Get All Your Benefits Plus Long-Term Care in One Simple Plan1
- For Medicare and Medicaid (Duals), beneficiaries who qualify for Long-Term Care
- Combines all your benefits, including medical, prescription drugs, behavioral health and long-term care, into one simple plan.
- Provides a personal care worker (PCW) to help you with daily activities, plus attention from a dedicated care management team to help coordinate all your benefits.
- Available in the Bronx, Kings, Nassau, Manhattan, Queens, Richmond, Westchester, Dutchess, Orange, Putnam and Rockland Counties.
Members and their Personal Care Assistants must register with PPL for CDPAS services to avoid disruption in care. Learn more.
Benefits at a Glance
Premium: Zero monthly plan premium
Primary Care: Zero copay for in-person or telehealth primary care visits
Specialist: The freedom to choose any specialist in or out-of-network, giving you greater access to care2
Dental: Includes preventative and comprehensive care, including root canals and crowns. Freedom to choose any dentist in and out of network2
Wellness Incentives: Earn rewards for doing preventative screenings and immunizations through our Wellness Incentive Program
BrainHQ: Improve brain function through a memory fitness program with games, puzzles and other fun exercises
Sign up for BrainHQ
Member-to-Member: Connect with other members with membership in our award-winning Member- to-Member program
Learn more about Member-to-Member
Community Rides: Eligible members3 have the freedom to use your OTC allowance toward community rides, which include grocery stores, farmers’ markets, places of worship, or visiting a friend. It can also be applied to gas, tolls, and parking.
NEW Increased for 2026! OTC: $9504 quarterly towards Traditional OTC. Eligible members3 can use the allowance toward Expanded OTC benefits – including community rides! – Plus, unused funds roll over to the next quarter.5
Flex Card: $500 allowance per year annual for out-of-pocket on dental, vision, hearing and fitness expenses
Learn about the Flex Card Benefit
neW for 2026! Gym Membership: Zero cost gym membership to help keep you fit and active, plus over 15,000 online videos6
Hearing: Zero copay for routine hearing exams + $2,500 on hearing aids – every year for both ears combined
Vision: Zero copay for routine eye exams + $600 on eyewear like contacts or eyeglasses, including lenses and frames – every year
INCREASED for 2025! Acupuncture: Zero copay on acupuncture, acupressure and reflexology visits — up to 60 visits per year
Worldwide Emergency Coverage: Zero copay for up to $50,000 in worldwide emergency coverage + travel assistance services 7
All cost sharing is based on your level of Medicaid eligibility.
Explore our network
Our network includes over 40,000 Specialists, Primary Care Doctors, Pharmacies and Dentists!
Interested in joining this plan?
To qualify for this plan, you must receive a health care assessment from one of our nurses.
Please call our Enrollment Center at 1-866-360-1934 (TTY: 711) to get started.
Representatives are available to assist you 8 a.m. to 8 p.m., seven days a week.
Did you know that now, even more people qualify for Medicaid?
Learn more about Medicaid Spend-down and Medically Needy Income Level (MNIL) in New York State.
Download plan details (PDF)
- To be eligible for this plan, you must be 18 years or older, have Medicare and Medicaid, need community-based long-term care services for more than 120 days, and be assessed as nursing home eligible.[↩]
- 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 SSBCI benefit (expanded OTC). Examples of SSBCI conditions include, but are not limited to, Cardiovascular Disorders, Diabetes, Arthritis, Chronic Lung Disorders, and Chronic Kidney Disease. There are other eligible conditions not listed. Standards may vary for this benefit.[↩][↩]
- The OTC card is not a debit or credit card and cannot be converted to cash.[↩]
- The OTC card balance will be carried over to the next quarter but will expire at the end of the year.[↩]
- No-cost gym membership is available at all fitness centers and select YMCAs in the Silver&Fit® network.[↩]
- Get help 24/7 when you travel more than 100 miles away from home or to another country. This program connects you to doctors, hospitals, pharmacies, and other services all over the world, so you’re never without access to care.[↩]
