help from Medicare, your monthly plan premium will be lower. Eligible beneficiaries who have limited income may qualify for a government program that helps pay for Medicare Part D prescription drug costs. The table below shows you what your monthly plan premium will be if you get extra help. 
2019 Medicare Platinum Plan
Level of Extra Help Part C Part D Part C+D
100% $187.60 $26.60 $214.20
75% $187.60 $36.40 $224.00
50% $187.60 $46.20 $233.80
25% $187.60 $56.10 $243.70
0% $187.60 $65.90 $253.50

Download Low Income Subsidy Chart

* This does not include any Medicare Part B premium you may have to pay. This premium includes coverage for both medical services and prescription drug coverage.

Check Your Medicare Eligibility  

Rights and Responsibilities Upon Disenrollment

Ending your membership in MetroPlus 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, 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 EOC.
If you have any questions, please call Member Services.
You must continue to pay your Medicare Part B premium. If you qualify for 100% LIS, you will be eligible for a $0 monthly plan premium, no deductible on Medicare Part D, and lower copays for prescription drugs. Premiums, copays, coinsurance, and deductibles may vary based on the level of help that beneficiaries may receive; beneficiaries should contact the plan for further details. You must use contracted network pharmacies to access your prescription drug benefit under non-routine circumstances, in which case, quantity limitations and restrictions may apply.
MetroPlus Health Plan is an HMO plan with a Medicare contract and a Coordination of Benefits Agreement with the New York State Department. Enrollment in MetroPlus Health Plan depends on contract renewal. MetroPlus Healh 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1-866-305-0408 (TTY:711).
Email Us to Enroll Now