2023 Elderplan for Medicaid Beneficiaries (HMO D-SNP)
A health plan for Medicare Beneficiaries who also have Medicaid that offers extra benefits beyond the doctor’s office.1
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 covering your medical, hospital and prescription drug benefits under one umbrella. Plus, enjoy coverage not available with Original Medicare, such as our Wellness Incentive and Member-to-Member programs, free gym membership and more. With this Plan, you’ll also benefit from a dedicated Care Manager.
Benefits at a Glance
- NEW! $1,860 per year toward Over-the-Counter health-related items plus groceries, home-delivered meals, internet, wireless and utility bill pay23
- Zero monthly plan premium4
- Zero co-pay for in-person or telehealth primary care and specialist doctor visits5
- Low co-pays for prescription drug coverage
- Preventative and Comprehensive dental, including root canals and crowns
- $100 for contacts or eyeglasses (lenses and frames) every year
- Zero-cost transportation to and from medical appointments
- No-cost gym membership to help keep you fit and active, plus over 8,000 online videos6
- BrainHQ— a memory fitness program to improve brain function through games, puzzles and other fun exercises
- Rewards for preventive screenings and immunizations through our Wellness Incentive program
- Membership in our award-winning Member-to-Member program
- Dedicated Care Manager who will stay in touch with your doctors and help arrange your medical visits and transportation to get you there.
- Worldwide emergency coverage up to $50,000
- 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 get in touch with the Elderplan for further details.
- 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 Low-Income Subsidy (LIS) (Extra Help) you may receive. Please get in touch with the Elderplan for further details. [↩]
- Members in this Plan receive a monthly maximum amount (of $155 every month) to purchase eligible OTC items at authorized retail stores. Your OTC card balance cannot carry over to the next month. The OTC card is not a debit or credit card and cannot be converted to cash. [↩]
- For eligible members (with certain chronic conditions) the Special Supplemental Benefits for the Chronically Ill (grocery benefit) combines with the OTC benefit to cover certain grocery items, home-delivered meals, internet, wireless and utility payments as part of the monthly OTC allowance. [↩]
- You pay a $38.90 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. [↩]