Elderplan has been approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) until 12/31/2015. NCQA’s approval is based on a review of Elderplan Model of Care and is an indicator of compliance with CMS requirements. NCQA’s approval is not an endorsement by CMS and/or NCQA of Elderplan or the quality of service provided by Elderplan. Elderplan will still need to be approved each year by CMS in order to operate. If you have questions regarding our approval by the NCQA, please contact us at 1-800-353-3765.

Elderplan is a health plan with a Medicare contract. Individuals must have both Part A and Part B to enroll. You must continue to pay your Medicare Part B premium if not otherwise paid for by Medicaid.

Members must receive all routine care from plan providers.

Authorization rules may apply for certain services. Limitations, copayments and restrictions may apply. Members may enroll in Elderplan only during specific times of the year. Contact Elderplan for more information. Plan materials are available in alternative formats or languages. Please call Elderplan’s Member Services Department at 1-800-353-3765 (TTY 711 for the hearing impaired), between 8 a.m. – 8 p.m., 7 days a week, to request materials in alternate formats.

Esta información puede estar disponible en diferentes idiomas o formatos. Favor de llamar al 1-800-353-3765 (TTY 711) de 8:00 a.m. a 8:00 p.m., 7 dias a la semana. Si necesita obtener información en otro formato o idioma, comuníquese con el Servicio de Atención al Cliente al número mencionado anteriormente.

Elderplan’s Medicare Prescription Drug benefit is only available to enrolled members. If a beneficiary is already enrolled in a Medicare Advantage Part D (MA-PD) Plan, the enrollee must receive his/her Medicare Prescription Drug benefit through that plan.

Elderplan renews its contract with the Centers for Medicare and Medicaid Services (CMS) annually. Benefits beyond the current contract year are not guaranteed.

Elderplan’s pharmacy network includes retail, mail order, long-term care and home infusion pharmacies. For mail order information and additional information about network pharmacies, contact Elderplan’s Member Services Department at 1-800-353-3765 (TTY 711 the hearing impaired), between 8 a.m.– 8 p.m., 7 days a week. Information may also be obtained by writing Elderplan, Attention: Member Service Department, 6323 Seventh Ave., 3rd Floor, Brooklyn, NY 11220-4711.

In general, beneficiaries must use network pharmacies to access their prescription drug benefit, except in non-routine circumstances, and quantity limitations and restrictions may apply.

Medicare beneficiaries may enroll in Elderplan through the CMS Medicare Online Enrollment Center, located at www.medicare.gov. For more information, contact Elderplan’s Member Services Department at 1-800-353-3765 (TTY 711) for the hearing impaired), between 8 a.m.– 8 p.m., 7 days a week.

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call:

  • 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week;
  • The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or
  • Your State Medicaid Office
  • People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you qualify, Medicare could pay for up to seventy-five (75) percent or more of your drug costs, including monthly prescription drug premiums, annual deductibles and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t know it. For more information about this Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.