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October 27, 2025 • 15 mins
Metro Plus Health is a not-for-profit insurance plan based in NYC, serving over 700,000 New Yorkers at over 34,000 sites across the five boroughs. Roger Milliner, Chief Growth Officer at MetroPlus Health, talks about their role in the health insurance landscape, options during the Medicare open enrollment period and explains upcoming Medicare health care changes.
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Episode Transcript

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Speaker 1 (00:01):
Welcome to Get Connected with Nina del Rio, a weekly
conversation about fitness, health and happenings in our community on
one oh six point seven Light FM.

Speaker 2 (00:12):
Thanks for listening to Get Connected. Well, we know there
are changes happening with healthcare. We will take the next
few minutes to get to know more about metro Plus Health,
a not for profit insurance plan based in New York
since nineteen eighty five. We'll talk about their role in
the health insurance landscape, how they work for New Yorkers,
and of course details on Medicare health changes. Our guest

(00:33):
is Roger Milliner, chief Growth Officer at Metroplus Health. Roger Milliner,
thank you for being on Get Connected.

Speaker 3 (00:40):
Oh good morning. Thank you for having me.

Speaker 2 (00:42):
You can find out more about metro Plus at metroplus
dot org. If you've been in New York City a while,
you've probably seen the ads at least so you're probably
familiar with the name Metroplus health plan. But let's find
out more so what is metro Plus Health?

Speaker 3 (00:56):
Roger Milliner, So, Metroplus is a health insurance company. We've
been in business since nineteen eighty five. We serve about
seven hundred thousand members. And what's unique about us is
that we are a subsidiary of the New York City
Health Plus Hospital System, the largest municipal hospital system in
the country. We're focused right here for New Yorkers, and

(01:18):
we're not for profit organization. We believe in people, not profits,
so we're very local and we specialize in government sponsor
programs everything from Medicaid managed care to child health plus
the Essential Plan where a huge health plan on the
New York State Affordable Care Act the ACAIGHT and we
also offer some specialized programs people with disabilities, HIV. So

(01:41):
we have a lot of different government sponsor programs and
we also have some products for city employees. We have
products for people with Medicare or Medicaid, so there's many
options for people to choose from that Metroplus.

Speaker 2 (01:54):
So you have, as you mentioned, seven hundred thousand members,
who is eligible and who is eligible for the Medicare programs.

Speaker 3 (02:00):
So specifically, for people eligible for our Medicare program, it's
typically someone who is either age sixty five and over
and they have Medicare, but they can also have Medicaid.
We call them dual eligibles. So some people they qualify
for medical care because of their age and or disability,

(02:20):
but they may also get Medicaid because of their income.
So usually someone with a lower income will also qualify
for Medicaid, So you can have Medicare and Medicaid together,
and that's called someone who's dual eligible. We also have
a product for people who just have Medicare by itself.
They're not eligible for the Medicaid conportion portion because their

(02:40):
income is higher, so they just have Medicare because they
met the age requirement being sixty five or over, or
they have a disability. And then we have a third
product for people who have Medicare but they need long
term care services, meaning they'll need care for more than
one hundred and twenty days, and typically that's in home
carene institutionalized hospital based care. They're living safely in their home,

(03:05):
but they may need a home health attendant or something
like that for care for more than one hundred and
twenty days, and that's our ultra care program.

Speaker 2 (03:12):
I wonder if you could drill down just a little
bit on again what it means to be a not
for profit health insurance plan. Where does that sort of
place you in the healthcare landscape is compared to a
national brand for instance.

Speaker 3 (03:25):
Well, good, good question. So, being a not for profit,
all of the revenue that we generate that comes from
the government, whether it be the state or the federal government.
Once that money comes into Metroplus, we then take it
and we distribute payments to all of our providers, all
of the doctors, the hospitals, the specialists that care for

(03:47):
our members. So you have to pay that out. That's
our administrative course, excuse me, our medical costs. Then we
have administrative courts to run the plan. We have to
pay salaries, and we have to pay rent and all
the different things that make up your administrative course. And
then the remaining money is the profit. That profit goes
back to our owner hospital system, the New York City

(04:10):
Health and Hospital System, to care for people that come
through their system for cares. So we only use about
twelve percent of the revenue that we generate to run
the plan, and the rest goes back to our owner
hospital system, so that New York City has a thriving
public hospital system.

Speaker 2 (04:26):
Here in New York, you are a subsidiary of the
New York Hospital System. Can you describe then the network
in terms of service areas and hospitals and urgent care centers, etc.

Speaker 3 (04:36):
Right, So, the New York City Health Plus hospital system
is made up of eleven acute hospitals here in New
York City and the five boroughs. In addition to the
eleven acute hospitals, they also run close around forty smaller
off sites. We might call them the Gotham sites or

(04:56):
FQHC sites, etc. But they have about forty sites that
are for child and family services that are not a hospital,
and then they have a number of other programs. They
run a home care division, they run a plan like Metroplus.
So it's a huge hospital system that serves over a
million people locally here in New York on an annual basis.

(05:18):
Between they are acute hospitals, they are smaller off sites
that are Article forty Article twenty eight facilities. They run
a health plan, they run a home care agency, and
a bunch of other type of services. So it's a
huge system serving, like I said, over a million people annually.

Speaker 2 (05:34):
Our guest is Roger Milliner. He's currently the chief Growth
Officer at Metroplus Health Plan and is a key member
of the executive C suite team. Mister Milliner, a Brooklyn native,
began his career at metroplus Health in February nineteen ninety.
You're listening to get connected on one oh six point
seven light FM. I'm Na del Rio and you can
find out more about metroplus Health at metroplus dot org.

(05:56):
And the topic of the day for so many people
are the changes in healthcare. First of all, the Medicare
annual enrollment period begins now through twelve seven.

Speaker 3 (06:04):
Who's eligible So, as I said earlier, if you are
a Medicare recipient because you've turned sixty five or you
will become sixty five in the next three months, you're
eligible to join. If you are Medicare recipient under the
age of sixty five because you receive Medicare due to
a disability, you're also able to join. If you're a

(06:28):
Medicare recipient who not only has Medicare because you reach
the age and the disability and or the disability and
you also have Medicaid, you're eligible to join. If you're
a Medicare recipient who needs long term care services, you
can join. So Medicare qualifications is usually because of age

(06:49):
and disability. Medicaid qualifications is income based, so typically if
someone is earning roughly around fifteen thousand dollars or less.
They will also qualify for Medicaid as a single individual.

Speaker 2 (07:05):
So the annual enrollment period for Medicare is now through
twelve seven. You have another product that's opening soon too, correct.

Speaker 3 (07:11):
Right, so as of November first, and it'll go from
November first to November thirtieth. Anybody who's who works for
a city agency a city, they're a city employee. So
if you're a police officer, correction officer, firefighter, you work
for the Department of Education, Probation, any city agency, and
there are over seventy three different hierarchy city agencies and

(07:35):
then a couple one hundred of subagencies within them. Those
city workers can change health insurance starting on November first,
and they have to do it between November first and
November thirtieth, and that will be for their new coverage
to start January first, So it's an important time for
city employees to know that they can change. And then
anybody who's new who starts working for the city, they

(07:58):
have thirty days to listen.

Speaker 2 (08:01):
Regarding current events, can you explain the changes happening with
the current White House administration regarding healthcare there's.

Speaker 3 (08:10):
A lot of changes. So as we know, the current
administration within the White House is making a lot of changes.
One particularly is that a lot of the expansion population
that became eligible under the previous White House administration, those
expansions were as the result of an executive order, and

(08:30):
some of the executive orders are being repealed back and
being eliminated. So, for example, if you were somebody whose
income was between two hundred and two hundred and fifty
percent of the federal poverty level and you got you
were able to join the Essential Plan, Let's say that
population will no longer be eligible for the Essential Plan
because income between two hundred and two hundred and fifty

(08:52):
percent of the federal poverty level was the result of
an expansion executive order under the Biden administration, that's being eliminated,
and so that population will have to be able will
have to seek coverage through some other means. They may
be eligible for QHP, which may mean that they have
a monthly premium that they have to pay. They may

(09:12):
have to try to get insurance through health and hospitals
to one of their fee scale programs, but they will
not be eligible for the Essential Plan anymore. There's other
types of changes such as work requirements. Pretty soon anybody
who's a medicaid recipient will have to demonstrate that they've
worked a certain number of hours in order to continue

(09:35):
to get medicaid. So work requirements are going to be
another thing that impacts people. Many of the subsidies that
people were able to receive from the federal government in
order to pay down some of their monthly premiums, that's
going to go away. So, for example, under the qualified
health plans, there won't be any subsidies that people will

(09:56):
be eligible to help absorb some of their monthly premium.
The consumer will have to pay the full premium. So
subsidies going away, Work requirements are going away. Anybody in
any of the expansion populations will no longer be eligible.
So New York had was a very generous state, and
there was a lot of people who benefited from some

(10:17):
of these executive orders that led to you being able
to earn more money in order to get health insurance subsidized.
We're talking hundreds of thousands of people just in the
state of New York who will no longer be eligible
for health insurance.

Speaker 2 (10:30):
And when does all this kick in.

Speaker 3 (10:32):
It happens in different wa waves, So the first round
of people that no longer will be eligible starts next year.
So as of July of twenty twenty six, if you
were on the Essential Plan, and you were on the
Essential Plan because you were between two hundred and two
hundred and fifty percent of federal poverty level, you will

(10:53):
no longer be able to be in the Essential Plan
for EP five. So that's going to kick in in
twenty twenty six as of July. Things like work requirements
that's going to take a little bit longer for the
government to operationalize, so that may you may be looking
more like a twenty twenty seven ramp up for the
work requirements subsidies. Subsidies are going away as of January first,

(11:18):
twenty twenty six, So anybody who's re enrolling for coverage
for January or enrolling for the first time for coverage
in January, they won't get any subsidies connected to helping
to absorb the financial course of their monthly premium. That's
going to happen as of January twenty twenty six.

Speaker 2 (11:37):
So what do you have in the works at metroplus
to help make sure people are in the correct plan
can find a plan a plan they're eligible for.

Speaker 3 (11:45):
Well, yeah, so Metroplus is going to for all of
our existing members. We're working closely with the New York
State of Health in order to determine when we get
a little closer to that time period of June of
next year, whether or not someone's inc is the same.
So we're going to be screening all of we have
thirty two thousand members that are going to be impacted

(12:06):
by this change with no longer be ineligible for Essential
Plan five. We're going to work with the state in
order to determine if any of their income has changed
where they may be eligible for a different tier of
the Essential Plan. So the Essential Plan has five tiers,
tier one through five. Tier five is the one that jeopardy.
That's the one that I was telling you where people

(12:28):
earn between two hundred and two hundred and fifty percent
of the federal bivery level. Some of that population, their
income might have changed and they now may earn less.
So we'll rescreen them to see if there is a
change in their income to see if they're able to
move from EP five to EP one through four. So
that's one way that we're going to be helping people.

(12:48):
Others whose income stayed the same or got higher will
have to rescreen them and see if they want to
join QHP, which stands for Qualified Health Plans. That particular
prog isn't free. The Essential Plan has no monthly premium.
QHP does have a premium, so we'll work with people
to see if they want to roll over into QHP,

(13:10):
but knowing that they will have a monthly premium to pay.
So we're going to be reassessing people's current household size,
their income to see what they qualify for in the future.

Speaker 2 (13:22):
Clearly, this is a lot that's going on. How can
people find out more?

Speaker 3 (13:28):
So, if you are a Medicare recipient and you're interested
in learning more about either switching from your current plan
to Metroplus during the open and rong period for Medicare,
you would call one eight three three nine six five
one five two six. That's our dedicated line for anybody

(13:48):
who's interested in rolling in our Medicare Advantage Plan, our
Medicare Platinum Plan, or our Ultracare plan. That's the best number.
You can also reach us on our website at www.
Metroplus dot org and you'll be able to see all
of the different products that we offer, the features, the benefits,
the enrollment time periods, the eligibility requirements. You can also

(14:11):
see the listing of all of our providers. We have
over thirty four thousand providers in the five boroughs of
New York City, so we have a very robust network
that people can take advantage of, and all of that
can be seen on our website. In addition, consumers can
walk right into one of our nine community offices that
we have all throughout the Burrows. We strategically placed in

(14:34):
person brick and mortar locations in the communities so people
can walk in to get help with enrollment assistance, learn
more about the features and benefits of our program. We
can help them with recertification. We can help them make
a premium payment, change their address, order a new ID card.
So it's a walking center for all things enrollment, customer

(14:58):
service and education.

Speaker 2 (15:00):
There is so much more at the website metroplus dot org.
Our guest is Rogermilliner, Chief Growth Officer at metro Plus Health.
Thank you for being to get connected and thank you
for your time.

Speaker 3 (15:10):
Thank you so much.

Speaker 1 (15:12):
This has been get connected with Nina del Rio on
one oh six point seven light Fm. The views and
opinions of our guests do not necessarily reflect the views
of the station. If you missed any part of our
show or want to share it, visit our website for
downloads and podcasts at one oh six to seven lightfm
dot com. Thanks for listening.
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