Elderplan for Medicaid Beneficiaries (HMO D-SNP)
A plan designed for Medicare and Medicaid beneficiaries that covers all medical expenses at no cost and prescription coverage with minimal co-payments. Plus, you will enjoy an over-the-counter (OTC) benefit which now includes both health-related and select grocery items, gym membership, comprehensive dental and transportation to medical appointments.
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 or telehealth primary care and specialist doctor visits3
- $120 every month for over-the-counter (OTC), health-related items45
- NEW! Use your OTC benefit to purchase groceries, too!45
- Low co-pays for prescription drug coverage
- $0 co-pay for acupuncture – up to 20 visits per year
- Free transportation to medical appointments – up to 6 one-way trips every 3 months
- Comprehensive dental, including root canals and crowns
- $0 co-pays for Medicare-covered diabetic supplies
- No-cost gym membership to help keep you fit and active6
- NEW! $0 co-pay for home-delivered meals after you have been discharged from a hospital or nursing home stay7
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.
- 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 $35.40 monthly plan premium, however, if you are eligible for Medicare cost-sharing assistance under Medicaid, you pay $0 monthly plan premium. [↩]
- You pay 20% coinsurance 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% coinsurance. There is no coinsurance or copayment for telehealth primary care services. You pay 20% coinsurance for telehealth specialist services, however if you are eligible for Medicare cost-sharing assistance under Medicaid, you pay 0% coinsurance. [↩]
- 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 as a part of the monthly OTC allowance. [↩] [↩]
- Members in this plan receive a monthly maximum amount ($120 every month) to purchase eligible over-the counter (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. [↩] [↩]
- 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. [↩]