SilverPlus Plans

SilverPlus

MetroPlus offers over a dozen different SilverPlus plans, including Small Business (SHOP) plans. Each plan adds additional levels of customization to fit your needs.

The plan has an individual deductible of $2,000 and a max out of pocket of $6,750 depending on eligibility. The family deductible ranging from $4,000 and a max out of pocket of $2,000 – $13,500 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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SilverPlus*
Product  S1 S2 S3 S5 (Adult) /
S3-4 (Child-Only)
S6
Product Type Standard Non-Standard Child-Only AI/NA-Standard □ AI/NA-Non-Standard
Premium $475.31 $481.20 $195.83 $0 $0
Deductible $2,000 $2,000 $2,000 $0 $0
Max out of Pocket $6,750 $6,750 $6,750 $0 $0
PCP $30 $30 $30 0% 0%
Specialist $50 $50 $50 0% 0%
Prescription Drug** $10/$35/$70 $10/$35/$70 $10/$35/$70 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 

 

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SilverPlus*
Product S1-1 S1-2 S1-3
Product Type Standard
 FPL
100-150%
Standard
 FPL
150-200%
Standard
 FPL
200-250%
Deductible $0 $300 $1,650
Max out of Pocket $1,000 $2,350 $5,700
PCP $10 $15 $30
Specialist $20 $35 $50
Prescription Drug** $6/$15/$30 $9/$20/$40 $10/$35/$70
Adult Dental/Vision No No No
Pediatric Dental / Vision Yes Yes Yes
Mail Order RX Yes Yes Yes
Exercise Facility Reimbursement 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). 
□ FPL = Federal Poverty Level

 

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SilverPlus*
Product S2-1 S2-2 S2-3
Product Type Non-Standard
 FPL
100-150%
Non-Standard
 FPL
150-200%
Non-Standard
 FPL
200-250%
Deductible $0 $300 $1,650
Max out of Pocket $1,000 $2,350 $5,700
PCP $10 $15 $30
Specialist $20 $35 $50
Prescription Drug** $6/$15/$30 $9/$20/$40 $10/$35/$70
Adult Dental/Vision Yes Yes Yes
Pediatric Dental / Vision Yes Yes Yes
Mail Order RX Yes Yes Yes
Exercise Facility Reimbursement 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). 
□ FPL = Federal Poverty Level 

 

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SilverPlus*
Product S3-1 S3-2 S3-3
Product Type Standard / Child-Only 
FPL
100-150%
Standard / Child-Only
 FPL
150-200%
Standard / Child-Only
 FPL
200-250%
Deductible $0 $300 $1,650
Max out of Pocket $1,000 $2,350 $5,700
PCP $10 $15 $30
Specialist $20 $35 $50
Prescription Drug** $6/$15/$30 $9/$20/$40 $10/$35/$70
Adult Dental/Vision No No No
Pediatric Dental / Vision Yes Yes Yes
Mail Order RX Yes Yes Yes
Exercise Facility Reimbursement 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).
□ FPL = Federal Poverty Level 


Cost Sharing Reductions (CSR) Plans are available to people who have incomes between 100% and 250% of the Federal Poverty Level (FPL).
The FPL rates for 2016 are:

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2016 Poverty Guidelines for 48 States and the District of Columbia
(Excludes Alaska and Hawaii)
 
Persons in Family / Household Poverty Guideline
1 $11,880 to $29,700
2 $16,020 to $40,050
3 $20,160 to $50,400
4 $24,300 to $60,750
5 $28,440 to $71,100
6 $32,580 to $81,450
7 $36,730 to $91,825
8 $40,890 to $102,225

These rates may change annually.

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
 
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