Elderplan for Medicaid Beneficiaries (HMO D-SNP)
Get All Your Medicare and Medicaid Benefits in One Plan
Making sure you receive the care you need is important to us. Making it easy for you to get that care is important too. We understand that coordinating your Medicare and Medicaid benefits can be challenging. That’s why we created a plan that makes your life a little easier by managing medical, hospital, and prescription drug expenses as well as your Medicare and Medicaid benefits.
Your medical expenses will be covered at little-to-no-cost to you, and you pay minimal co-payments for prescriptions. Plus, you will enjoy an OTC benefit, which includes health-related and select grocery items that you can purchase at a store or order online, as well as home-delivered meals. The plan also includes comprehensive dental and transportation to medical appointments.
If by now it is not clear that our main goal is keeping you healthy and happy, you should also know that as part of this plan, we offer a Wellness Incentive program, which rewards you for receiving preventive screenings and immunizations.
And because we care about your physical and mental well-being, we provide a fitness benefit (that allows you to join classes from home or work out at the gym) and the Brain HQ Memory Fitness Program, a memory fitness program to improve brain function through games, puzzles, and other fun exercises.
Perhaps one of the biggest perks of being enrolled in this plan is that you are assigned a dedicated Care Manager who leads a team of caring clinical professionals all committed to helping you stay healthy. Your Care Manager will stay in touch with your doctors, helping arrange your medical visits as well as transportation to get you there. They will be your go-to person and will work to help ensure you get the care you need to remain safely at home.
The Elderplan for Medicaid Beneficiaries1 plan provides benefits like:
- $0 monthly plan premium2
- $0 co-pay for in-person and telehealth primary care and specialist doctor visits3
- Low co-pays for prescription drug coverage
- Comprehensive dental, including root canals and crowns
- $0 for transportation to medical appointments — up to 6 one-way trips quarterly
- No-cost gym membership to help keep you fit and active, plus over 8,000 online videos4
- $0 co-pay for home-delivered meals after you have been discharged from a hospital or nursing home stay5
- NEW! $130 every month for OTC + Grocery + Meals67
- NEW! BrainHQ® — a memory fitness program to improve brain function through games, puzzles, and other fun exercises
All cost sharing is based on your level of Medicaid eligibility.
Available in the Bronx, Brooklyn, Manhattan, Queens, Nassau and Westchester counties.
Premiums, co-pays, co-insurance and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
Want to learn more about everything Elderplan for Medicaid Beneficiaries (HMO D-SNP) has to offer?
Click on the links below to read more.
- Elderplan for Medicaid Beneficiaries is a dual eligible Special Needs Plan available to Medicare beneficiaries who receive New York State Medicaid or other assistance through New York State medical assistance programs. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Medicaid assistance and/or level of Low-Income Subsidy (LIS) (Extra Help) that you may receive. Please contact the plan for further details. [↩]
- You pay a $39.90 monthly plan premium; however, if you are eligible for Medicare cost-sharing assistance under Medicaid, you pay a $0 monthly plan premium. [↩]
- You pay 20% co-insurance for in-person office primary care and specialist doctor visits; however, if you are eligible for Medicare cost-sharing assistance under Medicaid, you pay 0% co-insurance. There is no co-insurance or co-payment for telehealth primary care services. You pay 20% co-insurance for telehealth specialist services; however, if you are eligible for Medicare cost-sharing assistance under Medicaid, you pay 0% co-insurance. [↩]
- No-cost gym membership is available at all fitness centers and select YMCAs in the Silver&Fit® network. [↩]
- Meals are available following inpatient stay in either the hospital or skilled nursing facility. Limited to 2 meals a day for maximum of 14 days, 2 times per calendar year. [↩]
- For eligible members (with certain chronic conditions), the Special Supplemental Benefits for the Chronically Ill (grocery and meals benefit) combines with the OTC benefit to cover certain grocery items and meals as a part of the monthly OTC allowance. [↩]
- Members in this plan receive a monthly maximum amount ($130 every month) to purchase eligible OTC items at authorized retail stores. The OTC card balance cannot be carried over to the next month. The OTC card is not a debit or credit card and cannot be converted to cash. [↩]