Medicaid Beneficiaries
(HMO-POS D-SNP)
Welcome to Elderplan for Medicaid Beneficiaries (HMO-POS D-SNP)
Annual Notice of Change
General FAQs
How do my Medicare and Medicaid benefits work together?
Your Elderplan for Medicaid Beneficiaries plan brings your Medicare and Medicaid coverage together to help make it easier to get the care and services you need. Elderplan covers your Medicare benefits and coordinates with your Medicaid coverage for eligible services and costs. Your care team can also help you understand which benefits are covered and how to access them.
What should I do if I receive a bill for health care services?
If you receive a bill you weren’t expecting, don’t pay it right away. Contact Elderplan Member Services so we can review the bill and help determine whether you are responsible for the cost. Be sure to have the bill and your Elderplan Member ID card available when you call.
Who can I contact if I need help with my plan?
You don’t have to navigate your benefits on your own. Elderplan Member Services can answer questions about your coverage, costs and benefits, while your care team can help coordinate your care and connect you with services and resources available through your plan.
What’s Included with Your Plan
At Elderplan, your plan combines your Medicare and Medicaid benefits to help make it easier to get the care, services, and support you need.
This section provides an overview of your benefits (the services and programs available through your plan) and your coverage (how, when, and to what extent those benefits are provided)
Benefits & Coverage
Review what’s included in your plan. Click any section to learn more.
Core Medical Care
Benefits
- Your in-network benefits include inpatient hospital stays, surgery, emergency room visits, and visits to your primary care doctor.
Coverage
- $0 or 20% coinsurance1
- Prior authorization is required for inpatient hospital stays
Doctor Visits
Benefits
- Doctor visits for both Primary Care (PCP) and Specialists.
Coverage
- $0 or 20% coinsurance for Primary Care (PCP) visits for most members.1
- $0 or 20% coinsurance for Specialist visits for most members with Medicaid assistance. No referral is needed to see a specialist.
Preventive Services
Benefits
- Annual wellness visits, cancer screenings (mammograms, colonoscopies), and vaccines (flu, COVID-19).
Coverage
- $0 copayment for most covered services.
Prescription Drugs
Benefits
- Medicare Part D drugs and Medicare Part B drugs (injected or infused).
Coverage
- $0 or $37.90 per month Part D premium.
- $700 Part D deductible. If you receive “Extra Help,” your deductible depends on the level of “Extra Help” you receive and may be $0.
Transportation
Benefits
- Non-emergency trips to health-related locations (taxi, bus, subway/ van, or rideshare).
Coverage
- 24 One-way trips per year to plan-approved locations.
Dental Care
Benefits
- Preventive services (exams, cleanings) and Comprehensive services (fillings, crowns, root canals).
Coverage
- $0 copayment for supplemental services provided through the Point-of-Service (POS) benefit.
Vision
Benefits
- Routine exams, eyewear (frames/lenses).
Coverage
- Yearly routine eye exams.
- $0 copayment.
- $350 annual maximum for frames and lenses or contacts.
Hearing
Benefits
- Routine hearing services and diagnostic hearing services.
Coverage
- One routine hearing exam is covered every 3 years.
- $0 copayment.
- $1,300 for hearing aids every 3 years.
Acupuncture
Benefits
- Supplemental acupuncture services and Medicare-covered acupuncture for chronic low back pain.
Coverage
- $0 copayment for up to 20 in-network visits per year.
OTC
Benefits
- OTC allowance for eligible health-related items and expanded OTC if SSBCI 2 is eligible for groceries, home-delivered meals, pest control and indoor quality, utilities, and rent/mortgage assistance
Coverage
- $200 per month
Flex
Benefits
- Additional allowance for out-of-pocket dental, vision, hearing, or fitness expenses.
Coverage
- $375 annual allowance.
Worldwide Emergency Care
Benefits
- Emergency care, emergency transportation, and urgent care.
Coverage
- $0 copay.
- Maximum benefit of $50,000 per year. Travel assistance is available through Assist America® when more than 100 miles from home or outside the country, for stays of less than 90 consecutive days.
Extras
Wellness Incentive Program
Earn rewards for completing healthy activities
Rewards are earned by completing specific health milestones, such as annual wellness visits or preventive screenings.
Learn More About Your Wellness Incentive
Member-to-Member Program
Engagement and support program
Provides additional social support and peer interaction within the Elderplan community.
Learn More About the Member-to-Member Program
BrainHQ
Online memory fitness program with games and puzzles.
Accessible online to help improve brain function through fun and engaging exercises.
Start Playing Brain HQ Today
Fitness
In person or online
Provides access to participating fitness centers or to 1 Home Fitness Kit per year, plus 15,000 online videos.
Silver & Fit NetworkFootnotes
- 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 copayment 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. ↩
- Eligibility is determined by whether you have a chronic condition associated with the SSBCI benefit (expanded OTC). Examples include, but are not limited to, Cardiovascular Disorders, Diabetes, Arthritis, Chronic Kidney Disease, Chronic Respiratory Disease (e.g., COPD). There are other eligible conditions not listed. Standards may vary for this benefit. ↩
Your OTC & Flex Benefits
Your Elderplan for Medicaid Beneficiaries (HMO-POS D-SNP) plan includes two additional benefits to make everyday health costs more affordable. Together, they give you hundreds of dollars each year to spend on the things that matter most to your health and well-being.
- Your OTC benefit helps you pay for eligible everyday health items, such as vitamins, pain relievers, first-aid supplies, and more. If you qualify for the Expanded OTC benefit (SSBCI)1, you can also use it for additional covered items and services.
- Your Flex benefit gives you an additional annual allowance to help pay out-of-pocket costs for dental, vision, hearing, and fitness expenses.
One card, two benefits. You use the same OTC + Flex Card for both — just pick the right option at checkout. Your OTC and Flex allowances are tracked separately and cannot be combined or transferred.
$200 every month for eligible health items
$375 annual allowance
Footnotes
- 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 copayment 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. ↩
Core Plan Documents
Prescription Drugs
Benefits and Guides
Enrollment
Member Forms
Get Care with Elderplan for Medicaid Beneficiaries (HMO-POS D-SNP)
Everything you need to get the care you need and get the most out of your health plan — all in one place. Select a category below to search for providers, learn how your benefit works, or download a directory if available.
Always show your Elderplan Member ID card when you receive covered services, fill a prescription, or visit any provider.
Find Care & Learn About Your Benefits
Select a section below to search for in-network providers, understand your benefits, and access directories and quick links.
