MetroPlusHealth announced a significant expansion of its Gold Plan benefits for New York City employees and their families, effective July 1, 2026. The updates include the removal of specialist referral requirements, $0 copays for urgent care, and the introduction of new maternal health coverage, according to a company release.
What changes for Gold Plan members?
Starting July 1, 2026, members gain direct access to in-network specialists without the need for prior referrals. According to Dr. Talya Schwartz, President and Chief Executive Officer of MetroPlusHealth, this change aims to remove barriers to care and provide members with greater control over their medical needs. The plan also maintains a $0 monthly premium and $0 deductible for individuals and families. Additionally, members now have access to a $0 copay for 24/7 telehealth services through MetroPlusHealth Virtual Visit and an annual transportation allowance of up to $60 for doctor’s visits.
What new wellness and pharmacy benefits are available?
The updated Gold Plan offers a broader range of preventive and wellness incentives. Pharmacy benefits have grown to include $0 costs for over 125 medications, a 25% increase from the previous year. New additions to the no-cost drug list include ibuprofen 600mg, tretinoin, fluticasone nasal spray, and ketoconazole shampoo. Wellness perks now include 26 annual dietician visits, 10 acupuncture sessions, up to $1,400 in annual fitness club reimbursements, and $300 for wellness app usage. Members may also earn up to $250 in annual rewards.
What support services begin in 2027?
Beginning January 1, 2027, MetroPlusHealth will introduce coverage for doula services, which includes eight prenatal or postpartum visits and one in-person labor and delivery support visit per pregnancy. According to the company, this initiative is designed to improve maternal health outcomes. The 2027 expansion also includes $0 copays for urgent care visits and coverage for up to eight routine podiatry visits annually.
What happens next for the health plan?
As these benefits roll out, MetroPlusHealth is positioned to integrate these services across its network, which serves nearly 700,000 members. Because the plan is a wholly owned subsidiary of NYC Health + Hospitals, the administrative transition for these expanded benefits is likely to be managed through existing provider partnerships, which include major systems such as NYU Langone Health, Mount Sinai, and Memorial Sloan Kettering. While these changes are immediate for most, non-grandfathered members should monitor their specific plan documentation regarding the reduced pharmacy rider costs. The long-term impact of these enhancements could serve as a model for how the system addresses social determinants of health for the city’s workforce.
