Understanding Metroplus Insurance: Private Or Public?

MetroPlus Health Plan is a prepaid health services plan and a wholly owned subsidiary of NYC Health + Hospitals. It offers a range of health insurance plans, including Medicaid, Essential Plan, Child Health Plus, and Medicare Advantage plans. MetroPlus also provides private plans through the NY State of Health (NYSOH) for over 670,000 members. As a not-for-profit organisation, it prioritises affordability and accessibility, and it is one of the largest managed care organisations in New York City.

MetroPlus Health Plan's COVID-19 enrollment trends

MetroPlus Health Plan is a prepaid health services plan and a wholly owned subsidiary of NYC Health + Hospitals (H+H). MetroPlus offers managed care health care services such as Medicaid, Child Health Plus (CHP), and Medicare Advantage plans to over 670,000 members.

During the COVID-19 pandemic, MetroPlus saw an increase in enrollment, reaching a record high of 670,915 members, an increase of 159,284 (31%) between February 2020 and June 2022. Nearly 70% of MetroPlus members are enrolled in the mainstream Medicaid managed care plan, which experienced the largest growth in membership. The Essential Plan, a subsidized basic health plan, experienced a 44% growth rate, the largest of all plans.

To address the needs of members with frequent hospital utilization, MetroPlus and H+H have established initiatives such as comprehensive care management services and a housing task force to provide affordable and supportive housing. MetroPlus also implemented an SMS messaging campaign to contact members at higher risk of severe illness during the pandemic and used Interactive Voice Response (IVR) for telehealth registration, resulting in 7,000 enrollees.

Despite these efforts, most MetroPlus members use healthcare providers other than H+H. To maximize revenues, H+H is working to attract more members to utilize its health services and engage in routine chronic care management. MetroPlus and H+H have entered a value-based payment (VBP) arrangement, where H+H takes on the medical risk for all covered services, even if provided outside the H+H system.

As the federal public health emergency winds down, MetroPlus is developing strategies to maintain enrollment growth, facilitate rapid reenrollment in Medicaid, and shift ineligible members to Essential Plan coverage.

MetroPlus Health Plan's impact on NYC Health + Hospitals

MetroPlus Health Plan is a prepaid health services plan and a wholly owned subsidiary of NYC Health + Hospitals. MetroPlus offers low-cost, quality health care for New Yorkers, including $0 premiums, deductibles, and co-insurance for those who qualify. The basic plan is even free for NYC workers and their families.

MetroPlus contracts with NYC Health + Hospitals and other providers to offer managed care health care services such as Medicaid, Essential Plan, Child Health Plus (CHP), and Medicare Advantage plans. It also provides plans for eligible New York City employees and daycare workers of city agencies, and private plans through NY State of Health (NYSOH), the state's online marketplace. As of June 2022, MetroPlus had over 670,000 members, with nearly 70% enrolled in the mainstream Medicaid managed care plan.

Changes in MetroPlus enrollment directly impact NYC Health + Hospitals' financial stability. As more members choose NYC Health + Hospitals as a provider, the hospital system generates more revenue, which is an explicit goal of its strategic plan. During the COVID-19 pandemic, MetroPlus enrollment reached a record high, with an increase of 159,284 members (31%) between February 2020 and June 2022. This growth was due in part to federal policies that allowed states to keep individuals enrolled in Medicaid, CHP, and the Essential Plan without requiring them to go through annual renewals.

To maximize revenues from MetroPlus, NYC Health + Hospitals is working to attract more members to utilize its health services and engage in routine chronic care management to avoid unnecessary high-cost utilization. They have also taken steps to ensure that members with frequent hospital utilization have access to comprehensive care management, including services that address medical, social, and behavioral health needs. For example, in 2017, MetroPlus and NYC Health + Hospitals established a housing task force to connect patients in need of affordable and supportive housing, resulting in over 300 MetroPlus members being housed.

Despite these efforts, the majority of MetroPlus members use healthcare providers other than NYC Health + Hospitals. To address this, NYC Health + Hospitals must continue to provide quality care and maintain efforts to improve patient satisfaction, such as keeping appointment wait times low, to continue attracting MetroPlus members. These efforts will enable them to work towards their goal of 45% of MetroPlus medical spending and successfully execute their strategic plan.

MetroPlus Insurance quotes and plans

MetroPlus Health Plan is a not-for-profit organisation that offers low-cost, quality health care insurance to New Yorkers. It was established in 1985 as part of NYC Health + Hospitals and has since expanded its services to include Medicare, Essential Plan, and Qualified Health Plan options.

MetroPlus Insurance Plans

MetroPlus Health Plan offers a range of insurance plans, including:

• Medicaid Managed Care: This plan is for New Yorkers who have or are eligible for Medicaid.
• Essential Plan: This plan is for individuals who are not eligible for Medicaid and do not have access to other health insurance. The basic plan is free for NYC workers and their families, with $0 premiums, deductibles, and co-insurance.
• Medicare and Dual-Eligible Plans: These plans are for individuals who are eligible for Medicare, which includes those turning 65 within the next three months or who are already 65 or older.
• Child Health Plus: This plan provides health coverage for children under 19 who are not eligible for Medicaid and do not have other health insurance.
• Special Needs and Long Term Care: These plans cater to individuals with special needs, including long-term care requirements.
• Partnership in Care (PIC) HIV - SNP: This plan is specifically designed for New Yorkers living with HIV/AIDS and other select groups.
• Enhanced (HARP) Plan: The HARP plan is for Medicaid recipients aged 21 or older who require additional resources for behavioural health.
• BronzePlus, SilverPlus, GoldPlus, PlatinumPlus: These plans offer varying levels of coverage and benefits, with Bronze typically offering the most basic coverage and Platinum providing the highest level of benefits.
• MedPlus: This plan likely offers essential medical coverage.
• MetroPlus Medicare Advantage Plan: This plan is tailored for individuals who are enrolled in Medicare and seek additional benefits or coverage.
• MetroPlus Gold: This plan may provide comprehensive benefits and coverage, as suggested by the term "Gold".
• MetroPlus Gold Care: This plan may be an extension of the MetroPlus Gold plan, offering additional benefits or specialised care.
• MetroPlus Health Ultracare (MAP): Ultracare suggests a higher level of coverage and benefits beyond standard health insurance.

MetroPlus Insurance Quotes

To obtain a MetroPlus insurance quote, individuals can visit the Vista Health Solutions website and enter their zip code. This will allow them to view all the MetroPlus insurance plans available in their area and compare them side by side. Alternatively, individuals can contact the MetroPlus Health Plan directly through their general contact information line at 800-303-9626 or visit their website for more information on specific plans and their benefits.

MetroPlus Health Plan's Special Programs

MetroPlus Health Plans Special Programs cater to a diverse range of healthcare needs in New York City. Here is a detailed overview of the special programs offered:

• Enhanced (HARP) Plan: This program is designed for Medicaid recipients aged 21 and above who require additional support for behavioural health issues. It provides enhanced resources and services to address mental and behavioural health concerns.
• Managed Long-Term Care (MLTC): The MLTC program serves Medicaid recipients who meet specific income, resource, age, or disability criteria. It offers comprehensive long-term care services, ensuring that eligible individuals receive the necessary support for their unique needs.
• Partnership in Care (PIC) HIV - SNP: This program is tailored to meet the healthcare needs of New Yorkers living with HIV/AIDS and other select groups. It provides specialised care and support to individuals facing the challenges associated with HIV/AIDS.
• Special Needs and Long Term Care: MetroPlus Health recognises that some individuals have complex behavioural health needs, and they offer plans to cater to these requirements. These plans ensure that individuals with behavioural health concerns can access the necessary care and support.
• Medicare and Dual-Eligible Plans: These plans are designed for individuals who are eligible for both Medicare and Medicaid. They provide integrated benefits that address the healthcare needs of individuals who qualify for multiple coverage programs.
• Individual and Family Plans: MetroPlus Health offers a range of plans for individuals and families, ensuring that everyone can access quality healthcare. These plans are tailored to meet the diverse needs of New Yorkers, including those who may not be eligible for other programs.
• Medicaid Managed Care: This program is specifically for New Yorkers who have or are eligible for Medicaid. It ensures that individuals can access the healthcare services they need through the Medicaid program.
• Plans for NYC Employees: MetroPlus Health also offers plans designed specifically for employees of New York City. These plans recognise the unique needs of city workers and provide tailored benefits to address their healthcare requirements.
• MetroPlus Platinum Plan: This is an HMO (Health Maintenance Organization) plan designed for Medicare beneficiaries. It offers a comprehensive range of benefits and services to individuals enrolled in the Medicare program.
• Medicaid Advantage Plus Plan: This program is tailored for individuals who are dual-eligible for both Medicare and full Medicaid. It combines the benefits of both programs to provide a comprehensive range of healthcare services.

MetroPlus Health Plan's history

MetroPlus Health Plans is a prepaid health services plan and a wholly owned subsidiary of NYC Health + Hospitals. It was established in 1985 to serve Medicaid recipients, and has since expanded to include Medicare, Essential Plan, and Qualified Health Plan options. MetroPlus Health Plans is a not-for-profit organisation, and, as such, affordability and accessibility are key priorities.

In the early 2000s, MetroPlus Health Plans experienced significant growth, with an expanded provider network and improved services. This growth continued through the COVID-19 pandemic, with an increase of 159,284 members (31%) between February 2020 and June 2022. As of June 2022, MetroPlus Health Plans has over 670,000 members, making it one of New York City's largest managed care organisations.

MetroPlus Health Plans offers a range of health insurance plans, including individual insurance, special needs, MLTC, HARP, and others. They also offer special programs, such as the Quality Management Program, Chronic Care Improvement Programs, and Utilization Management.

MetroPlus Health Plans has offered low-cost, quality healthcare for New Yorkers for over 35 years. They have a range of plans available, including individual and family plans, Medicare and Dual-Eligible Plans, and Special Needs and Long-Term Care plans. Members can access a range of services through the Member Portal, including finding doctors, specialists, and pharmacies, and viewing member benefits.

Frequently asked questions