Plus Long-Term Care
(HMO POS D-SNP)
Welcome to Elderplan Plus Long-Term Care (HMO-POS D-SNP)
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Learn how to compare and choose a plan
General FAQs
How do I get home care or other long-term care services?
Your Care Manager is your first point of contact. They work with you, your doctors, and your caregivers to assess your needs, develop your care plan, and arrange covered long-term care services. If your needs change, contact your Care Manager so they can review and update your care plan.
Who should I call if I have questions about my coverage or need to change a service?
Start with your Care Manager. They can explain your benefits, coordinate your care, answer questions about covered services, and arrange or change services as your needs change.
Do I still have Medicare and Medicaid after joining the plan?
Yes. Elderplan Plus Long-Term Care combines your Medicare and Medicaid benefits into one coordinated plan. You’ll continue to receive covered Medicare and Medicaid services, but Elderplan helps coordinate your care and makes it easier to access the services you need.
What’s Included with Your Plan
At Elderplan, your Coverage supports your health, independence, and ability to remain in your home and community.
This section clearly outlines your benefits (the services and programs available to you) and your Coverage (how, when, and to what extent those benefits are provided).
Benefits at a Glance
Core Medical Care
Benefits
Inpatient hospital stays, surgery, and emergency room visits.
Coverage
Covered when medically necessary. Prior authorization is required.
Doctor Visits
Benefits
Primary Care Provider (PCP) and Specialist visits
Coverage
- Primary Care Provider: $0 copay, in-network only
- Specialist: $0 copay, in-network and out-of-network1. No referral needed to see a specialist.
Preventive Services
Benefits
Annual wellness visits, cancer screenings (mammograms, colonoscopies), and vaccines (flu, COVID-19, shingles, RSV, and more).
Coverage
$0 copay.
Prescription Drugs
Benefits
Medicare Part D prescription drugs
Coverage
- $0 monthly Part D premium
- $700 Part D deductible. Depending on your Extra Help, you pay $0, $1.65, $5.80, or 25% of the cost.
Long-Term Services and Supports (LTSS)
Benefits
Care Management, Home Health Care Services, Personal Care Services (PCS), Consumer-Directed Personal Assistance Services (CDPAS), Private-Duty Nursing, Adult Day Health Care, Social Day Care, Home-Delivered and Congregate Meals, Nutrition, Medical Social Services, Social and Environmental Supports, Personal Emergency Response Services (PERS), and a Routine Physical Exam.
Coverage
$0 cost for Medicaid-covered benefits, coordinated by your Elderplan care team. Most services require prior authorization.
Transportation
Benefits
Community Rides
Coverage
You get the freedom to travel to any location not related to your medical care, to visit friends and family, pharmacies, grocery stores, houses of worship,
fitness centers, banks, post offices and even your favorite senior center. Paid from your monthly OTC allowance for members who qualify through the Expanded OTC benefit 2.
Dental Care
Benefits
Preventive services (exams, cleanings, X-rays) and comprehensive services (fillings, crowns, root canals, dentures and more).
Coverage
$0 copay for covred dentail sevices, in- and out-of-network1. Some services may require prior authorization.
Vision
Benefits
Routine exams and eyewear (frames and lenses, or contact lenses).
Coverage
- $0 copay for your yearly routine eye exam.
- Up to $600 a year toward frames and lenses or contacts.
Hearing
Benefits
Routine hearing services, hearing aids (all types), and fitting and evaluation.
Coverage
- $0 copay for the diagnostic hearing exam.
- Up to $2,000 for hearing aids, both ears combined, each year. Prior authorization required for hearing aids.
Acupuncture
Benefits
Acupuncture and related therapies — cupping/moxa, acupressure, Tui Na, Gua Sha, reflexology, and infrared therapy
Coverage
$0 copay, up to 60 visits a year (in-network).
OTC
Benefits
Over-the-counter allowance for eligible health items — pain relief, vitamins, oral care, cold and allergy medicine, first aid, and more. Members who qualify can access the Expanded OTC benefit 2
Coverage
$290 per month. Your balance rolls over month to month but expires at the end of the calendar year
Flex
Benefits
Additional allowance for out-of-pocket dental, vision, hearing, or fitness expenses.
Coverage
$400 a year on a Visa-accepted prepaid card to use toward dental, vision, hearing, and fitness expenses.
Worldwide Emergency Care
Benefits
Emergency care, urgent care, and emergency transportation anywhere in the world.
Coverage
$0 copay, up to $50,000 a year. Travel assistance through Assist America® when more than 100 miles from home or outside the U.S., for stays under 90 consecutive days.
Additional Plan Notes
- Cost-Sharing: With Medicaid assistance, most members pay $0 for all covered services, as long as they follow plan rules, such as using network providers (where required) and obtaining necessary authorizations.
- Medicaid Coordination: Unlike many other plans, Elderplan Plus Long-Term Care (HMO-POS D-SNP) covers your long-term services and supports directly — you do not need a separate Medicaid card for most of your care.
- You must renew your Medicaid Coverage every year. Need help with your Medicaid application or renewal? Get Medicaid Support.
- Leaving Elderplan Plus Long-Term Care (HMO-POS D-SNP): Being in this plan is your choice. You can leave whenever you want. Learn more about disenrolling from your Elderplan plan.
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 BrainHQ 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.
Browse the Silver&Fit NetworkFootnotes
- Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our Member Services number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. ↩
- 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 Plus Long-Term Care (HMO-POS D-SNP) benefits come with two powerful extras designed 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 allows you to shop for eligible health items such as vitamins, pain relievers, first-aid supplies, and more. If you qualify for the Expanded OTC 2, your OTC benefit expands even further to help cover additional items.
- 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.
View Benefit Details
$290 every month for eligible health items
$400 annual allowance
Footnotes
- 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. ↩
Core Plan Documents
Prescription Drugs
Benefits and Guides
Enrollment
Member Forms
Prior Authorization
Get Care with Elderplan Plus Long-Term Care (HMO-POS D-SNP)
Everything you need to find doctors, check your coverage, and get the most out of your health plan — all in one place. Select a category below to search for a doctor, learn how your benefit works, or download a directory.
Always show your Elderplan Member ID card whenever you receive covered services, fill a prescription, or visit a provider.
Find Care & Learn About Your Benefits
