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Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP)
New York Medicare-Medicaid Dual Eligible D-SNP Plan (2024 Plan)
Monthly Premium
Your Cost
$34
by Elderplan
Additional Coverage
HearingVisionDental
Overall Government Star Rating
3.5
out of 5 stars
Ready to Enroll Online?
Plan Overview
Plan Name
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP)
Insurance Carrier
Elderplan
Plan Type
Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP)
Network Type
HMO
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) is a Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP), which is available in New York and offered by the health insurance company Elderplan. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.
Cost Summary
Monthly Premium
$34
Annual Deductible
$0 or $240 per year for in-network services.
Max Out-of-Pocket
$8,850
Primary doctor visit
0% or 20% coinsurance per visit
Specialist visit
0% or 20% coinsurance per visit
ER visit
0% or 20% coinsurance per visit (always covered)
Ambulance
0% or 20% coinsurance
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) has a monthly premium cost of $34 per month, with an annual deductible of $0 or $240 per year for in-network services. and a maximum out of pocket cost sharing of $8,850 In and Out-of-network
$8,850 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) are defined below.
Additional Benefits and Coverage
Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) includes coverage for the following additional benefits:
Other benefits
Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Not covered
Annual physical exams
Not covered
Telehealth
Limited coverage
Comparing the Quality Score of Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) to Other Plans in New York
Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2024, Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) received an overall government quality rating of 3.5 stars out of 5 stars.
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) performed better than New York’s State average overall quality score of 3.4 stars.
This Plan’s 5-star Gov’t Quality Score
New York State Average Score
Overall Government 5 Star Quality Rating
3.5
3.4
Summary rating of health plan quality
3.5
3.4
Staying healthy: screenings, tests, & vaccines
3
3.8
Managing chronic (long term) conditions
4
3.4
Member experience with health plan
3
2.9
Member complaints & changes in the health plan's performance
4
3.2
Health plan customer service
4
3.9
Summary rating of drug plan quality
3
3.4
Drug plan customer service
4
3.9
Member complaints & changes in the drug plan's performance
4
3.4
Member experience with the drug plan
3
3.1
Drug safety & accuracy of drug pricing
3
3.3
The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) received 3.5 stars for its health plan quality score which is better than the New York State average health plan quality score of 3.4 stars.
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) received 3 stars for its drug plan quality score which is worse than the New York State average drug plan quality score of 3.4 stars.
In-network: 0% or 20% coinsurance per visit
Out-of-network: No Data
Specialist visit
In-network: 0% or 20% coinsurance per visit
Out-of-network: 20% coinsurance per visit
Tests, labs, & imaging
Diagnostic tests & procedures
In-network: 0% or 20% coinsurance
Out-of-network: No Data
Lab services
In-network: $0 copay
Out-of-network: No Data
Diagnostic radiology services (like MRI)
In-network: 0% or 20% coinsurance
Out-of-network: No Data
Outpatient x-rays
In-network: 0% or 20% coinsurance
Out-of-network: No Data
Emergency care
0% or 20% coinsurance per visit (always covered)
Urgent care
0% or 20% coinsurance per visit (always covered)
Hospital Services
Inpatient hospital coverage
In-network: In 2024 the amounts for each benefit period are $0 or:
$1,632 deductible for days 1 through 60
$408 copay per day for days 61 through 90
Out-of-network: Not Applicable
Outpatient hospital coverage
In-network: 0% or 20% coinsurance per visit
Out-of-network: No Data
Skilled nursing facility
Skilled nursing facility
In-network: In 2024 the amounts for each benefit period are $0 or:
$0 copay for days 1 through 20
$204 copay per day for days 21 through 100
Out-of-network: Not Applicable
Preventive services
Preventive services
In-network: $0 copay
Out-of-network: No Data
Ambulance
Ground ambulance
In-network: 0% or 20% coinsurance
Out-of-network: No Data
Therapy services
Occupational therapy visit
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Physical therapy & speech & language therapy visit
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Mental health services
Outpatient group therapy with a psychiatrist
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient individual therapy with a psychiatrist
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient group therapy visit
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient individual therapy visit
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Opioid treatment services
Opioid treatment services
Covered
Other services
Durable medical equipment (like wheelchairs & oxygen)
In-network: 0% or 20% coinsurance per item
Out-of-network: No Data
Prosthetics (like braces, artificial limbs)
In-network: 0% or 20% coinsurance per item
Out-of-network: No Data
Diabetes supplies
In-network: $0 copay per item
Out-of-network: No Data
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
Tiers
Initial coverage phase
Gap coverage phase
Catastrophic coverage phase
Preferred Generic
Generic drugs :
25%
Brand-name drugs :
25%
Generic drugs :
$0 copay
Brand-name drugs :
$0 copay
Generic
Preferred Brand
Non-Preferred Drug
Specialty Tier
Part B Drugs
Chemotherapy drugs
In-network: 0% or 0-20% coinsurance
Out-of-network: No Data
Other Part B drugs
In-network: 0% or 0-20% coinsurance
Out-of-network: No Data
Extra Benefits
Hearing
Hearing exam
In-network: 0% or 20% coinsurance
Out-of-network: No Data
Fitting/evaluation
In-network: $0 copay
Out-of-network: No Data
Hearing aids - All types
In-network: $0 copay
Out-of-network: No Data
Preventive Dental
Oral exam
Covered under office visit
Cleaning
Covered under office visit
Fluoride treatment
Not covered
Dental x-rays
Covered under office visit
Comprehensive dental
Non-routine services
Not covered
Diagnostic services
Not covered
Restorative services
In-network: $0 copay
Out-of-network: $0 copay
Endodontics
In-network: $0 copay
Out-of-network: $0 copay
Periodontics
In-network: $0 copay
Out-of-network: $0 copay
Extractions
Not covered
Prosthodontics, other oral/maxillofacial surgery, other services
In-network: $0 copay
Out-of-network: $0 copay
Vision
Routine eye exam
In-network: $0 copay
Out-of-network: No Data
Contact lenses
In-network: $0 copay
Out-of-network: No Data
Eyeglasses (frames & lenses)
In-network: $0 copay
Out-of-network: No Data
Eyeglass frames (only)
In-network: $0 copay
Out-of-network: No Data
Eyeglass lenses (only)
In-network: $0 copay
Out-of-network: No Data
Upgrades
In-network: $0 copay
Out-of-network: No Data
When Can I Sign Up for Medicare?
Enter your birthday month and year to learn when you can sign up for different Medicare plan options.
In this article we rank New York Medicare Advantage plans based on our evaluation of government 5-star quality scores. Each year the government rates the quality of Medicare Advantage health insurance plans with a 5-star quality score. An overall quality score is assigned to each plan which is based on the scores of various quality metrics.
The Medicare landscape in New York is constantly changing. In this article we show a summary of new and returning health insurance companies offering Medicare Advantage Plans (Part C) and Medicare Prescription Drug Plans (Part D) in New York.