MetroPlus is a Medicaid plan, not Medicare

MetroPlus Health Plan is a managed Medicaid insurance company. It is not Medicare. If you are looking at MetroPlus because you turned 65 or became may be able to access for Medicare, you may be confusing the two programs — they are separate, and MetroPlus does not serve Medicare beneficiaries.

MetroPlus operates in New York State only. It manages health coverage for people who meet Medicaid income and may be able to access rules set by New York. The company contracts with the state to deliver Medicaid benefits, but it is not a government agency itself — it is a private insurance company that administers the Medicaid program on the state's behalf.

If you are already on MetroPlus Medicaid and you turn 65, your coverage will end on the day you become Medicare-may be able to access. You will then need to enroll in Medicare Part A and Part B through Social Security, and you may also choose a Medicare Advantage plan or a Medigap supplemental policy. MetroPlus does not bridge that transition.

Key Takeaways

  • MetroPlus is a Medicaid managed care plan available only in New York State, not a Medicare plan.
  • Medicaid and Medicare are two separate federal programs with different income limits, age requirements, and covered services.
  • If you turn 65 while on MetroPlus Medicaid, your Medicaid coverage ends and you must enroll in Medicare through Social Security.
  • Some people over 65 can have both Medicare and Medicaid at the same time, but MetroPlus does not offer a dual-may be able to access plan in New York.

How Medicaid and Medicare are different

Medicaid is a joint federal and state program that covers people based on income and household size. There is no age requirement — children, working-age adults, and seniors can all be on Medicaid if they meet the income threshold. In New York, MetroPlus is one of several Medicaid managed care companies you can choose from.

Medicare is a federal program for people 65 and older, regardless of income. You become may be able to access on the first day of the month you turn 65. Some younger people with disabilities or end-stage renal disease also may have access to for Medicare, but MetroPlus does not serve those groups either.

The two programs cover different services and have different cost structures. Medicaid in New York covers doctor visits, hospital care, prescription drugs, and long-term care services. Medicare Part A covers hospital stays and some skilled nursing care; Part B covers doctor visits and outpatient services; Part D covers prescription drugs. Neither program is "better" — they are designed for different populations.

What happens to your MetroPlus coverage at age 65

When you turn 65, your MetroPlus Medicaid plan ends automatically. You do not need to cancel it yourself. On your 65th birthday month, you become may be able to access for Medicare, and that is when your Medicaid coverage stops.

Before that date arrives, you should contact Social Security to enroll in Medicare Part A and Part B. You can do this online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office. If you do not enroll within three months of turning 65, you may face a permanent penalty on your Part B premiums.

After you enroll in Medicare, you can then choose a Medicare Advantage plan (Part C) or a Medigap supplemental policy to cover costs that Original Medicare does not pay. MetroPlus does not offer either of these products in New York, so you will be switching to a different insurance company.

If you are under 65 and looking for coverage

If you are not yet 65 and you live in New York, you may be able to join MetroPlus Medicaid if your household income is below the state limit. In 2024, New York covers adults earning up to 138 percent of the federal poverty level, though this varies by household size and family composition. You can check whether you may be covered by contacting the New York State Department of Health or by calling 211 for a local referral.

MetroPlus also serves children and pregnant people under Medicaid. If you are explore on behalf of a family member, the income rules and covered services differ by age and category. The MetroPlus website (metroplus.org) has enrollment information, or you can call their member services line to ask about coverage for your situation.

If you are already on Medicare and considering MetroPlus

If you are 65 or older and on Medicare, you cannot enroll in MetroPlus Medicaid unless you also meet Medicaid's income requirement. Some people may have access to for both programs at the same time — these are called dual-may be able to access beneficiaries. However, MetroPlus does not currently offer a plan specifically designed for dual-may be able to access seniors in New York.

If you are on Medicare and have a low income, you may be able to join a different Medicaid managed care plan in New York that does serve dual-may be able to access people. You can also look into Medicare Savings Programs, which are state-run programs that help pay your Medicare premiums and cost-sharing. Call 211 or the New York State Department of Health to learn which programs you may be able to join.

How to find the right coverage for your situation

The easiest way to understand which program you belong in is to start with your age. If you are under 65, you may be on Medicaid (including MetroPlus). If you are 65 or older, you are on Medicare. If you are both 65 and have a very low income, you might have both at the same time, but MetroPlus is not the plan for that situation in New York.

If you are unsure whether you are on Medicaid or Medicare, check your insurance card. It will say "Medicaid" or "Medicare" at the top. If you have a MetroPlus card, it is Medicaid. If you have a card from Social Security or a Medicare Advantage company, it is Medicare.

If you need help figuring out which program fits your situation, call 211 (available in all of New York) or contact the New York State Department of Health directly. They can tell you what you may be covered under based on your age and income, and they can point you toward enrollment.

Frequently Asked Questions

Can I stay on MetroPlus after I turn 65?

No. Your MetroPlus Medicaid coverage ends when you turn 65 and become Medicare-may be able to access. You must then enroll in Medicare Part A and Part B through Social Security. You cannot hold both MetroPlus and Medicare at the same time in New York.

Is MetroPlus the same as Medicare Advantage?

No. MetroPlus is a Medicaid plan for people under 65 with low income. Medicare Advantage is a Medicare plan for people 65 and older. They are different programs run by different companies. MetroPlus does not offer a Medicare Advantage product.

What if I am 65 and have a low income — can I get MetroPlus?

No, because you are Medicare-may be able to access. However, you may be able to join a different Medicaid managed care plan in New York that serves dual-may be able to access seniors, or you may be covered by a Medicare Savings Program. Call 211 to find out which programs you may be able to join.

How do I know if I am on Medicaid or Medicare?

Check your insurance card. It will clearly say "Medicaid" or "Medicare" at the top. If you have a MetroPlus card, you are on Medicaid. If you are unsure, call the number on your card and ask a representative.

What should I do before my MetroPlus coverage ends at 65?

Contact Social Security at least one month before your 65th birthday to enroll in Medicare Part A and Part B. You can enroll online at ssa.gov, by phone at 1-800-772-1213, or in person at your local office. Enrolling on time helps you avoid a permanent penalty on your Part B premium.