MetroPlus Medicare Platinum Plan (HMO) provides all the benefits of Original Medicare PLUS:
- Monthly Plan Premium: You pay $226.20. (Members must continue to pay their Medicare Part B premium)
- Doctors Visits: You pay nothing.
- Specialist visits: You pay $40 co-pay per visit. (Prior authorization is required)
- Preventive Care: You pay nothing.
- Emergency Care: You pay 0% or 20% of the cost. (up to $75). Cost is waived if you are admitted within 3 days.
- Urgently Needed Services: You pay nothing.
To access more information about your prescription drug benefits click here:
CVS-Caremark - MetroPlus Prescription Drug Provider.
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Platinum Plan Summary of Benefits (SB)
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Platinum Plan Evidence of Coverage (EOC)
A detailed explanation of your coverage, what we must do, your rights, and what you must do as a member of our plan
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Platinum Plan Annual Notice of Change (ANOC)
A summary of changes to your benefits and costs for the next year. These changes take effect on January 1, 2016.
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.
|2017 Medicare Platinum Plan
|Level of Extra Help
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.