MetroPlus Platinum Plan (HMO)
METROPLUS HEALTH PLAN, INC. · 2026 plan year
Plan ID H0423-004-000
HMO★ 4 CMS Stars
- MOOP (in-network)
- $9,250
- MOOP (combined)
- —
- Monthly premium
- $58.80/mo
- Part C $0 + Part D $58.80, before Extra Help
- Prescription drugs
- Included
This plan in 2027
Plan information
- Contract / Plan / Segment
- H0423-004-000
- Medical deductible
- $0 — no deductible
- Part D premium
- $58.80/mo (part of the monthly premium above)Before Extra Help, which can lower or remove it for people with limited income.
- Part D deductible
- $615/yr
- Also owed
- Your Medicare Part B premium, paid separately
More METROPLUS HEALTH PLAN, INC. plans in NY
Benefits & cost sharing
Hospital
| Benefit | In-network |
|---|---|
| Inpatient Hospital — Acute | $225/day for days 1–8, $0 after |
| Inpatient Hospital — Psychiatric | $195/day for days 1–8, $0 after |
Pharmacy
| Benefit | In-network |
|---|---|
| Part B Drugs | See plan details |
| Chemotherapy & Radiation Drugs (Part B) | 0%-20% coinsurance |
| Other Part B Drugs | 0%-20% coinsurance |
Mental Health
| Benefit | In-network |
|---|---|
| Mental Health Specialty Services | See plan details |
| Mental Health — Individual Sessions | $40 |
| Mental Health — Group Sessions | $40 |
Other
| Benefit | In-network |
|---|---|
| Other Health Care Professional Services | 20% coinsurance |
| Psychiatric Services — Individual Sessions | $40 |
| Physical Therapy & Speech-Language Pathology | $25 |
| Additional Telehealth Services (Part B) | No charge |
| Opioid Treatment Program Services | No charge |
| Diagnostic Tests & Lab Services | See plan details |
| Diagnostic Procedures & Tests | 20% coinsurance |
| Laboratory Services | 20% coinsurance |
| Radiological Services | See plan details |
| Diagnostic Radiology | 20% coinsurance |
| Therapeutic Radiology | 20% coinsurance |
| X-Ray Services | 20% coinsurance |
| Outpatient Hospital Services | 20% coinsurance |
| Hospital Observation Services | 20% coinsurance |
| Ambulatory Surgical Center (ASC) | $95 |
| Outpatient Substance Abuse Services | See plan details |
| Substance Abuse — Individual Sessions | $40 |
| Substance Abuse — Group Sessions | $40 |
| Outpatient Blood Services | No charge |
| Ambulance Services | See plan details |
| Ground Ambulance | $100 |
| Air Ambulance | $100 |
| Durable Medical Equipment (DME) | 20% coinsurance |
| Prosthetics & Orthotics | See plan details |
| Prosthetic Devices | 20% coinsurance |
| Medical Supplies | 20% coinsurance |
| Diabetic Supplies | 20% coinsurance |
| Diabetic Supplies & Services | See plan details |
| Diabetic Therapeutic Shoes & Inserts | 20% coinsurance |
| Dialysis Services | No charge |
| Medicare-Covered Preventive Services | See plan details |
| Kidney Disease Education Services | No charge |
| Glaucoma Screening | No charge |
| Diabetes Self-Management Training | No charge |
| Digital Rectal Exams | No charge |
| Welcome to Medicare EKG | No charge |
| Insulin (Part B) | $35 |
| Dental — Medicare-Covered Services | No charge |
| Vision — Eye Exams | No charge |
| Vision — Eyewear | No charge |
| Vision — Eyewear | See plan details |
| Vision — Contact Lenses | No charge |
| Vision — Eyeglasses (Lenses & Frames) | No charge |
| Vision — Eyeglass Lenses | No charge |
| Vision — Eyeglass Frames | No charge |
| Vision — Eyewear Upgrades | No charge |
| Hearing — Exams | $20 |
| Hearing — Routine Exams | $20 |
| Hearing — Fitting & Evaluation for Hearing Aid | $20 |
| Hearing — Prescription Hearing Aids | See plan details |
| Hearing — Hearing Aids (All Types) | No charge |
| Occupational Therapy Services | $25 |
| Skilled Nursing Facility (SNF) | Original Medicare cost sharing |
| Cardiac & Pulmonary Rehabilitation | See plan details |
| Cardiac Rehabilitation — Additional Sessions | No charge |
| Intensive Cardiac Rehabilitation — Additional Sessions | No charge |
| Pulmonary Rehabilitation — Additional Sessions | No charge |
| Supervised Exercise Therapy (SET) | No charge |
| Emergency Services | $100 |
| Urgently Needed Services | No charge |
| Partial Hospitalization Program | $40 |
| Intensive Outpatient Program (IOP) | $40 |
| Psychiatric Services | See plan details |
| Psychiatric Services — Group Sessions | $40 |
| Hearing — Exams | See plan details |
| Chiropractic Services | $15 |
| Physician Specialist Services | $40 |
| Podiatry Services | $30 |
| Home Health Services | No charge |
| Primary Care Physician Services | No charge |
Service area
- NY: 5 counties
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