What MetroPlusHealth does

MetroPlusHealth is a nonprofit New York City health plan founded in 1985 and headquartered at 50 Water Street, serving approximately 690,000 members across all five NYC boroughs. The company offers a full multi-line portfolio: Medicaid Managed Care, the Essential Plan, Child Health Plus, Marketplace/Qualified Health Plans, NYC Employee Gold and GoldCare plans, Medicare Advantage HMO plans, D-SNP and UltraCare dual-eligible plans, plus a set of Special Needs Plans covering HIV/AIDS (Partnership in Care), behavioral health (HARP), and Managed Long-Term Care.

The underlying technology stack centers on a Salesforce-based Member Portal and Broker Portal, third-party ExpressCare Video for 24/7 telehealth, mobile applications for iOS and Android, a Provider Search directory, an InstaMed (J.P. Morgan) payment integration for premium billing, and a Member Rewards program that uses points mechanics with retailer redemption at Duane Reade, Walgreens, CVS, Rite Aid, Family Dollar, and Amazon. Operations are distributed across community offices (including a second Staten Island location opened in November 2025), virtual offices, in-person enrollment support, and a Salesforce-mediated broker channel.

MetroPlusHealth's revenue mechanics are capitation-driven: per-member per-month premiums from Medicaid, Essential Plan (with federal/state subsidies), Child Health Plus, Medicare Advantage, and Marketplace plans, plus employer premiums for the City of New York employee plans. Distribution leverages NY State of Health (On- and Off-Exchange), certified brokers and navigators, community-based outreach, and provider referrals through a network of 34,000+ providers, 40+ hospitals, and 110+ urgent care centers anchored by NYC Health + Hospitals, Mount Sinai, NYU Langone, and Montefiore. The company is rated as NYC's highest-rated Medicaid Managed Care plan by the New York State Department of Health.

Name

MetroPlusHealth

Legal name

MetroPlusHealth

Website

https://metroplus.org

Company type

Private

Founded year

1985

Operating status

Operating

Headcount range

1,001–5,000 employees

Short description

MetroPlusHealth is a nonprofit New York City health plan founded in 1985, serving roughly 690,000 members across all five boroughs with Medicaid, Essential Plan, Child Health Plus, Marketplace, Medicare Advantage/D-SNP, HIV-SNP, HARP, MLTC, and NYC employee plans. Operations run through community offices, a Salesforce-based portal, a 34,000+ provider network, and 24/7 telehealth.

Ownership category

akta.pro rank

Product category

Managed Health Insurance

NAICS

Social Assistance (624), Individual and Family Services (6241), Ambulance Services (621910)

SIC

Services-Health Services (8000), Services-Social Services (8300), Services-Home Health Care Services (8082)

akta.pro primary industry

Long-Term Services & Supports (LTSS) / MLTC Managed Care Plans (HLAEAEAD)

akta.pro secondary industries

Children’s & Family Medicaid Managed Care Plans (HLAEAEAF), Specialty Medicaid Managed Care (e.g., HIV/AIDS, SMI/SED) (HLAEAEAG), Maternity & Pregnancy (Perinatal) Medicaid Managed Care Programs (HLAEAEAH), Integrated Physical-Behavioral-Social Care (Whole-Person) Medicaid Plans (HLAEAEAI), Mobile & Street Medicine Primary Care Programs (HLAFAGAH), Hospital-Based EMS & Mobile Integrated Health (HLAFANAC)

Keywords

• Medicaid managed care
• Health insurance plans
• Medicare Advantage plans
• Managed care services
• Community health coverage

Headquarters

HQ city

New York

HQ country

United States

HQ region

North America

Offices7 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

Operations, Personnel, Technology or R&D, Marketing or Sales, Infrastructure

Revenue model

1. Medicaid Managed Care Premiums: Government-funded healthcare coverage for eligible low-income New Yorkers. MetroPlusHealth receives capitation payments from Medicaid to provide comprehensive health benefits to members.
2. Essential Plan Premiums: Low-cost health insurance for adults who don't qualify for Medicaid, with $0 premiums for eligible members. Funded through a combination of member premiums (based on income) and federal/state subsidies.
3. Marketplace/Qualified Health Plan Premiums: Comprehensive health plans offered through NY State of Health marketplace for individuals and families who don't qualify for Medicaid or employer coverage. Members may receive premium subsidies based on income.
4. Medicare Advantage Premiums: Medicare Advantage plans including HMO and D-SNP options for Medicare beneficiaries and dual-eligible individuals. Includes MetroPlus Advantage Plan (HMO D-SNP), MetroPlus Platinum Plan (HMO), and MetroPlus UltraCare (HMO D-SNP).
5. Child Health Plus Premiums: Low-cost health insurance for children under 19 who are not eligible for Medicaid. Premiums vary based on family income from $0 to $60 per child per month.
6. NYC Employee Plan Premiums: Gold Plan and GoldCare Plan for NYC municipal employees and their families. The Gold Plan offers $0 premiums for eligible NYC workers.

Pricing tiers

Go-to-market motion3 records

Distribution channels6 records

Marketing channels7 records

Core offering

MetroPlusHealth is a nonprofit New York City health plan that provides government-sponsored and commercial health insurance products, including Medicaid Managed Care, Essential Plan, Child Health Plus, Qualified Health Plans on the NY State of Health marketplace, Medicare Advantage and Dual-Eligible Special Needs Plans, and employer-sponsored coverage for NYC municipal workers. The plan serves approximately 690,000 members across all five NYC boroughs through a network of more than 34,000 providers, 40+ hospitals, and 110+ urgent care centers, complemented by member portals, 24/7 telehealth, rewards programs, and in-person community offices.

Product overview

MetroPlusHealth is a non-profit New York City health plan offering a comprehensive portfolio of health insurance products and digital services. The core offering consists of Individual & Family Plans (Essential Plan, Child Health Plus, Medicaid Managed Care, Marketplace/Qualified Health Plans, Explore Plan), NYC Employee Plans (MetroPlusHealth Gold Plan, GoldCare Plan), and Medicare/Dual-Eligible Plans (Medicare Advantage HMO D-SNP, MetroPlus Platinum Plan, MetroPlus UltraCare). Special Needs Plans include the Enhanced HARP Plan, Partnership In Care HIV-SNP, and Managed Long-Term Care. Supporting digital sub-products include a Member Portal, Virtual Visit/Telehealth, Member Rewards Program, Pay My Premium payment system, Provider Search directory, Gym Reimbursement, OTC/Wellness Card benefits, and Broker/Provider Portals. The company serves nearly 700,000 members throughout New York City with over 34,000 providers, 40+ hospitals, and 110+ urgent care locations.

Differentiator

Problem solved

Functional benefit

Brands

• Explore Plan: Individual and family health coverage plan offering flexibility and peace of mind with broad network access.
• Elevate You

Products and services

• Essential Plan $0 premium health plan for qualified New Yorkers with income up to 250% of federal poverty level. Includes dental, vision, mental health, urgent care, $112 quarterly OTC/grocery allowance, and gym reimbursement up to $200 every 6 months.
• Child Health Plus Low-cost health insurance for children under 19 in New York State, regardless of immigration status. Features $0 checkups, dental, vision, immunizations, hospital care, emergency care, X-rays, lab tests, and prescriptions, with income-based premiums from $0 to $60 per child per month.
• Medicaid Managed Care No-premium, no-copay health plan for New Yorkers eligible for Medicaid. Includes freedom to choose a primary care physician, access to specialists, emergency services, prenatal care, preventive services, and free non-emergency medical transportation.
• Marketplace Plans (Qualified Health Plans) Qualified Health Plans offered through NY State of Health marketplace for individuals and families not eligible for Medicaid or employer-sponsored insurance, with potential income-based premium subsidies. Includes essential health benefits, preventive care, and prescription coverage.
• Explore Plan Comprehensive individual and family health coverage plan offering flexibility for people transitioning between jobs, newly eligible for coverage, or seeking affordable insurance with broad network access.
• MetroPlusHealth Gold Plan $0 premiums, deductibles, and co-insurance health plan available exclusively to NYC municipal employees and their families. Includes gym reimbursement up to $250 for primary member and dependents every 6 months.
• GoldCare Plan Low-cost health plan designed for large employer groups associated with NYC.
• MetroPlus Advantage Plan (HMO D-SNP) Dual-Eligible Special Needs Plan HMO for Medicare beneficiaries who also qualify for Medicaid.
• MetroPlus Platinum Plan (HMO) HMO Medicare Advantage plan for Medicare beneficiaries.
• MetroPlus UltraCare (HMO D-SNP) Medicaid Advantage Plus plan for individuals dual-eligible for Medicare and full Medicaid.
• Enhanced (HARP) Plan Health and Recovery Plan for Medicaid recipients 21 or older who need additional behavioral health resources for mental health and substance use disorder treatment.
• Partnership In Care (PIC) HIV - SNP Special Needs Plan for New Yorkers living with HIV/AIDS and other select groups, offering specialized care management with rewards for completing care visits.
• Managed Long-Term Care Plan for Medicaid recipients who meet certain income, resource, age, or disability requirements and need long-term care services.

Quantifiable outcome

• NYC's highest-rated Medicaid Managed Care plan by the New York State Department of Health
• +3 more outcomes

Named customers8 records

Segments7 records

Ideal customer profiles6 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration4 records

Feature3 records

Partnerships

14 partnerships are on record, tiered core and major.

• NYC Health + HospitalscoreTechnology or IntegrationMajor healthcare provider network partner with 40+ hospitals and thousands of providers throughout NYC. MetroPlusHealth and NYC Health + Hospitals collaborate on community initiatives including youth clinics, tax preparation services, and comprehensive care for MetroPlusHealth members.
• Mount Sinai Health SystemcoreTechnology or IntegrationPremier hospital partner within MetroPlusHealth provider network offering specialized and general medical services to MetroPlusHealth members across the NYC area.
• NYU Langone HealthcoreTechnology or IntegrationPremier academic medical center partner within MetroPlusHealth provider network providing specialized healthcare services to members.
• Montefiore Health SystemcoreTechnology or IntegrationMajor hospital system partner within MetroPlusHealth provider network serving members in the Bronx and surrounding areas.
• Hospital for Special Surgery (HSS)coreTechnology or IntegrationSpecialized orthopedic and rheumatology hospital partner within MetroPlusHealth network providing specialized surgical and rehabilitation services.
• CityMDcoreTechnology or IntegrationUrgent care partner with 110+ locations throughout NYC within MetroPlusHealth provider network for accessible urgent care services.
• LabcorpcoreTechnology or IntegrationLaboratory services partner providing diagnostic testing and laboratory services to MetroPlusHealth members through their network of testing facilities.
• Quest DiagnosticscoreTechnology or IntegrationLaboratory services partner providing diagnostic testing services to MetroPlusHealth members through their extensive laboratory network.
• Lenox Hill Radiology (RadNet)coreTechnology or IntegrationRadiology imaging services partner providing diagnostic imaging services including X-rays, MRI, CT scans, and other imaging to MetroPlusHealth members.
• Tribeca PediatricscoreTechnology or IntegrationPediatric primary care provider recently added to MetroPlusHealth network with 50+ new locations and nearly 150 primary care pediatricians across NYC, expanding pediatric access.
• NYC Department of Consumer and Worker Protection (DCWP)majorStrategic or Co-development PartnerCity agency partnership for the 2026 NYC Free Tax Prep initiative, offering free tax preparation services to New Yorkers earning up to $97,000 annually through 140+ sites.
• NYC Health + Hospitals/WoodhullmajorStrategic or Co-development Partner$4 million funding from MetroPlusHealth to establish Elevate You youth clinic at NYC Health + Hospitals/Woodhull providing comprehensive healthcare to young people ages 16-25 including behavioral health, primary care, reproductive care, and social services.
• NYC Health + Hospitals/QueensmajorStrategic or Co-development Partner$4 million funding from MetroPlusHealth to establish Elevate You youth clinic at NYC Health + Hospitals/Queens providing comprehensive healthcare to young people ages 16-25 including behavioral health, primary care, reproductive care, and social services.
• Social Care Networks (SCNs)majorStrategic or Co-development PartnerMedicaid SCN partners including Public Health Solutions (Manhattan, Queens, Brooklyn), Staten Island Performing Provider System, and Somos Healthcare Providers (Bronx) connecting members to housing support, food assistance, employment resources, childcare, and transportation.

Scale indicators7 records

Recent moves7 records

Expansion highlights6 records

Direct peers

• Amerigroup: Amerigroup is Anthem's Medicaid managed care brand with a New York presence focused on Medicaid and related public programs. It directly competes with MetroPlusHealth in NY government segments while benefiting from the scale of a national parent.
• Healthfirst: Healthfirst is NYC's largest not-for-profit health insurer and the city's biggest Medicaid Managed Care plan, with Medicaid, Child Health Plus, Medicare Advantage, and individual/family offerings. It is MetroPlusHealth's most direct same-metro, same-product-line competitor.
• Molina Healthcare: Molina is a national managed care company serving Medicaid, Medicare, and Marketplace members in many states including New York. It is comparable as a government-program-focused health plan operator with significant NY Medicaid exposure and a similar value-based, low-overhead operating model.
• Fidelis Care: Fidelis Care is a New York State-wide health plan owned by Centene focused on Medicaid, Child Health Plus, Essential Plan, Marketplace, Medicare Advantage, and dual-eligible products. It competes head-to-head with MetroPlusHealth across every public-program line in New York.
• Oscar Health: Oscar Health is a New York-area technology-driven health insurer selling individual ACA Marketplace, small group, and Medicare Advantage plans. It directly competes with MetroPlusHealth on the NY State of Health Marketplace where both offer qualified health plans to individuals and families.
• CareSource: CareSource is a national not-for-profit managed care plan serving Medicaid, Marketplace, and Medicare members across multiple states with a mission-driven whole-person care model. The peer is most relevant for its nonprofit governance and Medicaid-centric orientation, mirroring MetroPlusHealth's structure and philosophy.
• VillageCareMax: VillageCareMax is the managed care plan of NYC-based VillageCare, offering Medicaid Managed Long-Term Care and HIV-SNP products in NYC. It directly overlaps with MetroPlusHealth's MLTC and Partnership in Care HIV-SNP and competes for dual-eligible and senior members in the same geography.
• EmblemHealth: EmblemHealth is a New York-based not-for-profit health insurer serving the NYC metro through Medicaid, Medicare, and employer/individual plans. As a fellow mission-driven NYC plan with a multi-line portfolio, it is a close comparable to MetroPlusHealth in product mix and operating geography.

Broad incumbents

• UnitedHealthcare: UnitedHealthcare is the largest U.S. health insurer and has a major New York presence through UnitedHealthcare Community & State (Medicaid), Medicare Advantage, and employer/individual plans. It is a broad incumbent competing with MetroPlusHealth on every product line in NYC at national scale.
• Empire Blue Cross Blue Shield: Empire BlueCross BlueShield is a large New York statewide health plan from Anthem offering commercial, Marketplace, Medicaid, and Medicare products. It is a broader incumbent that competes with MetroPlusHealth across multiple lines as part of a much larger statewide portfolio.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat6 records

Key risks4 records

Key highlights7 records

Customer concentration

• Xx.com/MetroPlusHealth
• Facebookfacebook.com/MetroPlusHealth

Revenue estimate

Valuation estimate

Number of profiles

Profiles2 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments1 record

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about MetroPlusHealth