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MetroPlus UltraCare (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MetroPlus UltraCare (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MetroPlus UltraCare (HMO D-SNP) in 2026, please refer to our full plan details page.
MetroPlus UltraCare (HMO D-SNP) is a HMO D-SNP plan offered by New York City Health and Hospitals Corporation available for enrollment in 2025 to people living in NYC - All five boroughs. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that MetroPlus UltraCare (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
MetroPlus UltraCare (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about MetroPlus UltraCare (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For MetroPlus UltraCare (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $58.80. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The MetroPlus UltraCare (HMO D-SNP) Medicare plan features an annual prescription drug deductible of $615. This deductible represents the out-of-pocket amount you must pay for your prescription medications before the plan's drug coverage begins to pay. Specific drug tier details, such as copays and coinsurance rates for generic or brand-name drugs, are currently unavailable for this plan. To determine your exact prescription costs, you should consult the MetroPlus UltraCare (HMO D-SNP) comprehensive formulary or contact the plan provider.
Additional Benefits
The MetroPlus UltraCare (HMO D-SNP) provides comprehensive healthcare coverage with no copays for most primary care, outpatient, and inpatient hospital services. While many of these medical services, including emergency care and diagnostic tests, require a standard 20% coinsurance, essential services like home health care and annual physicals are covered with no copay and no coinsurance. This plan ensures predictable out-of-pocket costs for core medical needs. In addition to medical care, the plan offers robust supplemental benefits such as preventive and comprehensive dental care with no copay and no coinsurance. Members also benefit from eyewear and prescription hearing aids up to $500 annually with no copay, as well as unlimited public transportation to approved health-related locations. Additional perks like acupuncture, over-the-counter item reimbursements, and chronic illness meals are also provided with no copay and no coinsurance.
Inpatient Hospital See details
MetroPlus UltraCare (HMO D-SNP) partially covers inpatient hospital services, requiring prior authorization for acute and psychiatric stays with Medicare-defined cost sharing, no copay, and no coinsurance. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
MetroPlus UltraCare (HMO D-SNP) covers outpatient services with no copays, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services. Referrals are required for ambulatory surgical center and outpatient blood services.
Partial Hospitalization See details
MetroPlus UltraCare (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive this benefit.
Ambulance and Transportation Services See details
MetroPlus UltraCare (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, requiring prior authorization. Transportation services are partially covered, offering unlimited one-way bus or subway trips to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
MetroPlus UltraCare (HMO D-SNP) covers emergency services with a 20% coinsurance (up to $115 per visit) and no copay, and urgently needed services with a 20% coinsurance (up to $40 per visit) and no copay. Worldwide emergency services are partially covered with no copay and no coinsurance, though worldwide urgent care and worldwide emergency transportation are not covered.
Primary Care See details
MetroPlus UltraCare (HMO D-SNP) covers primary care, specialist, therapy, mental health, and telehealth services with no copay and a 20% coinsurance. Chiropractic services are partially covered under this plan, with routine care covered but other chiropractic services not covered.
Preventive Services See details
MetroPlus UltraCare (HMO D-SNP) covers preventive services, offering annual physical exams with no copay and no coinsurance, while kidney disease education, glaucoma screenings, diabetes self-management, digital rectal exams, and post-welcome visit EKGs require a 20% coinsurance and no copay. Additional preventive benefits are partially covered with no copay and no coinsurance for PERS, home safety devices, a fitness benefit, and nutritional visits, but do not cover health education, in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, massage, adult day health, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, or counseling.
Hearing Services See details
Hearing services are partially covered by MetroPlus UltraCare (HMO D-SNP), featuring diagnostic hearing exams and prescription hearing aids up to $500 annually with no copays and no coinsurance. However, routine hearing exams, fitting and evaluation for hearing aids, OTC hearing aids, and inner ear, outer ear, or over the ear prescription hearing aids are not covered.
Vision Services See details
MetroPlus UltraCare (HMO D-SNP) partially covers vision services, providing eyewear with no copay and no coinsurance, except for contact lenses which require a 20% coinsurance, up to a $500 yearly limit. Eye exams, including routine and other eye exam services, are not covered by this plan, and a referral is required for eyewear benefits.
Dental Services See details
Dental services are covered by MetroPlus UltraCare (HMO D-SNP), which offers Medicare-covered dental care with no copay and a 20% coinsurance. Other preventive and comprehensive dental services, including exams, cleanings, and orthodontics, are covered with no copay and no coinsurance, though prior authorization is required.
Home Infusion bundled Services See details
Home infusion bundled services are covered by MetroPlus UltraCare (HMO D-SNP) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy and other drugs carry a coinsurance of 0% to 20%, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by MetroPlus UltraCare (HMO D-SNP) with no copay and a 20% coinsurance, though a referral is required to receive care.
Medical Equipment See details
MetroPlus UltraCare (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
MetroPlus UltraCare (HMO D-SNP) covers diagnostic and radiological services with no copay and a 20% coinsurance. These services, which include diagnostic procedures, lab tests, x-rays, and therapeutic radiological services, require a referral, and radiological services also require prior authorization.
Home Health Services See details
Home health services are covered by MetroPlus UltraCare (HMO D-SNP) with no copay and no coinsurance. Prior authorization and a referral are required to receive this benefit.
Cardiac Rehabilitation Services See details
MetroPlus UltraCare (HMO D-SNP) offers some covered cardiac rehabilitation services with no copay, but standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by MetroPlus UltraCare (HMO D-SNP) with no coinsurance and Medicare-defined copays, as additional days beyond the Medicare-covered limit are not covered. Prior authorization and a three-day prior inpatient hospital stay are required for SNF admission.
Other Services See details
Other services are partially covered by MetroPlus UltraCare (HMO D-SNP) with no copay and no coinsurance, as highly integrated dual-eligible SNP services and certain over-the-counter items like naloxone are not covered. Covered benefits under this category include up to 20 acupuncture visits per year with prior authorization, chronic illness meal benefits, and over-the-counter item reimbursements.
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