FAQs For Existing Members

MetroPlus Health Plan is the plan of choice for nearly half a million New Yorkers. Below are some frequently asked questions that will provide guidance on several topics around the NY State of Health and what you may need to reenroll for coverage.

Frequently Asked Questions:

When is the Open Enrollment Period?
  • November 1, 2016: Open Enrollment starts — first day you can enroll in a 2017 insurance plan through the Health Insurance Marketplace. Coverage can start as soon as January 1, 2017.
  • December 15, 2016: Last day to enroll in or change plans for new coverage to start January 1, 2017. January 1, 2017: 2017 coverage starts for those who enroll or change plans by December 15.
  • January 15, 2017: Last day to enroll in or change plans for new coverage to start February 1, 2017 January 31, 2017: 2017 Open Enrollment ends. Enrollments or changes between January 16 and January 31 take effect March 1, 2017.

Please note that if you don’t enroll in a 2017 health insurance plan by January 31, 2017, you must experience a qualifying life event and enroll during the Special Enrollment Period.
Can I change my plan if I am not satisfied with the health plan’s network?
Yes, if you are not satisfied with your current qualified health plan, you have the option to change plans during the Open Enrollment Period. If you want to switch plans after the Open Enrollment period, you will need to meet the qualifications of the Special Enrollment period.
 
Can I search for doctors, hospitals or facilities in the health plan’s network?
Yes, we have a comprehensive search tool. To find a doctor or a facility near you, visit our search page.
Can I still get health insurance if I am disabled or chronically ill?
Yes, you may still be eligible for health insurance if you have an illness, injury or disability that is expected to last for a minimum of 12 months that may prevent you from working for at least a year. The NY State of Health Marketplace, along with the Local Departments of Social Services, will aid you with the correct services you may need.  
How do I pay my health plan premium?
You can pay your premium several different ways - by phone, by mail, or online.
  • To make a secure online payment, remember to pay only with MetroPlus. Click here. All you need is your Account or Exchange Number AND your Invoice Number. 
  • To pay by mail, send your invoice stub and check to the address referenced on the invoice.
  • To pay over the phone, call Member Services at 1.800.809.4073. Representatives are available to take your payment from 8:30 am - 6 pm. 
Make sure to sign up for your free member account. You can pay online, easily update member information, and access account history. 
What if I have an appeal?
What is an appeal?
If you wish to have your eligibility determined by the Marketplace reviewed, you may submit a formal request, known as an appeal. Appeals can be requested for yourself or any member in your household who was also an applicant for health insurance in the Marketplace. Once an appeal has been requested, a hearing will be scheduled by the Marketplace. A hearing is where you will explain your disagreements with the Marketplace regarding health insurance.
 
Where do I go to appeal?
The Marketplace will not directly accept your appeals about health care services. Medicaid members can contact the Office of Administrative Hearings at www.otda.ny.gov/oah or call 1.800.342.3334. Child Health Plus members or those enrolled in a qualified health plan, contact your health plan 1.800.809.4073
 
Are there time limits to file an appeal request?
The time limit for requesting an appeal is 60 days. The Marketplace will review your appeal request once received and follow up with you to discuss the next steps.
 
What do I do if I no longer want to appeal?
It is possible for you to withdraw if you decide the appeal is no longer necessary. You can call the Marketplace at 1.855.355.5777 to find out more about the withdrawal process.
Where can I talk to a MetroPlus representative for more information about enrolling?
MetroPlus representatives can be found at our community events. To see a full listing of our events, visit the MetroPlus Events Page. You can also speak with a MetroPlus Marketplace Facilitated Enroller (FE) in person at one of the participating malls in Brooklyn or Queens.

Visit MetroPlus At The Mall to see times and locations.