Get All Your Benefits Plus Long-Term Care in One Simple Plan
This plan may be right for you if you have both Medicare and Medicaid, need long-term care services at home, and want your health care and benefits coordinated through one plan. One Plan for Your Health and Long-Term Care Needs
With Elderplan Plus Long-Term Care, you don’t need a separate long-term care plan. Your Medicare and Medicaid benefits work together under one plan, bringing your medical care, prescription drugs, behavioral health and long-term care services together. If you need help with everyday activities at home, you may also receive support from a personal care worker (PCW), based on your individual needs. A dedicated Care Management Team works with you, your doctors and other providers to coordinate your care, connect you with covered services and help make sure you have the support you need to continue living safely at home.
Our Care Network
Our network includes over 50,000 Specialists, Primary Care Doctors, Pharmacies and Dentists!
Benefits Overview
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.
Plan Documents
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Part C and D Star Ratings New Document Coming Soon
- Summary of Benefits (SOB)
How to Enroll
-
Speak to an Enrollment Specialist1-866-360-1934 (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
- 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.
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