SilverPrime

SilverPrime

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

The plan has an individual deductible of $2,350 and a max out of pocket of $7,150 depending on eligibility. It also has a family deductible ranging of $4,700 and a max out of pocket of $14,300 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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SilverPrime*
Product  SS1 SS2 SS3 SS5 (Adult) /
SS3-4 (Child-Only)
SS6
Product Type Standard Non-Standard Child-Only AI/NA-Standard □ AI/NA-Non-Standard
Deductible $2,350 $2,350 $2,350 $0 $0
Max out of Pocket $7,150  $7,150  $7,150  $0 $0
PCP $35 $35 $35 0% 0%
Specialist $55 $55 $55 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 

 

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SilverPrime*
Product  SS1-1 SS1-2 SS1-3
Product Type Standard
 FPL
100-150%
Standard
 FPL
150-200%
Standard
 FPL
200-250%
Deductible $0 $400 $2,000
Max out of Pocket $1,000 $2,000 $5,700
PCP $10 $15 $35
Specialist $20 $35 $55
Prescription Drug** $6/$15/$30 $9/$20/$40 $10/$40/$80
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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SilverPrime*
Product  SS2-1 SS2-2 SS2-3
Product Type Non-Standard
 FPL
100-150%
Non-Standard
 FPL
150-200%
Non-Standard
 FPL
200-250%
Deductible $0 $400 $2,000
Max out of Pocket $1,000 $2,000 $5,700
PCP $10 $15 $35
Specialist $20 $35 $55
Prescription Drug** $6/$15/$30 $9/$20/$40 $10/$40/$80
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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SilverPrime*
Product  SS3-1 SS3-2 SS3-3
Product Type Standard / Child-Only 
FPL
100-150%
Standard / Child-Only
 FPL
150-200%
Standard / Child-Only
 FPL
200-250%
Deductible $0 $400 $2,000
Max out of Pocket $1,000 $2,000 $5,700
PCP $10 $15 $35
Specialist $20 $35 $55
Prescription Drug** $6/$15/$30 $9/$20/$40 $10/$40/$80
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 - Household of 1 = $11,490, Household of 4 = $23,550

 
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
 
*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.