November 21, 2025 • 22 mins
Roger Milliner Opens Up on State of Health Insurance, Benefits of MetroPlus Health & More
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:07):
All right, guys, was popping about one five point one
important information and conversation happening today, which I'm very excited
to have. We have today in the room Roger Milliner,
who is the chief Growth Officer at Metro Plus Health Plan,
and we are going to talk about open enrollment and
just the climate by the way right now of insurance
(00:28):
and also Metro Plus Health wants to ensure New Yorkers
are well informed, so we are here to help serve
that right now today. What is it that makes Metro
Plus special.
Speaker 2 (00:38):
We're owned by the New York City Health and Hospital Corporation,
which makes us a public benefit or organization. We're not
for profit. We're not publicly traded. We don't have the
same distractions that some other health plans when they have
to meet shareholders demands or you know, they're worrying about
making a certain profit. So being a not for profit plan,
(00:59):
we're really there for the people. We do a lot
of things in the community. We've always been here for
people and we put people before profits at all times.
Speaker 1 (01:07):
Mm hmm. That's why you got those high ratings.
Speaker 3 (01:09):
Exactly.
Speaker 1 (01:10):
What is the number one thing New Yorkers especially need
to know about this climate right now, and there's.
Speaker 3 (01:17):
A lot going on right now.
Speaker 2 (01:19):
With all the changes going on at the federal level,
We're going to see a lot of people across the country,
but particularly in New York State, whose health insurance is
going to be in jeopardy. So, for example, a lot
of people who got insurance through the Affordable Care Act
aka Obamacare, they're going to start seeing things like subsidies
that they were used to getting going away.
Speaker 3 (01:38):
They're going to see soon.
Speaker 1 (01:39):
Do you expect that.
Speaker 2 (01:40):
That started already as of eleven to one November. First,
anybody who was receiving subsidies to help pay for their
health insurance, particularly for the the.
Speaker 3 (01:51):
Gold plan that's gonna go away.
Speaker 1 (01:53):
Wow, that's so scary, yeah some people. Yeah, absolutely, So
how does metroplus fit into this, and how does and
and what is the best case scenario for somebody in
that situation.
Speaker 3 (02:03):
So we're here to educate you.
Speaker 2 (02:04):
The best thing to do is to come down and
see one of the marketing representatives. We're stationed that a
lot of the city hospitals all throughout the city. You
can call us on our dedicated line to reach somebody.
You can actually go to our website and get more information.
But we are in the community. We have community offices
all throughout the five boroughs, So if you want to
in person session, come see us. But you can also
(02:25):
recess through social media, through our website, through calling out
dedicated enrollment line as well.
Speaker 1 (02:30):
And what types of coverage are we talking about.
Speaker 2 (02:32):
So there's a couple of things. We're in the middle
of open enrollment for a lot of different things. So
if you're a city worker right now, it's time for
you to consider which health plan you want to switch
to or change too. So anybody who works for any
of the city agencies, the police department, fire department, corrections,
Metropus Gold is an option. I know a lot of
people have been used to, you know, just not making
any changes, staying with their plan. But Metropus Gold offers
(02:54):
a lot of good benefits. So for example, we have
one hundred.
Speaker 1 (02:58):
That you have laid out.
Speaker 3 (03:00):
It's all laid out.
Speaker 2 (03:01):
If you are somebody who's on any type of high
blood pressure medication, cholesterol medication, you're on contraceptives, you like
those glp ones for weight loss, we offer one hundred
free drugs. We offer people Jimmy imbursement. So if you
are somebody who takes advantage of the gym and you're
paying a membership fee on a monthly basis, Metropus will
(03:21):
give you five hundred dollars a year towards your Gimmy imbursement.
We'll also give five hundred dollars to your spouse and
forger for your children, So that's a value of fourteen
hundred dollars a year just in Jimmy imbursement. If you're
somebody who doesn't like to go to gym physically and
you take advantage of wellness apps like Peloton or Noom
or city Bike, we'll give you three hundred dollars a
year towards your city Bike membership or your Peloton or
(03:44):
your Zooma. If you're somebody who's into like taking steps
or drinking a lot of water, we have a rewards
program where we give you money for wellness activities. So
there's a lot of ways in which we reimburse people
for things they're spending money out for right now.
Speaker 1 (03:58):
Yeah, how does it differ from like, I don't know,
how does metro Plus, especially as New Yorkers are concerned,
How does it differ from like some of the other plans.
Speaker 2 (04:07):
Yeah, One of the things that makes us different than
any other health plan is our big network. We have
over thirty four thousand providers all throughout the five boroughs.
So besides all of the city hospitals, which is Bellevue,
King's County, Woodhall, Queen's Hospital, Mers, we also have a
lot of private hospitals like NYU, Mount Sinai, Bronx, Lebanon,
you know many city md There's a lot of choices.
Speaker 1 (04:29):
Yeah, right, So a lot of times you have a
health plan you cannot find a doctor anywhere near you.
Speaker 3 (04:33):
Yeah, networks very good.
Speaker 1 (04:35):
Oh yeah, you can't find a good doc there. That's
like a challenge for a lot of people.
Speaker 2 (04:38):
Benefits, Yeah, Metro Plus has zero copais when you go
to the specialists, zero when you go to your lab work,
your X rays all zero. There's no payroll deduction for
city workers.
Speaker 3 (04:48):
So it's a very.
Speaker 2 (04:49):
Affordable plan with zero premium. Course, big network, all those
added value benefits I told you about, like the rewards program,
the Jimmy embarrassement, the one hundred free drug that we're
giving out to people. It just goes on and on.
It's a big value add is that a new thing?
Speaker 1 (05:05):
The drugs.
Speaker 2 (05:06):
Yeah, So most health plans you have to take the
option rider as part of your benefit in order to
get the drugs.
Speaker 3 (05:13):
We also have an option rider.
Speaker 2 (05:15):
It's a small bi weekly pay out of someone's paycheck
if you're a city worker. But we tell people to
get the option rider first. Look and see if one
of those drugs you're taking is on our list of
one hundred free drugs.
Speaker 3 (05:26):
We did surveys.
Speaker 2 (05:27):
We know what the popular drugs people are taking, so
we just added it for free contraceptives, antidepressants, blood pressure, cholesterol,
the GLP ones, over one hundred of them is on
a list on our website that you can see. And
you say, I don't even need to take the option rider.
I'm going to get them for free from Metroplus. So
(05:48):
that is new for this year.
Speaker 1 (05:51):
What if you have a drug that is not on
the list.
Speaker 3 (05:54):
Then you will need to take the option rider.
Speaker 1 (05:56):
Got it?
Speaker 2 (05:56):
But city employees have thirteen different health plans they can
choose from. We're one of them, but we're one that's
only one of the of the thirteen that's free. There's
only three that's free, and we're one of them.
Speaker 1 (06:06):
Got it.
Speaker 2 (06:07):
If the drugs that you're not that you're taking and
not on there. I'd advise you to take an option rider,
which is like sixty two dollars a biweekly if you're single,
one hundred and twelve dollars if you're a family, to
get those other drugs that you may need.
Speaker 1 (06:19):
Got it. But chances are of the one hundred.
Speaker 2 (06:22):
Yeah, we did a lot of surveyance to understand what
are the most common drugs. Yeah, and most city workers
I told to found out, oh, my drug is on there,
so the base plan is free. They don't need the
option rider because their drug is there.
Speaker 1 (06:33):
Got it. What about open enrollment and dates and things
like that and cut offs? What do your people know
about that?
Speaker 3 (06:38):
Good question.
Speaker 2 (06:39):
Open enrollment for a city employee started on November first
and ends on November thirtieth, So I employ people to
make sure that you don't just get settled on the
plan that you've always had, because you may find that
that's not the best value for you. But you do
have to make that decision by November thirtieth. Just go
on your city agency's portal. So, for example, if you
work for Health and Hospital, we have a portal with
(07:01):
Health and Hospital poyees can go if you work for NYPD,
there's a different portal. So just go to your city
agency's portal where you actually enroll or make switches.
Speaker 3 (07:10):
But you have to do it.
Speaker 1 (07:11):
By the thirtieth Okay, so like today, Yeah, so get
on it.
Speaker 2 (07:15):
Today, Get on it today, Andrew. Like I said, a
lot of city employees tend to say, well, you know,
I've been on the same plan year after year. I
don't want to make any changes. But they're losing out
on all these values, the network, the gim reimbursement, the
one hundred free drugs, the wellness apps, you know, not
having to pay for specialist visits.
Speaker 3 (07:33):
Or you know a lab worker X ray. So we
have a lot to offer you talk.
Speaker 1 (07:37):
You were talking about the city workers and the deals
they get. But what about what if you're not What
if you're do something else or you're a freelancer.
Speaker 3 (07:44):
Yeah, good, does that affect you?
Speaker 2 (07:45):
Yeah, So we have a multiple programs for different people.
If you are not eligible for Medicaid because you earn
your income is higher than the Medicaid alliable threshold, more
likely you may be eligible for the Essential Plan, which
is typical for somebody who's like a freelancer. So let's
say you're a freelancer. You are able to get the
Essential Plan with no cost to you.
Speaker 3 (08:06):
It's a zero plan.
Speaker 2 (08:07):
We offer a benefit called the Flex Card, so someone
can get groceries and OTC benefit over the counter drugs
for one hundred and twelve dollars a month. We give
you towards that benefit. So that's pretty impressive.
Speaker 1 (08:22):
Yeah, I find that some of this stuff always gets complicated,
so complicated for people that it scares them out of Yeah,
either switching a plan or understanding your resources, or I
don't know, how easy is it to get enrolled?
Speaker 3 (08:38):
And it's easy.
Speaker 2 (08:40):
Metroplus has sales representatives that can help walk you through
the process. The only We're going to ask a few questions.
What's your family size, meaning is that you are singled,
Do you have a spouse or you have children. We're
going to ask you a little bit about your income
in order to see if you're eligible for Medicaid, the
Essential Plan or the Qualified Health Plan. We're going to
ask you some questions around your status are you are
(09:01):
you a citizen or are you an immigrant who just
came to New York So that we can know what
documentation we need to supply in order for you to
be elegible.
Speaker 1 (09:10):
It might be scary for some immigrants to walk into
the office.
Speaker 3 (09:12):
It totally is.
Speaker 2 (09:13):
There is a lot of fear right now around whether
or not if I'm an immigrant, am I able to apply?
Let us figure that out. There's a lot of different
ways in which immigrants can qualify. We know all of
the documents that are required. We can help you upload
it to the state in order to make sure that
you're eligible and if not. Metro Plus is owned by
the New York City Health and Hospital Corporation, so that's
(09:34):
the city public hospital system. So if you are an
immigrant and you haven't finished all the proper paperwork to
be able to be eligible for a government sponsor program,
Health and Hospital has a fee scale program that you
can get on. It's called H and H Options or
NYC Cares, and that program will allow you to get
coverage with minimal costs if you're an immigrant undocumented.
Speaker 1 (09:56):
So what happens if somebody misses this period this enrollment period?
Is it over or is there other opportunities?
Speaker 2 (10:02):
There's opportunities if you are eligible for Medicaid, the Essential Plan,
it's every month you can join at anytime there's no
sort of open and roman period. If you are already
on let's say one of the qualified health plans, that's
when you have to do it by December thirty first,
and if not, you will have to wait till the
next open enrollment period. So let us come and screen you.
(10:23):
We have to know what your income is, what your
family size is. Did you already have a health insurance
plan and you want to change health insurance plans? These
are all the types of things that a trained representative
can help decipher for anybody.
Speaker 1 (10:35):
What about like vision or dental or are those things covered?
Speaker 3 (10:40):
Dental Envision is covered.
Speaker 2 (10:41):
We metro Plus was fortunate to offer people another what
we call added value product, where not only do they
get the ten Essential plans that are part of the
Affordable Care Act Obamacare, we add it on dental envision
as another rider for a few extra bucks.
Speaker 1 (10:58):
Wow, that's amazing.
Speaker 2 (11:00):
It must be.
Speaker 1 (11:01):
It must feel good to help people in this way,
right like it is. And I'm sure you see so
many stories people who come in didn't even know they qualified,
struggling or sick.
Speaker 2 (11:12):
Metroplus has been here for New Yorkers through many different things.
Speaker 3 (11:15):
During the pandemic.
Speaker 2 (11:16):
We were one of the first plans to you know,
after everybody kind of went underground and you couldn't really
find anybody, Metropluss got back out there right away. We
made sure we did the right precautions. We put on
our you know, mask and our gloves, and we went
back out to the community to help people get insurance.
And it was truly eye opening to watch people struggle
when there was a pandemic going on, trying to get
(11:37):
the resources they need like health insurance, et cetera. We
worked through the large influx of migrants that came to
New York that was being shipped here from California and Texas.
We were there, Metropus was there to embrace the migrants
and make sure we assisted them with being able to
get the resources they need, not just insurance.
Speaker 3 (11:53):
We put on a lot.
Speaker 2 (11:54):
Of different resource fares where we brought different organizations together
to help people get registered for school, help them get
a job, help them do the paperwork needed to become
a citizen, etc. So we've been Metroplus has been in
the community for a long time, which is why we
open up community offices. We help people during the time
where it was food and security, and that's still going
on right now. Everybody's feeling the pinch right now with
(12:16):
SNAP benefits being taken away. Metropluses out there offering benefits
for people who are losing their SNAP by giving out
non perishables at our community offices. We're doing different events
with city agencies, with community based organizations to make sure
people who were getting SNAP benefits can still get the
things that they need.
Speaker 1 (12:35):
Specific questions who is eligible for the Essential Plan, the
managed Medicaid plan, and then the children there's a Child
Health Fund too, right.
Speaker 3 (12:48):
Yeah, sure.
Speaker 2 (12:49):
So for example, if you are a single individual and
you earn under sixteen thousand dollars a year, you'll be
eligible for Medicaid. If you're earning over sixteen thousand dollars
a year, but somewhere around thirty six thousand dollars a year,
you'll be eligible for the Essential Plan. If you earn
more than thirty six thousand, then you have to go
to qualified health plan and we have all of those
(13:09):
products available. And that was a scenario for a single individual.
If you are a family where there's more than just
one person the household, the dollar amounts increase, so you're
able to earn a little bit more for those different programs.
But I just gave you a single individual as an example.
Speaker 1 (13:24):
Yeah, what about the Child Health Plus?
Speaker 2 (13:27):
Child Plus is good. Yeah, every kid is eligible for
Child Plus regardless of immigration status or income. So, for example,
if you're undocumented, all children can get Child Health Plus. Okay,
there's no sort of cap on immigration related to Child Plus,
but it also goes on family size and income. So
let's just say I'm a family of four and I
(13:48):
have you know, a spouse and four kids. I'm a
family of five.
Speaker 3 (13:51):
Excuse me.
Speaker 2 (13:52):
You may have to pay nine or twelve or fifteen
dollars a month for a child to get on Child Plus,
but if you're earning less than that, it'll be zero
for you.
Speaker 1 (14:00):
Got it. What about for seniors?
Speaker 2 (14:02):
So Metroplus offers two Medicare advantage plans for seniors. This
program is for people who are usually sixty five and
over who have Medicare and Medicaid, or you could be
sixty five and over with Medicare by itself. In addition,
if you are someone who gets Medicare because of a disability,
meaning you're unda aged sixty five but you have a disability,
(14:23):
that qualifies you for SSI. We have two Medicare programs
for you.
Speaker 1 (14:27):
Got it.
Speaker 2 (14:28):
Medicare advantage is a wonderful program in that there's a
lot of supplemental and added value benefits that you don't
get with traditional medicare. So, for example, everyone talks about
the famous OTC card, which seniors could take advantage of.
OTC stands for over the counter drugs, over the counter
types of items, band aids, TAIL and all stuff like that.
(14:49):
Metroplus offers a five hundred dollars five hundred and twenty
five dollars per quarter OTC benefit. That means that someone
can take that OTC benefit called the Flex card and
use it not just for OTC benefits. Because Metroplus offer
the Flex version of it. They can use it to
pay utility bills, wow, they can use it to buy groceries,
(15:11):
they can use it for bathroom safety items. They can
mix and match, So that Flex benefit allows people to
mix and match these benefits. Sometimes you may want to
put one hundred and fifty dollars towards your cell phone bill.
You may want to take two hundred dollars and buy
groceries and the others. You want to get the personal
personal response system. You know, I fall in and I
can't get up, and then that button you press. We
(15:33):
allow you five hundred and twenty five dollars per quarter
with this OTC flex benefit, and you can use it
anytime in the quarter. Some other health plans you have
to use it month to month, meaning you get a
certain value for the month. If you don't use it,
you lose it. We allow people the flexibility to spend
that money across a quarter, so you can save it
all for one month or use it all in the
first month.
Speaker 3 (15:53):
It's up to you.
Speaker 2 (15:53):
Yeah, so you get that flex benefit. That's very important
for seniors.
Speaker 1 (15:56):
Yeah for sure.
Speaker 2 (15:57):
Yeah, you get eyewear. We cover up to five hundred
dollars in eyewear a year. We come up to five
hundred dollars in hearing.
Speaker 3 (16:04):
Aid services a year.
Speaker 2 (16:07):
There's just so many rich benefits that someone on Medicare
can take advantage of as well. And that opening rollment
period is going on now as well. There's a lot
of opening role periods.
Speaker 1 (16:16):
The moral of the story is the phone number pop
up in one of the locations, yep, in the way it's.
Speaker 3 (16:24):
A website, Yeah, and then you can find out more information.
Speaker 1 (16:26):
Given the information one more time again.
Speaker 2 (16:28):
So if you want to talk to someone who could
speak to you more about the open enrollment in person
on the phone, call us at one eight five five
eight on nine four zero seven three. If you want
to visit us in person and you want to figure
out where can I find a metro Plus representative, we
have ten community offices all throughout the five boroughs. If
you need the address and the time and hours of operation,
(16:51):
go to our website and it's listed there. If you
just want to go on our website because you want
to look at these benefits on your own, visit us
at www dot metro plus dot org. And you can
also find a representative on our website with their specific
cell phone number, the languages that they speak. It's a
personalized person that you may want to select from our
(17:11):
virtual office on our website.
Speaker 1 (17:13):
Beautiful, And I should also mention that it has metro
Plus has achieved a high quality rating and an overall
five star rating in the New York State Consumers Guide.
Just to give you a little just to give you a.
Speaker 2 (17:27):
Little confidence, you know these benefits better than well you
shoot down there.
Speaker 1 (17:30):
I mean, we've done this a few times, Roger.
Speaker 2 (17:32):
Listen between network, which is very important. You have to
have a big network, robust, a lot of providers. You
have to have good benefits like I told you about
Jimmy Embarrassment's wellness apps, one hundred free drugs, eyeglasses, airing aids.
You also have to go with a plan that's highly
rated for customer satisfaction and quality of care. The State
(17:52):
reviews and audit health plans all the time. They survey members,
not us, They serve a members to find out how
they're experiencing wait times, customer satisfaction.
Speaker 3 (18:02):
Et cetera.
Speaker 2 (18:03):
So we've scored a very high rating on all of
our different products, whether it's Medicare, whether it's the Essential
Plan or Medicaid matage Care. The State reviews us and
we have very high star ratings and you can see
our star ratings on our website.
Speaker 1 (18:18):
How many New Yorkers do you think are walking around
with no insurance?
Speaker 2 (18:24):
There's a lot of New Yorkers walking around no insurance
right now. And what's about to happen in g is
that due to a lot of the federal changes that
are happening right now. The Essential Plan has five different
tiers to it, and it's all based on poverty level.
So if somebody is between two hundred and two hundred
and fifty percent of the federal poverty level, that's about
to go away. These new changes coming down from the
(18:45):
federal government that anybody who got on the Essential Plan
whose income falls between two hundred and two hundred and
fifty percent of the.
Speaker 3 (18:52):
Federal poverty level, they won't be eligible anymore.
Speaker 2 (18:55):
So remember that single I was saying about that can
earn up to about thirty six thousand. If you earn
fifty thousand dollars a year and you were able to
get on it. Because of EP five, that's going away.
Speaker 1 (19:06):
Wow.
Speaker 2 (19:06):
Metropuss is about to lose like thirty thousand people wo
because of this new federal change.
Speaker 1 (19:12):
So if you enroll now, will will that be taken
away from you at that after the federal change.
Speaker 2 (19:17):
It's the federal change is going to kick in June
thirtieth of twenty twenty six.
Speaker 3 (19:22):
So let me backtrack.
Speaker 2 (19:25):
Essential Plan five was created as an extension to the
existing EP plan under the previous presidential office.
Speaker 3 (19:34):
Right, it was an.
Speaker 2 (19:35):
Executive order that allowed those additional people to get insurance.
The new administration said no, we're going to reverse that
executive order. We're ending it. So all those hundreds of
thousands of people who was able to get insurance because
of that executive order under the previous administration, that's going away.
June thirtieth, we are going to experience about thirty thousand.
(19:56):
But across New York State, there's going to be hundreds
of thousands of people who fit that EP five category
that will no longer be eligible. So they'd have to
either go to QHP, where there's going to be a
monthly premium, or they're gonna go without insurance for a while.
So imagine having to pay zero for the Essential Plan.
And now July first kicks in. You now have to
(20:19):
get screened again, and your income makes you eligible to
get QHP, but now you have to play a monthly
premium of five hundred dollars a month. That's gonna be
a big sticker shock for some people.
Speaker 1 (20:30):
That is a huge sticker shock.
Speaker 2 (20:31):
Another thing that's changing is before used to be able
to get subsidies from the federal government to pay for
some of that monthly premium. That's going away too. So
that started on November first. Anybody who was getting subsidies
to help pay for their QHP plan that doesn't exist anymore.
You're on the hook for the full premium. So that's
(20:51):
gonna be a lot of money. So there's gonna be
a lot of people's gonna go without insurance right now.
Speaker 1 (20:55):
Wow, I hate to hear that. Yes, I hate to hear.
Speaker 3 (20:58):
That it's getting bad.
Speaker 2 (20:59):
OK.
Speaker 1 (21:00):
For now, what do people do again?
Speaker 2 (21:03):
I would suggest that people reach out to Metroplus. You
can call us at one eight five five eight O
nine four zero seven three. I have people on standby
ready to answer any questions that you may have about
the Essential Plan, Child Plus, Medicaid managed Care. We have
ten community offices all through throughout New York. Go on
our website and those community office are walking centers where
(21:25):
people can go. I have representatives and all these centers
that can help you, know, educate you, and screen you.
You can go to our website and talk to someone
through a virtual office that we have. You can find
a rep who speaks your language, whether you speak Chinese,
South Asian, Russian, Albanian, Spanish. We have representatives who speak
all those different languages, so you can connect with them
(21:47):
by go into our virtual office on our website. You
can find information at www dot metroplus dot org. But
come to us and let us help walk you through
the timelines for all these different open and Roman periods
to determine your elgi ability to talk to you about
some of the changes that's coming down from the federal government.
Speaker 1 (22:03):
Amazing, and you can get all this information, all this
beautiful information absolutely all right. There you have it, guys,
www dot metro plus dot org. Thank you so much,
Roger
Speaker 3 (22:15):
Thank you, Andie thanks for having me
All right, guys, was popping about one five point one
important information and conversation happening today, which I'm very excited
to have. We have today in the room Roger Milliner,
who is the chief Growth Officer at Metro Plus Health Plan,
and we are going to talk about open enrollment and
just the climate by the way right now of insurance
(00:28):
and also Metro Plus Health wants to ensure New Yorkers
are well informed, so we are here to help serve
that right now today. What is it that makes Metro
Plus special.
Speaker 2 (00:38):
We're owned by the New York City Health and Hospital Corporation,
which makes us a public benefit or organization. We're not
for profit. We're not publicly traded. We don't have the
same distractions that some other health plans when they have
to meet shareholders demands or you know, they're worrying about
making a certain profit. So being a not for profit plan,
(00:59):
we're really there for the people. We do a lot
of things in the community. We've always been here for
people and we put people before profits at all times.
Speaker 1 (01:07):
Mm hmm. That's why you got those high ratings.
Speaker 3 (01:09):
Exactly.
Speaker 1 (01:10):
What is the number one thing New Yorkers especially need
to know about this climate right now, and there's.
Speaker 3 (01:17):
A lot going on right now.
Speaker 2 (01:19):
With all the changes going on at the federal level,
We're going to see a lot of people across the country,
but particularly in New York State, whose health insurance is
going to be in jeopardy. So, for example, a lot
of people who got insurance through the Affordable Care Act
aka Obamacare, they're going to start seeing things like subsidies
that they were used to getting going away.
Speaker 3 (01:38):
They're going to see soon.
Speaker 1 (01:39):
Do you expect that.
Speaker 2 (01:40):
That started already as of eleven to one November. First,
anybody who was receiving subsidies to help pay for their
health insurance, particularly for the the.
Speaker 3 (01:51):
Gold plan that's gonna go away.
Speaker 1 (01:53):
Wow, that's so scary, yeah some people. Yeah, absolutely, So
how does metroplus fit into this, and how does and
and what is the best case scenario for somebody in
that situation.
Speaker 3 (02:03):
So we're here to educate you.
Speaker 2 (02:04):
The best thing to do is to come down and
see one of the marketing representatives. We're stationed that a
lot of the city hospitals all throughout the city. You
can call us on our dedicated line to reach somebody.
You can actually go to our website and get more information.
But we are in the community. We have community offices
all throughout the five boroughs, So if you want to
in person session, come see us. But you can also
(02:25):
recess through social media, through our website, through calling out
dedicated enrollment line as well.
Speaker 1 (02:30):
And what types of coverage are we talking about.
Speaker 2 (02:32):
So there's a couple of things. We're in the middle
of open enrollment for a lot of different things. So
if you're a city worker right now, it's time for
you to consider which health plan you want to switch
to or change too. So anybody who works for any
of the city agencies, the police department, fire department, corrections,
Metropus Gold is an option. I know a lot of
people have been used to, you know, just not making
any changes, staying with their plan. But Metropus Gold offers
(02:54):
a lot of good benefits. So for example, we have
one hundred.
Speaker 1 (02:58):
That you have laid out.
Speaker 3 (03:00):
It's all laid out.
Speaker 2 (03:01):
If you are somebody who's on any type of high
blood pressure medication, cholesterol medication, you're on contraceptives, you like
those glp ones for weight loss, we offer one hundred
free drugs. We offer people Jimmy imbursement. So if you
are somebody who takes advantage of the gym and you're
paying a membership fee on a monthly basis, Metropus will
(03:21):
give you five hundred dollars a year towards your Gimmy imbursement.
We'll also give five hundred dollars to your spouse and
forger for your children, So that's a value of fourteen
hundred dollars a year just in Jimmy imbursement. If you're
somebody who doesn't like to go to gym physically and
you take advantage of wellness apps like Peloton or Noom
or city Bike, we'll give you three hundred dollars a
year towards your city Bike membership or your Peloton or
(03:44):
your Zooma. If you're somebody who's into like taking steps
or drinking a lot of water, we have a rewards
program where we give you money for wellness activities. So
there's a lot of ways in which we reimburse people
for things they're spending money out for right now.
Speaker 1 (03:58):
Yeah, how does it differ from like, I don't know,
how does metro Plus, especially as New Yorkers are concerned,
How does it differ from like some of the other plans.
Speaker 2 (04:07):
Yeah, One of the things that makes us different than
any other health plan is our big network. We have
over thirty four thousand providers all throughout the five boroughs.
So besides all of the city hospitals, which is Bellevue,
King's County, Woodhall, Queen's Hospital, Mers, we also have a
lot of private hospitals like NYU, Mount Sinai, Bronx, Lebanon,
you know many city md There's a lot of choices.
Speaker 1 (04:29):
Yeah, right, So a lot of times you have a
health plan you cannot find a doctor anywhere near you.
Speaker 3 (04:33):
Yeah, networks very good.
Speaker 1 (04:35):
Oh yeah, you can't find a good doc there. That's
like a challenge for a lot of people.
Speaker 2 (04:38):
Benefits, Yeah, Metro Plus has zero copais when you go
to the specialists, zero when you go to your lab work,
your X rays all zero. There's no payroll deduction for
city workers.
Speaker 3 (04:48):
So it's a very.
Speaker 2 (04:49):
Affordable plan with zero premium. Course, big network, all those
added value benefits I told you about, like the rewards program,
the Jimmy embarrassement, the one hundred free drug that we're
giving out to people. It just goes on and on.
It's a big value add is that a new thing?
Speaker 1 (05:05):
The drugs.
Speaker 2 (05:06):
Yeah, So most health plans you have to take the
option rider as part of your benefit in order to
get the drugs.
Speaker 3 (05:13):
We also have an option rider.
Speaker 2 (05:15):
It's a small bi weekly pay out of someone's paycheck
if you're a city worker. But we tell people to
get the option rider first. Look and see if one
of those drugs you're taking is on our list of
one hundred free drugs.
Speaker 3 (05:26):
We did surveys.
Speaker 2 (05:27):
We know what the popular drugs people are taking, so
we just added it for free contraceptives, antidepressants, blood pressure, cholesterol,
the GLP ones, over one hundred of them is on
a list on our website that you can see. And
you say, I don't even need to take the option rider.
I'm going to get them for free from Metroplus. So
(05:48):
that is new for this year.
Speaker 1 (05:51):
What if you have a drug that is not on
the list.
Speaker 3 (05:54):
Then you will need to take the option rider.
Speaker 1 (05:56):
Got it?
Speaker 2 (05:56):
But city employees have thirteen different health plans they can
choose from. We're one of them, but we're one that's
only one of the of the thirteen that's free. There's
only three that's free, and we're one of them.
Speaker 1 (06:06):
Got it.
Speaker 2 (06:07):
If the drugs that you're not that you're taking and
not on there. I'd advise you to take an option rider,
which is like sixty two dollars a biweekly if you're single,
one hundred and twelve dollars if you're a family, to
get those other drugs that you may need.
Speaker 1 (06:19):
Got it. But chances are of the one hundred.
Speaker 2 (06:22):
Yeah, we did a lot of surveyance to understand what
are the most common drugs. Yeah, and most city workers
I told to found out, oh, my drug is on there,
so the base plan is free. They don't need the
option rider because their drug is there.
Speaker 1 (06:33):
Got it. What about open enrollment and dates and things
like that and cut offs? What do your people know
about that?
Speaker 3 (06:38):
Good question.
Speaker 2 (06:39):
Open enrollment for a city employee started on November first
and ends on November thirtieth, So I employ people to
make sure that you don't just get settled on the
plan that you've always had, because you may find that
that's not the best value for you. But you do
have to make that decision by November thirtieth. Just go
on your city agency's portal. So, for example, if you
work for Health and Hospital, we have a portal with
(07:01):
Health and Hospital poyees can go if you work for NYPD,
there's a different portal. So just go to your city
agency's portal where you actually enroll or make switches.
Speaker 3 (07:10):
But you have to do it.
Speaker 1 (07:11):
By the thirtieth Okay, so like today, Yeah, so get
on it.
Speaker 2 (07:15):
Today, Get on it today, Andrew. Like I said, a
lot of city employees tend to say, well, you know,
I've been on the same plan year after year. I
don't want to make any changes. But they're losing out
on all these values, the network, the gim reimbursement, the
one hundred free drugs, the wellness apps, you know, not
having to pay for specialist visits.
Speaker 3 (07:33):
Or you know a lab worker X ray. So we
have a lot to offer you talk.
Speaker 1 (07:37):
You were talking about the city workers and the deals
they get. But what about what if you're not What
if you're do something else or you're a freelancer.
Speaker 3 (07:44):
Yeah, good, does that affect you?
Speaker 2 (07:45):
Yeah, So we have a multiple programs for different people.
If you are not eligible for Medicaid because you earn
your income is higher than the Medicaid alliable threshold, more
likely you may be eligible for the Essential Plan, which
is typical for somebody who's like a freelancer. So let's
say you're a freelancer. You are able to get the
Essential Plan with no cost to you.
Speaker 3 (08:06):
It's a zero plan.
Speaker 2 (08:07):
We offer a benefit called the Flex Card, so someone
can get groceries and OTC benefit over the counter drugs
for one hundred and twelve dollars a month. We give
you towards that benefit. So that's pretty impressive.
Speaker 1 (08:22):
Yeah, I find that some of this stuff always gets complicated,
so complicated for people that it scares them out of Yeah,
either switching a plan or understanding your resources, or I
don't know, how easy is it to get enrolled?
Speaker 3 (08:38):
And it's easy.
Speaker 2 (08:40):
Metroplus has sales representatives that can help walk you through
the process. The only We're going to ask a few questions.
What's your family size, meaning is that you are singled,
Do you have a spouse or you have children. We're
going to ask you a little bit about your income
in order to see if you're eligible for Medicaid, the
Essential Plan or the Qualified Health Plan. We're going to
ask you some questions around your status are you are
(09:01):
you a citizen or are you an immigrant who just
came to New York So that we can know what
documentation we need to supply in order for you to
be elegible.
Speaker 1 (09:10):
It might be scary for some immigrants to walk into
the office.
Speaker 3 (09:12):
It totally is.
Speaker 2 (09:13):
There is a lot of fear right now around whether
or not if I'm an immigrant, am I able to apply?
Let us figure that out. There's a lot of different
ways in which immigrants can qualify. We know all of
the documents that are required. We can help you upload
it to the state in order to make sure that
you're eligible and if not. Metro Plus is owned by
the New York City Health and Hospital Corporation, so that's
(09:34):
the city public hospital system. So if you are an
immigrant and you haven't finished all the proper paperwork to
be able to be eligible for a government sponsor program,
Health and Hospital has a fee scale program that you
can get on. It's called H and H Options or
NYC Cares, and that program will allow you to get
coverage with minimal costs if you're an immigrant undocumented.
Speaker 1 (09:56):
So what happens if somebody misses this period this enrollment period?
Is it over or is there other opportunities?
Speaker 2 (10:02):
There's opportunities if you are eligible for Medicaid, the Essential Plan,
it's every month you can join at anytime there's no
sort of open and roman period. If you are already
on let's say one of the qualified health plans, that's
when you have to do it by December thirty first,
and if not, you will have to wait till the
next open enrollment period. So let us come and screen you.
(10:23):
We have to know what your income is, what your
family size is. Did you already have a health insurance
plan and you want to change health insurance plans? These
are all the types of things that a trained representative
can help decipher for anybody.
Speaker 1 (10:35):
What about like vision or dental or are those things covered?
Speaker 3 (10:40):
Dental Envision is covered.
Speaker 2 (10:41):
We metro Plus was fortunate to offer people another what
we call added value product, where not only do they
get the ten Essential plans that are part of the
Affordable Care Act Obamacare, we add it on dental envision
as another rider for a few extra bucks.
Speaker 1 (10:58):
Wow, that's amazing.
Speaker 2 (11:00):
It must be.
Speaker 1 (11:01):
It must feel good to help people in this way,
right like it is. And I'm sure you see so
many stories people who come in didn't even know they qualified,
struggling or sick.
Speaker 2 (11:12):
Metroplus has been here for New Yorkers through many different things.
Speaker 3 (11:15):
During the pandemic.
Speaker 2 (11:16):
We were one of the first plans to you know,
after everybody kind of went underground and you couldn't really
find anybody, Metropluss got back out there right away. We
made sure we did the right precautions. We put on
our you know, mask and our gloves, and we went
back out to the community to help people get insurance.
And it was truly eye opening to watch people struggle
when there was a pandemic going on, trying to get
(11:37):
the resources they need like health insurance, et cetera. We
worked through the large influx of migrants that came to
New York that was being shipped here from California and Texas.
We were there, Metropus was there to embrace the migrants
and make sure we assisted them with being able to
get the resources they need, not just insurance.
Speaker 3 (11:53):
We put on a lot.
Speaker 2 (11:54):
Of different resource fares where we brought different organizations together
to help people get registered for school, help them get
a job, help them do the paperwork needed to become
a citizen, etc. So we've been Metroplus has been in
the community for a long time, which is why we
open up community offices. We help people during the time
where it was food and security, and that's still going
on right now. Everybody's feeling the pinch right now with
(12:16):
SNAP benefits being taken away. Metropluses out there offering benefits
for people who are losing their SNAP by giving out
non perishables at our community offices. We're doing different events
with city agencies, with community based organizations to make sure
people who were getting SNAP benefits can still get the
things that they need.
Speaker 1 (12:35):
Specific questions who is eligible for the Essential Plan, the
managed Medicaid plan, and then the children there's a Child
Health Fund too, right.
Speaker 3 (12:48):
Yeah, sure.
Speaker 2 (12:49):
So for example, if you are a single individual and
you earn under sixteen thousand dollars a year, you'll be
eligible for Medicaid. If you're earning over sixteen thousand dollars
a year, but somewhere around thirty six thousand dollars a year,
you'll be eligible for the Essential Plan. If you earn
more than thirty six thousand, then you have to go
to qualified health plan and we have all of those
(13:09):
products available. And that was a scenario for a single individual.
If you are a family where there's more than just
one person the household, the dollar amounts increase, so you're
able to earn a little bit more for those different programs.
But I just gave you a single individual as an example.
Speaker 1 (13:24):
Yeah, what about the Child Health Plus?
Speaker 2 (13:27):
Child Plus is good. Yeah, every kid is eligible for
Child Plus regardless of immigration status or income. So, for example,
if you're undocumented, all children can get Child Health Plus. Okay,
there's no sort of cap on immigration related to Child Plus,
but it also goes on family size and income. So
let's just say I'm a family of four and I
(13:48):
have you know, a spouse and four kids. I'm a
family of five.
Speaker 3 (13:51):
Excuse me.
Speaker 2 (13:52):
You may have to pay nine or twelve or fifteen
dollars a month for a child to get on Child Plus,
but if you're earning less than that, it'll be zero
for you.
Speaker 1 (14:00):
Got it. What about for seniors?
Speaker 2 (14:02):
So Metroplus offers two Medicare advantage plans for seniors. This
program is for people who are usually sixty five and
over who have Medicare and Medicaid, or you could be
sixty five and over with Medicare by itself. In addition,
if you are someone who gets Medicare because of a disability,
meaning you're unda aged sixty five but you have a disability,
(14:23):
that qualifies you for SSI. We have two Medicare programs
for you.
Speaker 1 (14:27):
Got it.
Speaker 2 (14:28):
Medicare advantage is a wonderful program in that there's a
lot of supplemental and added value benefits that you don't
get with traditional medicare. So, for example, everyone talks about
the famous OTC card, which seniors could take advantage of.
OTC stands for over the counter drugs, over the counter
types of items, band aids, TAIL and all stuff like that.
(14:49):
Metroplus offers a five hundred dollars five hundred and twenty
five dollars per quarter OTC benefit. That means that someone
can take that OTC benefit called the Flex card and
use it not just for OTC benefits. Because Metroplus offer
the Flex version of it. They can use it to
pay utility bills, wow, they can use it to buy groceries,
(15:11):
they can use it for bathroom safety items. They can
mix and match, So that Flex benefit allows people to
mix and match these benefits. Sometimes you may want to
put one hundred and fifty dollars towards your cell phone bill.
You may want to take two hundred dollars and buy
groceries and the others. You want to get the personal
personal response system. You know, I fall in and I
can't get up, and then that button you press. We
(15:33):
allow you five hundred and twenty five dollars per quarter
with this OTC flex benefit, and you can use it
anytime in the quarter. Some other health plans you have
to use it month to month, meaning you get a
certain value for the month. If you don't use it,
you lose it. We allow people the flexibility to spend
that money across a quarter, so you can save it
all for one month or use it all in the
first month.
Speaker 3 (15:53):
It's up to you.
Speaker 2 (15:53):
Yeah, so you get that flex benefit. That's very important
for seniors.
Speaker 1 (15:56):
Yeah for sure.
Speaker 2 (15:57):
Yeah, you get eyewear. We cover up to five hundred
dollars in eyewear a year. We come up to five
hundred dollars in hearing.
Speaker 3 (16:04):
Aid services a year.
Speaker 2 (16:07):
There's just so many rich benefits that someone on Medicare
can take advantage of as well. And that opening rollment
period is going on now as well. There's a lot
of opening role periods.
Speaker 1 (16:16):
The moral of the story is the phone number pop
up in one of the locations, yep, in the way it's.
Speaker 3 (16:24):
A website, Yeah, and then you can find out more information.
Speaker 1 (16:26):
Given the information one more time again.
Speaker 2 (16:28):
So if you want to talk to someone who could
speak to you more about the open enrollment in person
on the phone, call us at one eight five five
eight on nine four zero seven three. If you want
to visit us in person and you want to figure
out where can I find a metro Plus representative, we
have ten community offices all throughout the five boroughs. If
you need the address and the time and hours of operation,
(16:51):
go to our website and it's listed there. If you
just want to go on our website because you want
to look at these benefits on your own, visit us
at www dot metro plus dot org. And you can
also find a representative on our website with their specific
cell phone number, the languages that they speak. It's a
personalized person that you may want to select from our
(17:11):
virtual office on our website.
Speaker 1 (17:13):
Beautiful, And I should also mention that it has metro
Plus has achieved a high quality rating and an overall
five star rating in the New York State Consumers Guide.
Just to give you a little just to give you a.
Speaker 2 (17:27):
Little confidence, you know these benefits better than well you
shoot down there.
Speaker 1 (17:30):
I mean, we've done this a few times, Roger.
Speaker 2 (17:32):
Listen between network, which is very important. You have to
have a big network, robust, a lot of providers. You
have to have good benefits like I told you about
Jimmy Embarrassment's wellness apps, one hundred free drugs, eyeglasses, airing aids.
You also have to go with a plan that's highly
rated for customer satisfaction and quality of care. The State
(17:52):
reviews and audit health plans all the time. They survey members,
not us, They serve a members to find out how
they're experiencing wait times, customer satisfaction.
Speaker 3 (18:02):
Et cetera.
Speaker 2 (18:03):
So we've scored a very high rating on all of
our different products, whether it's Medicare, whether it's the Essential
Plan or Medicaid matage Care. The State reviews us and
we have very high star ratings and you can see
our star ratings on our website.
Speaker 1 (18:18):
How many New Yorkers do you think are walking around
with no insurance?
Speaker 2 (18:24):
There's a lot of New Yorkers walking around no insurance
right now. And what's about to happen in g is
that due to a lot of the federal changes that
are happening right now. The Essential Plan has five different
tiers to it, and it's all based on poverty level.
So if somebody is between two hundred and two hundred
and fifty percent of the federal poverty level, that's about
to go away. These new changes coming down from the
(18:45):
federal government that anybody who got on the Essential Plan
whose income falls between two hundred and two hundred and
fifty percent of the.
Speaker 3 (18:52):
Federal poverty level, they won't be eligible anymore.
Speaker 2 (18:55):
So remember that single I was saying about that can
earn up to about thirty six thousand. If you earn
fifty thousand dollars a year and you were able to
get on it. Because of EP five, that's going away.
Speaker 1 (19:06):
Wow.
Speaker 2 (19:06):
Metropuss is about to lose like thirty thousand people wo
because of this new federal change.
Speaker 1 (19:12):
So if you enroll now, will will that be taken
away from you at that after the federal change.
Speaker 2 (19:17):
It's the federal change is going to kick in June
thirtieth of twenty twenty six.
Speaker 3 (19:22):
So let me backtrack.
Speaker 2 (19:25):
Essential Plan five was created as an extension to the
existing EP plan under the previous presidential office.
Speaker 3 (19:34):
Right, it was an.
Speaker 2 (19:35):
Executive order that allowed those additional people to get insurance.
The new administration said no, we're going to reverse that
executive order. We're ending it. So all those hundreds of
thousands of people who was able to get insurance because
of that executive order under the previous administration, that's going away.
June thirtieth, we are going to experience about thirty thousand.
(19:56):
But across New York State, there's going to be hundreds
of thousands of people who fit that EP five category
that will no longer be eligible. So they'd have to
either go to QHP, where there's going to be a
monthly premium, or they're gonna go without insurance for a while.
So imagine having to pay zero for the Essential Plan.
And now July first kicks in. You now have to
(20:19):
get screened again, and your income makes you eligible to
get QHP, but now you have to play a monthly
premium of five hundred dollars a month. That's gonna be
a big sticker shock for some people.
Speaker 1 (20:30):
That is a huge sticker shock.
Speaker 2 (20:31):
Another thing that's changing is before used to be able
to get subsidies from the federal government to pay for
some of that monthly premium. That's going away too. So
that started on November first. Anybody who was getting subsidies
to help pay for their QHP plan that doesn't exist anymore.
You're on the hook for the full premium. So that's
(20:51):
gonna be a lot of money. So there's gonna be
a lot of people's gonna go without insurance right now.
Speaker 1 (20:55):
Wow, I hate to hear that. Yes, I hate to hear.
Speaker 3 (20:58):
That it's getting bad.
Speaker 2 (20:59):
OK.
Speaker 1 (21:00):
For now, what do people do again?
Speaker 2 (21:03):
I would suggest that people reach out to Metroplus. You
can call us at one eight five five eight O
nine four zero seven three. I have people on standby
ready to answer any questions that you may have about
the Essential Plan, Child Plus, Medicaid managed Care. We have
ten community offices all through throughout New York. Go on
our website and those community office are walking centers where
(21:25):
people can go. I have representatives and all these centers
that can help you, know, educate you, and screen you.
You can go to our website and talk to someone
through a virtual office that we have. You can find
a rep who speaks your language, whether you speak Chinese,
South Asian, Russian, Albanian, Spanish. We have representatives who speak
all those different languages, so you can connect with them
(21:47):
by go into our virtual office on our website. You
can find information at www dot metroplus dot org. But
come to us and let us help walk you through
the timelines for all these different open and Roman periods
to determine your elgi ability to talk to you about
some of the changes that's coming down from the federal government.
Speaker 1 (22:03):
Amazing, and you can get all this information, all this
beautiful information absolutely all right. There you have it, guys,
www dot metro plus dot org. Thank you so much,
Roger
Speaker 3 (22:15):
Thank you, Andie thanks for having me
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