GoldPrime

GoldPrime

MetroPlus offers six different GoldPrime plans. Each plan adds additional levels of customization to fit your needs. All GoldPrime plans include *three Primary Care Physician (PCP) visits that are not subject to the deductible.

The plan has an individual deductible of $650 and a max out of pocket of $5,000 depending on eligibility. It also has a family deductible of $1,300 and a max out of pocket of $10,000 depending on eligibility.

This plan also has a Native American / American Indian plan with a $0 deductible and $0 max out of pocket for those that qualify.

Learn if you qualify

Our cost treatment calculator is intended for individuals who are uninsured or covered by private insurance. Cost estimates reflect health care professional fees and are not the negotiated rates which may be available through insurance plan networks. 

Calculate Costs

Access the NY State of Health Tax Credit and Premium Rate Estimator 

Check Eligibility 

Get The Details

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GoldPrime*
Product  GS1 GS2 GS3 GS5 (Adult) /
GS3-4 (Child) 
GS6
Product Type Standard Non-Standard Child-Only □ AI/NA-Standard □  AI/NA-Non-Standard
Premium $550.43 $557.26 $226.78 $0 $0
Deductible $650 $650 $650 $0 $0
Max out of Pocket $5,000 $5,000 $5,000 $0 $0
PCP $25 $25 $25 0% 0%
Specialist $40 $40 $40 0% 0%
Prescription Drug** $10/$40/$80 $$10/$40/$80 $10/$40/$80 0% 0%
Adult Dental/Vision No Yes No No Yes
Pediatric Dental / Vision Yes Yes Yes Yes Yes
Mail Order RX Yes Yes Yes Yes Yes
Exercise Facility Reimbursement Yes Yes Yes Yes Yes
 

* This chart is a brief description of benefits for plan.
** Prescription Drug: Generic / Formulary Brand / Non-Formulary Brand
 Deductible must be met first before cost sharing begins. Family cost is multiplied by (2).
□ AI / NA - American Indian / Native Alaskan 

 

Premiums listed are example base rates for individuals. Rates may differ based according to family size, income level, and eligibility for tax credits.


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Certificate of Coverage
  English Español
Individual Standard GoldPrime GS1 GoldPrime GS1
Individual Non-Standard GoldPrime GS2 GoldPrime GS2
Child-Only GoldPrime GS3 GoldPrime GS3
American Indian / Child-Only GoldPrime GS3-4 GoldPrime GS3-4
American Indian Standard GoldPrime GS5 GoldPrime GS5
American Indian Non-Standard GoldPrime GS6 GoldPrime GS6
 
*For all standard plans with three PCP visits not subject to the deductible, the cost sharing co-pay is still applicable to the first three visits. 

Child-Only Plans
offer benefits to members who are under the age of 21 at the beginning of the year.
Non-Standard Plans offer additional benefits not included on the Standard Plans and allows members to purchase Adult Vision and Dental coverage.
FPL or Federal Poverty Level is based on income and is used to determine cost assistance
CSR = Cost-sharing Reduction may lower out-of-pocket costs, based on income, for SilverPlus plans


For more information about Prime plans, click here.