Quick answer: Neither MetroPlus nor Healthfirst is automatically the better choice for your state and situation. Both sell plans through NY State of Health, including Essential Plan tiers, but their provider networks and drug lists differ. The right plan is the one that covers your doctors, hospitals, and prescriptions at the lowest total yearly cost — verify on the official marketplace before enrolling.
Citation-ready summary: MetroPlus and Healthfirst are both major New York City health plans offered through NY State of Health, including Essential Plan tiers, and the reliable way to choose between them is to check your own doctors, hospitals, prescriptions, eligibility tier, and total yearly cost against each plan's current-year documents rather than looking for an overall winner.
Last reviewed: July 6, 2026.
Two NYC plans, two different networks
Asking "MetroPlus vs Healthfirst" is the right instinct, but "which is better" has no universal answer. Both are major New York City-focused plans sold through NY State of Health, the state's official marketplace, and both offer Essential Plan tiers alongside other coverage.
What separates them in practice is the network. MetroPlus is the plan tied to NYC Health + Hospitals, the city's public hospital system, so its network is built around those hospitals and their affiliated clinics and physicians. Healthfirst maintains its own, separate network of hospitals and doctors. A cardiologist who takes one plan may not take the other, and participation can even differ between plans from the same carrier. So start the comparison with your providers and prescriptions, not the carrier's name or anyone's ranking.
The six checks that actually decide it
Work through these before you enroll:
- Are your doctors and hospitals in-network? Search each plan's provider directory for the exact plan and tier you'd buy, not just the carrier name. If you rely on NYC Health + Hospitals facilities, confirm coverage under Healthfirst; if you use other hospital systems, confirm them under MetroPlus.
- Are your prescriptions on the formulary? Pull up each plan's current drug list and check every medication you take, including how it's tiered and whether prior authorization applies.
- Which Essential Plan tier do you qualify for? Essential Plan cost-sharing depends on your eligibility tier, which is determined when you apply on NY State of Health — not by the carrier.
- What is the total yearly cost? Add twelve months of premium to the deductible, copays, and coinsurance you'd realistically pay, and note the out-of-pocket maximum. A low premium paired with the wrong network or drug list can cost more overall.
- What changed this plan year? Networks, formularies, and cost-sharing can change every year. Even if you're happy with your current plan, recheck items 1-4 at renewal.
- Does everything check out on NY State of Health? Enrollment in these marketplace and Essential Plan options completes on NY State of Health, and its plan-detail pages are the tiebreaker if a directory and a summary disagree.
| # | Check | Where to verify it |
|---|---|---|
| 1 | Doctors and hospitals in-network for the exact plan | MetroPlus and Healthfirst provider directories |
| 2 | Prescriptions covered at an acceptable tier | Each plan's current-year formulary |
| 3 | Your Essential Plan tier or other program eligibility | NY State of Health application and screening |
| 4 | Total yearly cost, not premium alone | Plan summary of benefits and coverage |
| 5 | Plan-year changes to network, drugs, cost-sharing | Current-year plan documents |
| 6 | Final plan details and enrollment | NY State of Health directly |
Essential Plan shoppers: tier first, carrier second
Both MetroPlus and Healthfirst participate in New York's Essential Plan, which enrolls year-round for those who qualify. Because your tier drives what you pay when you use care, sort out eligibility before you agonize over the carrier — our Essential Plan eligibility guide walks through how the tiers work, and our New York health insurance overview covers the broader marketplace picture. Once you know your tier, run checks 1 and 2 against each carrier's Essential Plan network and drug list specifically, since those can differ from the same carrier's other products.
Timing: when you can actually switch
For 2027 coverage, federal rules require marketplaces to open by November 1, 2026, and close no later than December 31, 2026. NY State of Health has not yet published its exact 2027 open enrollment dates, so verify them on the marketplace before you plan a switch. Outside open enrollment, a qualifying life event — losing job-based coverage, moving, getting married, having a baby — generally gives you 60 days to report it and pick a plan; our guide to health coverage after job loss explains how that works. Essential Plan, Medicaid, and CHIP enroll year-round for those who qualify, so those programs never require waiting for a window.
Sources
- MetroPlus Health Plan: https://metroplus.org/
- Healthfirst: https://healthfirst.org/
- NY State of Health (official New York marketplace): https://nystateofhealth.ny.gov/
If you'd like a second set of eyes on these six checks — doctors, prescriptions, and realistic yearly cost under each plan — use the contact form on this site and we'll help you compare, with licensed producer support where applicable. Availability, eligibility, pricing, and enrollment support depend on the state, carrier, plan year, and licensed producer involved — verify current details with the official marketplace before enrolling.