Enjoy Having All Your Benefits in One Plan
An ideal plan for dual Medicare and Medicaid beneficiaries who seek medical, hospital and prescription drug Coverage all under one umbrella.
Receive assistance from a dedicated care manager who will help you navigate your benefits, ensuring that you get the care and services you need.
Available in the Bronx, Manhattan, Queens, and Brooklyn, as well as Westchester, Nassau, Putnam and Richmond Counties.
Our Care Network
Our network includes over 40,000 Specialists, Primary Care Doctors, Pharmacies and Dentists!
Dedicated Care Manager: Helps you navigate your benefits, ensuring that you get the care and services you need.
Benefits Overview
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.
Plan Documents
How to Enroll
-
Find a Doctor1-866-360-1934 (TTY: 711)
8 a.m. to 8 p.m., 7 days a week -
Make an AppointmentTo confirm eligibility, please
book an appointment. -
MailDownload our Enrollment Form and mail it with the Attestation for Enrollment Eligibility.
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.
- 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.
Common Plan & Coverage Questions
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