Elderplan Frequently Asked Questions

Get answers to frequently asked questions (FAQ) about Elderplan. Explore what makes our coverage different, when you can enroll, and more.

What is Elderplan?

Elderplan provides health plans for at-risk New Yorkers. Our Medicare Advantage Plans provide you with the benefits covered under Original Medicare plus additional benefits like prescription drugs, hearing, vision, dental and more. Learn more about our health plan options.

Is Elderplan new?

No, Elderplan has been providing care to New Yorkers for more than 35 years ago, it’s a not-for-profit health plan that provides Medicare Advantage, and Managed Long-Term Care plans (MLTCP) for Medicare, Medicaid and Dual Medicare and Medicaid beneficiaries across the greater New York area.

What makes Elderplan different?

Elderplan is a not-for-profit health plan. That means we reinvest our earnings into providing more benefits and services for our valued members at little or no additional cost.

Elderplan is also part of MJHS, a not-for-profit health system. Should you require access to additional support and guidance over time and choose to receive services from MJHS, the Elderplan team can work together across the system to coordinate your care better and make it easier for you.

We are proud to be the only health plan that offers a 5-star Medicaid Advantage Plus (MAP) plan in New York State*.

Where is Elderplan offered?

Depending on your health plan, we can provide coverage if you live in the Bronx, Dutchess, Kings, Monroe, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Westchester, Ontario, Orleans, Seneca, Yates, and Livingston counties.

Browse our health plan options to ensure the plan you are interested in is covered in your area.

Why should I enroll in Elderplan if I already have Medicare?

Original Medicare covers a lot of important medical needs like hospital insurance, inpatient care and hospice care through Part A and Medical (Part B). However, it does not provide coverage for other essential benefits such as; comprehensive dental, vision, hearing, gym membership, and Over-the-Counter (OTC) and prescription drug coverage. Enrolling in Elderplan will lower out-of-pocket costs like deductibles and the 20% cost sharing you are responsible for under traditional Original Medicare.

Does Elderplan usually cost less than Original Medicare?

Yes! In most cases, Elderplan can save you money on your Medicare coverage. Elderplan lowers your out-of-pocket expenses like deductibles and the 20% cost-sharing you are responsible for under traditional Original Medicare. Most of our plans have no premium (you continue to pay your Medicare Part B premium) but include extra benefits and coverage that you can’t get with Original Medicare alone. For detailed cost information, please see each plan’s Summary of Benefits.

Do I give up my Original Medicare if I join Elderplan?

No, when you become a member of Elderplan, you are simply telling Medicare that you prefer to have your medical needs taken care of by Elderplan and our extensive network of doctors, hospitals, and pharmacies. If you continue to pay your Medicare Part B premium and Part A premium, if applicable, you will always be entitled to Medicare.

Do I get to keep my doctor?

You must choose a primary care doctor (PCP) that is part of the Elderplan provider network.

You can choose any specialist you want at no additional cost.

Do I have to get a referral for a specialist?

No, you do not need a referral to see specialists, such as cardiologists, gynecologists, dentists, or optometrists. Authorization rules do apply for some specialist services. Call Member Services for more details.

What are Elderplan’s eligibility requirements?
  • You must have Medicare Part A and B
  • Live in the service area for your plan. Please check the service area for the plan you feel best meets your needs.
  • Fall within one of the three enrollment periods for Medicare Advantage. Learn more about Medicare Advantage enrollment periods.
  • Because our plans are tailored to fit your specific needs, additional eligibility requirements may be required for selected plans.
When can I enroll in Elderplan?

The timeframe for enrolling in a Medicare Advantage plan is called an enrollment period. You have three enrollment periods during which you can choose or switch plans each calendar year. Most people become eligible for a Medicare Advantage Plan three months before turning 65. Learn more about Medicare Advantage enrollment periods.

Elderplan MAP is the only 5-Star plan in New York State. This is the highest rating a plan can achieve.*  The New York State Department of Health rates and rewards MAP plans based on their performance on quality measures related to patient safety, preventive screenings, quality of life, satisfaction, and overall health status.

*Based on the most recent results from the DOH Consumer Guide published October 2023