Select
(HMO-POS I-SNP/IE-SNP)
Welcome to Elderplan Select (HMO-POS I-SNP/IE-SNP)
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General FAQs
Does Elderplan Select pay for my nursing home or assisted living?
Elderplan Select does not pay for your room, meals, or the cost of living in a nursing home or assisted living community.
Your Elderplan Select plan covers your Medicare health care and benefits while you live there. This can include doctor visits, hospital care, prescription drugs, and other covered services and benefits included with your plan.
The cost of living in a nursing home or assisted living community — including your room, meals, and help with everyday activities such as bathing, dressing, or eating — is separate from your Elderplan Select coverage. Depending on your situation, these costs may be paid through Medicaid, long-term care insurance, or private payment.
Who will take care of me, and can I keep my doctor?
With Elderplan Select, you have a care team that works with you and the staff at the place where you live to help coordinate your care.
As part of your plan, a nurse practitioner or physician assistant can provide care where you live. They work closely with you, your doctors, and your facility or community to understand your health needs, monitor changes in your health, and help you get the care you need.
How does my OTC benefit work, and what additional allowances do I have?
Your plan includes a monthly OTC allowance for eligible over-the-counter health and wellness items.
Your plan also includes additional allowances to help with certain out-of-pocket expenses, including dental care, transportation and vision services.
Each allowance is separate and can only be used for eligible expenses within that benefit category. You cannot combine or transfer allowances between categories. For example, you can’t use an unused dental allowance for vision or transportation expenses.
The amount available, how often it renews and what expenses are eligible depend on the benefit.
Visit the OTC and Additional Allowances section to learn more about your monthly OTC benefit, your additional allowances and how to use them.
What’s Included with Your Plan
With Elderplan Select, you get your own care team. Your team includes a nurse practitioner or physician assistant and a registered nurse. Your care team works with your doctors to manage and coordinate your care.
Below you’ll find a clear overview of your benefits (the services and programs available to you) and your Coverage (how, when, and to what extent those benefits are provided). For full details, refer to your Evidence of Coverage.
Benefits at a Glance
Routine Doctor Visits
Benefits
Get the routine medical care you need from primary care providers, specialists, nurse practitioners and physician assistants, in person or through telehealth.
Coverage
| Benefit | In-network cost | Out-of-network cost | Prior Authorization |
|---|---|---|---|
| Care team visits (nurse practitioner or physician assistant) | $0 | $0 | May be required |
| Primary care (PCP)
Office visits or telehealth |
$0 copay per visit | $0 copay per visit
|
Not needed |
| Specialist
Office visits or telehealth. |
$45 copay per visit
|
$45 copay per visit
|
A referral may be needed |
| Nurse Practitioner & Physician Assistants | $0 copay | $0 copay | Referral may be required |
| Routine Podiatry | $10 per visit | $10 per visit | Up to 6 visits per year, in- and out-of-network combined |
Tests and Imaging
Benefits
Get the tests and imaging your doctor needs to help diagnose, monitor and manage your health
Coverage
| Benefit | In-network cost | Out-of-network cost | Prior Authorization |
|---|---|---|---|
| PET, MRI, MRA | $75 Copay
|
$75 Copay | Required |
| Labs, diagnostic tests, X-rays | $0 copay | $0 copay | Required |
| CT Scans | $0 | $0 copay
|
Required |
| Radiation Therapy | $85 Copay | $85 Copay | No |
Mental Health Care
Benefits
Mental Health
Coverage
| Benefit | In-network cost | Out-of-network cost | Prior Authorization |
|---|---|---|---|
| Inpatient mental health care | Per admission: $250 copay each day for days 1–6. $0 copay each day from day 7 on.
|
Not Covered | Required |
| Outpatient mental health care: Individual and group sessions | $50 copay per session. Also available by telehealth. Call your provider for details. | $50 copay per session | Required |
| Psychiatric services: Individual and group sessions | $55 copay per session. Also available by telehealth. Call your provider for details. | $55 copay per session
|
Required |
Hospital and Emergency
Benefits
Get the care you need when you’re seriously ill, injured or need immediate medical attention, including hospital stays and emergency services.
Coverage
| Benefit | In-network Cost | Out-of-network Cost | Prior Authorization |
|---|---|---|---|
| Emergency Room | $115 waived if admitted within 24 hours | $115 waived if admitted within 24 hours | No |
| Ambulance | Ground $115/trip; air 20% | Ground $115/trip; air 20% | Authorization is required for non-emergency services and ground |
| Inpatient Hospital | $320/day for days 1-6, then $0. | $320/day for days 1-6, then $0. | Yes |
| Outpatient Hospital | $175 | $175 | No |
| Ambulatory Surgical Center | $100 | $100 | Referral may be required |
Recovery and Rehab
Benefits
Get the care and support you need to recover, regain strength and maintain your independence after an illness, injury or hospital stay.
Coverage
| Benefit | In-network cost | Out-of-network cost | Prior Authorization |
|---|---|---|---|
| Skilled nursing facility | $0 for days 1–20; $221/day for 21–100; full cost after 100 | Not covered | Yes (no prior hospital stay needed) |
| Home Health | $0 | $0 | Yes, must be homebound |
| Physical and Speech Therapy | $55/visit | $55/visit | Yes |
| Occupational Therapy | $35/visit | $35/visit | Yes |
| Cardiac Pulmonary Rehab | Cardiac $30 (intensive $40); pulmonary $25 | Not Covered | Yes |
Prescription Drugs
Benefits
Drugs you fill at the pharmacy, plus drugs a provider gives you (like infusions). Insulin is capped at $35 for a one-month supply.
Coverage
| Benefit | In-network cost | Out-of-network cost | Prior Authorization |
|---|---|---|---|
| Part D | Deductible: $0 for Tier 1, 2 and 3 drugs. $350 for Tier 4 and 5 drugs.
Then, for a 1-month supply: Tier 1: $0. Tier 2: $2. Tier 3: $25. Tier 4: $100. Tier 5: 29% of the cost. Insulin: no more than $35 for a 1-month supply. |
Not Covered | Some drugs |
| Part B | 20% of the cost. Part B insulin: up to $35. | May be required for certain drugs. Some drugs require step therapy (trying another drug first). | |
Dental, Vision, Hearing
Benefits
Get Coverage for dental, hearing and vision care to help you maintain your overall health and quality of life.
Coverage
| Benefit | In-network cost | Out-of-network cost | Prior Authorization |
|---|---|---|---|
| Medicare-covered dental | 20% coinsurance | Not Covered | |
| Supplemental Dental- Preventative and Comprehensive | $0 copay up to $1,950 annual allowance | Not Covered | No |
| Vision Care (Medicare & Routine) | $0 copay for Medicare exams & post-cataract
$0 copay for routine exam and eyewear up to $150 per year |
In-Network Only | No |
| Medicare Covered Hearing | $0 copay for Medicare-covered hearing exams
$0 copay for diagnostic hearing services and hearing aids and $1,000 annual allowance |
In-network only for hearing | No |
Preventive Services
Benefits
Screenings & wellness
Coverage
| Benefit | In-network cost | Out-of-network cost | Prior Authorization |
|---|---|---|---|
| Annual wellness visit, cancer screenings (mammograms, colonoscopies), smoking cessation, and vaccines (flu, COVID-19). | $0 copay for Medicare-covered preventative services to in-network cost-share | $0 copay for Medicare-covered preventative services | Not needed |
Transportation
Benefits
Getting to medical and therapeutic places.
Coverage
| Benefit | In-network cost | Out-of-network cost | Prior approval |
|---|---|---|---|
| Ground ambulance | $115 copay per one-way trip | Needed only for rides that are not emergencies | |
| Air ambulance | 20% of the cost per one-way trip | ||
| Rides to your appointments:
Unlimited one-way rides to medical and therapeutic places by taxi, ride-share, bus, subway, van or medical transport |
Covered up to $1,000 every 3 months | Prepaid allowance used at approved retailers. |
OTC and Flexible Spending Allowances
Benefits
Monthly OTC allowance toward health-related items and additional spending alternatives toward dental and vision.
Coverage
| Benefit | In-network cost | Out-of-network cost | Prior approval |
|---|---|---|---|
| Over-the-counter (OTC) items | $175 per month | N/A | Not needed |
| Flexible Spending Alternative Loaded on your OTC Card. |
Dental Up to $1,950 per year. |
N/A | Not needed |
| Vision (routine) Up to $150 per year. |
|||
| Transportation (plan-approved) Up to $1,000 every 3 months. |
|||
| Acupuncture, chiropractic & alternative therapy $250 every three months |
- Maximum out-of-pocket (MOOP). $9,850 combined in-network and out-of-network for Part A and Part B services. Once you reach this amount, Elderplan Select pays the full cost of covered Part A and Part B services for the rest of the year.
- Part B premium giveback. Elderplan Select credits $2.50 per month toward your Medicare Part B premium. If your Part B premium is deducted from your Social Security check, the giveback is added back each month.
- Out-of-network: Non-contracted providers must agree to treat you and may deny care except in an emergency or urgent situation.
- Cost-sharing. If you have Medicaid, your Medicaid plan may pay some or all of your Medicare cost-sharing. Show both your Elderplan card and your Medicaid card every time you receive services.
- Leaving Elderplan Select: This plan is your choice. You can leave whenever you want. Learn more about disenrolling from your Elderplan plan.
Extras
Therapeutic Leave
Overnight stays away from your skilled facility.
Learn more about Therapeutic Leave
BrainHQ
Online memory fitness program with games and puzzles
Accessible online to help improve brain function through fun and engaging exercises
Start Playing BrainHQ TodayYour OTC & Extra Allowances
Your Elderplan Select (HMO-POS I-SNP/EI-SNP) includes an OTC benefit that gives you money on a prepaid card to spend on eligible health and wellness items you use every day. Your plan also includes additional allowances to help with certain health-related expenses, such as transportation, vision care and more.
Eligible members may have access to more. If you have a qualifying chronic condition, your OTC benefit may expand to cover additional everyday needs and expenses, including healthy foods, home-delivered meals, hearing aids and more.
$175 every month for eligible health items
Learn more about your flexible spending allowances
Get Care with Elderplan Select (HMO-POS I-SNP/IE-SNP)
Everything you need to get the care you need and get the most out of your Elderplan Select (HMO-POS I-SNP/IE-SNP) 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.
Show your Elderplan card every time you receive covered services, fill a prescription, or visit any provider.
Find a Provider and Learn How Your Coverage Works
Select a section below to search for in-network providers, understand your benefits, and access directories and quick links.
