Is Metroplus Medicaid or Medicare? Demystifying MetroPlus in 5 Simple Steps

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Navigating healthcare coverage options can be overwhelming, especially with terms like MetroPlus, Medicaid, and Medicare.

This article aims to clarify the differences and explain how MetroPlus works within these programs. It helps New Yorkers make informed decisions about their healthcare access.

Is Metroplus Medicaid or Medicare (1)
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Is Metroplus Medicaid or Medicare?

Firstly, it’s important to understand that MetroPlus is neither solely Medicaid nor Medicare. It functions as a Managed Care Organization (MCO), meaning it contracts with both government programs to offer health plans to eligible individuals.

So, can you have both MetroPlus and Medicaid/Medicare?

Absolutely! This dual eligibility opens up a wider range of coverage options:

  • MetroPlus Medicaid Managed Care: For those who qualify for Medicaid, this plan provides comprehensive health coverage at little or no cost, including doctor visits, hospital stays, prescriptions, and preventive care.

  • MetroPlus Medicare Plans: For individuals eligible for Medicare (typically 65 or older or with certain disabilities), MetroPlus offers various plans like MetroPlus Advantage and MetroPlus Platinum. These plans cover everything traditional Medicare does, plus additional benefits like vision, dental, and hearing coverage.

Understanding Medicare vs. Medicaid: Key Differences

While both programs provide healthcare coverage, they differ in eligibility, funding sources, and benefits:

Eligibility:

  • Medicare: Primarily for those 65 or older, certain disabled individuals, and people with End-Stage Renal Disease (ESRD).
  • Medicaid: Income-based program primarily serving low-income individuals and families, pregnant women, children, and people with disabilities.

Funding:

  • Medicare: Funded jointly by federal and state governments, with beneficiaries paying premiums and deductibles depending on the plan.
  • Medicaid: Funded primarily by the federal government with varying state contributions. Premiums and cost-sharing are minimal or absent.

Benefits:

  • Medicare: Covers hospital stays, doctor visits, preventive care, and some prescription drugs.
  • Medicaid: Covers a broader range of services beyond Medicare, including long-term care, dental, vision, and mental health services.

MetroPlus Plans Are Tailored For Diverse Needs

Within these programs, MetroPlus offers diverse plans catering to specific needs:

  • MetroPlus UltraCare (HMO D-SNP): This plan caters to individuals who are dually eligible for Medicare and full Medicaid and require long-term care services like home care or personal care assistance.
  • MetroPlus Advantage (HMO D-SNP): This plan provides all the benefits of Original Medicare, plus additional benefits like vision, dental, and transportation, specifically designed for those dually eligible for Medicare and Medicaid.
  • MetroPlus Platinum Plan (HMO): This plan targets individuals eligible for Medicare Parts A and B, offering comprehensive coverage with additional benefits like vision and dental.

Is Metroplus Medicaid or Medicare? Making the Right Choice

Selecting the appropriate plan depends on your individual circumstances. Consider:

  • Eligibility: Check your eligibility for both Medicaid and Medicare through their respective websites.
  • Needs: Identify your specific healthcare needs and preferred benefits.
  • Cost: Compare premiums, deductibles, and copays of different plans.

Benefits of Choosing Metroplus

MetroPlus doesn’t just offer one program; it acts as a bridge connecting people to both Medicare and Medicaid. It provides different benefits depending on your eligibility and chosen plan.

  1. Comprehensive Coverage
  • Medicaid Managed Care: Covers essential health services like doctor visits, hospital stays, prescriptions, preventive care, and long-term care services in specific plans.
  • Medicare Advantage Plans: These plans offer more than traditional Medicare, including vision, dental, hearing coverage, and transportation assistance for appointments.
  1. Additional Perks
  • Member Rewards Program: Earn rewards for healthy habits like attending preventive appointments, participating in wellness activities, and managing chronic conditions.
  • Telehealth: Get convenient virtual access to doctors and therapists from home.
  • 24/7 Support: MetroPlus offers 24/7 customer service and multilingual assistance.
  • Variety of Plans: With options like HMOs, PPOs, and SNP plans, you can find a plan that fits your needs and budget.
  • Focus on Preventative Care: MetroPlus emphasizes preventive care, offering screenings, vaccinations, and health education programs.
  1. Tailored Options for Different Needs
  • MetroPlus UltraCare: For individuals needing long-term care services under dual Medicare and Medicaid eligibility.
  • MetroPlus Advantage: For those seeking additional benefits beyond traditional Medicare.
  • MetroPlus Platinum Plan: Designed for individuals on Medicare Part A and B, offering comprehensive coverage with vision and dental benefits.
  1. Additional Considerations
  • Cost-Effectiveness: Depending on eligibility and plan choice, MetroPlus can offer significant cost savings compared to traditional Medicare or paying out-of-pocket.
  • Accessibility: MetroPlus has a vast network of providers throughout New York City for easy access to quality healthcare.
  • Community Resources: Partnerships with community organizations offer additional support services like nutrition counseling and transportation assistance.

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