Elderplan Frequently Asked Questions
Is Elderplan new?
No, Elderplan is a well-established, not-for-profit Medicare Advantage plan that has been caring for Medicare beneficiaries across the greater New York area for more than 35 years.
What should I know about Elderplan?
Elderplan, a member of the MJHS Health System, provides quality and affordable Medicare Advantage and Long-Term Care plans for New Yorkers. We encourage you to explore all our plans.
Where is Elderplan offered?
Depending on which plan you choose, we can provide you coverage if you live in any of the five boroughs of New York City, Westchester, Nassau, Suffolk, Monroe, Putnam, Rockland, Dutchess or Orange counties. Our members are our neighbors … and we treat them that way.
Why should I enroll in Elderplan if I already have Medicare and Medicaid?
Medicaid may help pay for costs and services that Medicare does not cover, but it is not all-inclusive. Elderplan covers many services that are not included in Medicare or Medicaid like comprehensive dental, vision, hearing, gym membership, OTC drug coverage and prescription drug coverage. Additionally, we offer plans that help coordinate your care and plans that help people with a long-lasting health problem or disability to stay safely at home.
What makes Elderplan Medicare coverage different?
Elderplan is not-for-profit. We can offer affordable co-payments for medical services AND provide additional health benefits beyond what is available in Original Medicare.
Does Elderplan offer all the same benefits as Medicare, including prescription drug coverage?
Yes, all of our plans include prescription drug coverage, and some of our plans cover comprehensive dental and vision, as well as annual over-the-counter allowance and transportation. None of these benefits are included in Original Medicare.
Does Elderplan usually cost less than Original Medicare?
Yes! In most cases, Elderplan can actually save you money on your Medicare coverage. Most of our plans have no plan premium (you continue to pay your Medicare Part B premium) but include extra benefits and coverage that you can’t get with Original Medicare alone. For detailed information about costs, please see the Summary of Benefits for each plan.
How can Elderplan offer so much more than Original Medicare without costing more?
Elderplan is a not-for-profit organization. That means we reinvest our revenue into providing more benefits and services for our valued members. Being not-for-profit enables us to focus our resources on our members and deliver a wide variety of valuable services at little or no additional cost.
Do I give up Medicare if I join Elderplan?
No, when you join Elderplan, you are simply telling Medicare that you prefer to have all of your medical needs taken care of by Elderplan and our extensive network of doctors, hospitals and pharmacies. As long as you continue to pay your Medicare Part B premium and Part A premium, if applicable, you will always be entitled to Medicare.
Do I get to keep my doctor?
If your doctor is in our network, you may continue to see them. As an HMO (Health Maintenance Organization), Elderplan has a large network of providers and pharmacies that includes more than 150,000 provider locations across the New York metropolitan area.
If your doctor is not part of the Elderplan network, please contact Elderplan so that we can work with you to find an in-network provider.
Do I have to get a referral for a specialist?
No, you do not need a referral to see in-network specialists, such as cardiologists, gynecologists, dentists or optometrists. Authorization rules do apply for some specialist services. Call Member Services for more details.
What are the eligibility requirements?
- Have Medicare Part A and B
- Live in the service area of the 5 boroughs of New York City, Westchester, Nassau, Suffolk, Monroe, Putman, Rockland, Dutchess and Orange counties
Because our plans are tailored to fix your specific needs, additional eligibility requirements may be required for selected plans.
When can I enroll in Elderplan?
You may join during certain times of the year based on special needs and other eligibility requirements. To find out when you are eligible to join Elderplan, call 1-866-360-1934 [TTY: 711], 8 a.m. to 8 p.m., 7 days a week. If you think you are ready to enroll, enroll online.
Between February 14 and October 15, you generally cannot change plans or discontinue your membership unless you meet special criteria. This restricted period of time is called a “lock in” period. So it’s important that you choose your plan wisely. Consider ALL the benefits, like prescription drugs and skilled nursing, and speak with one of our enrollment counselors before you join any plan.
Starting October 15th, and through December 7th, anyone with Medicare can change the type of Medicare coverage they receive. The changes will take effect the following calendar year (January 1st).
Starting January 1st and ending on March 31st, members of a Medicare Advantage Prescription Drug (MA-PD) will only be able to switch to another Medicare Advantage Plan (with or without drug coverage) or switch to Original Medicare or a standalone Part D Plan with Original Medicare.
Between March 31 and October 15, you generally cannot change plans or discontinue your membership unless you meet special criteria (e.g., you move into a new service area, you qualify for or lose eligibility for Medicaid or Low-Income Subsidy).
Beneficiaries who have both Medicare and Medical Assistance from the State and/or who require an institutional level of care may enroll at any time.
There is a new special enrollment period that allows people with Medicare and Medicaid to enroll, disenroll or switch to another Medicare Advantage plan once per quarter during the first three quarters of the year. During the fourth quarter, duals wishing to change plans must take advantage of the Annual Enrollment Period (October 15 – December 7), with their changes becoming effective January 1 of the following year.
How do I enroll in Elderplan?
If you are ready to enroll in one of our Medicare Advantage plans such as Elderplan Extra Help (HMO) or Elderplan for Medicaid Beneficiaries (HMO D-SNP) you can enroll today by enrolling online or calling 1-866-360-1934 [TTY: 711 for the hearing impaired], 8 a.m. to 8 p.m., 7 days a week.
If you are ready to enroll in one of our Medicare Advantage plans such as Elderplan Plus Long-Term Care (HMO D-SNP), Elderplan Advantage for Nursing Home Residents (HMO I-SNP), or Elderplan Assist (HMO IE-SNP) you can get started by calling 1-866-360-1934 [TTY: 711 for the hearing impaired], 8 a.m. to 8 p.m., 7 days a week to confirm your eligibility.
If you want to begin enrollment in HomeFirst Managed Long-Term Care (MLTC), you can get started by calling 1-866-386-4177 [TTY: 711 for the hearing impaired], 8:30 a.m. to 5 p.m., Monday to Friday to confirm your eligibility.