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.
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.
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.
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.
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.
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.
Is Elderplan new?
No, Elderplan is a well-established, not-for-profit Medicare Advantage health insurance plan that has been serving New York Medicare Beneficiaries, like you, for 35 years. In fact, we started in Brooklyn and then expanded to all five boroughs so that we could also serve the coverage needs of New Yorkers in Manhattan, Queens, Staten Island and the Bronx. In addition, Elderplan also serves Westchester, Nassau, Suffolk Monroe, Putnam and Rockland counties. Our members are our neighbors … and we treat them that way. We understand that New Yorkers have a wide variety of needs when it comes to selecting a health plan. That’s why Elderplan offers a variety of heath care plans for Medicare and long-term care individuals. Who better knows the health care needs of our community? Contact us for more information or to speak with one of our friendly representatives about how you can enroll.
Does Elderplan have a doctor network?
Yes, as an HMO (Health Maintenance Organization), Elderplan has a large network of providers and pharmacies that includes more than 102,684 network health care provider office locations in the New York metropolitan area. If your doctor is in our network, you may continue to see him or her. If your doctor is not part of the Elderplan network, please contact Elderplan so that we may invite your doctor into the network. Or, we can work with you to find a new network physician.
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.
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. – 8 p.m., 7 days a week. If you think you are ready to enroll, click here.
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 15, and through December 7, anyone with Medicare can change the type of Medicare coverage they receive for the following calendar year. Starting January 1 and ending on February 14, members of Medicare Advantage Prescription Drug (MA-PD) will only be able to disenroll from the current Medicare Advantage plan they are on and be allowed to enroll in a standalone Part D Plan with Original Medicare or select just Original Medicare, which would leave them without any prescription coverage.
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.