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Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP)

New York Institutional Special Needs I-SNP Plan (2026 Plan)

Monthly Premium

Your Cost
$45
by Elderplan

Additional Coverage

HearingVision

Overall Government Star Rating

 3.5
out of 5 stars

Ready to Enroll Online?

Plan Overview

Plan Name
Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP)
Insurance Carrier
Elderplan
Plan Type
Institutional Special Needs Plan (I-SNP)
Network Type
HMO

Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) is a Institutional Special Needs Plan (I-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
$45
Annual Deductible
Coming soon
Max Out-of-Pocket
$9,250
Primary doctor visit
$0 copay
Specialist visit
0%-20% coinsurance
ER visit
20% coinsurance
Ambulance
20% coinsurance

Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) has a monthly premium cost of $45 per month, with an annual deductible of Coming soon and a maximum out of pocket cost sharing of $9,250 In and Out-of-network $9,250 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 Advantage For Nursing Home Residents (HMO-POS I-SNP) are defined below.

Additional Benefits and Coverage

Yes
Part D Prescription Drug Coverage
No
Dental
Yes
Vision
Yes
Hearing

Elderplan Advantage For Nursing Home Residents (HMO-POS I-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 Advantage For Nursing Home Residents (HMO-POS I-SNP) includes coverage for hearing, vision.

Medicare Advantage health plans can offer even more additional benefits. Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Not covered
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 Advantage For Nursing Home Residents (HMO-POS I-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 2026, Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) received an overall government quality rating of 3.5 stars out of 5 stars.

Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) performed worse than New York’s State average overall quality score of 3.8 stars.

This Plan’s 5-star Gov’t Quality Score
New York State Average Score
Overall Government 5 Star Quality Rating
 3.5
 3.8
Summary rating of health plan quality
 3
 3.6
Staying healthy: screenings, tests, & vaccines
 4
 3.8
Managing chronic (long term) conditions
 3
 3.2
Member experience with health plan
 3
 3.3
Member complaints & changes in the health plan's performance
 4
 4.1
Health plan customer service
 4
 3.8
Summary rating of drug plan quality
 3.5
 3.9
Drug plan customer service
 4
 4.3
Member complaints & changes in the drug plan's performance
 4
 4.3
Member experience with the drug plan
(coming soon)
 3.3
Drug safety & accuracy of drug pricing
 4
 3.8

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 Advantage For Nursing Home Residents (HMO-POS I-SNP) received 3 stars for its health plan quality score which is worse than the New York State average health plan quality score of 3.6 stars.

Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) received 3.5 stars for its drug plan quality score which is worse than the New York State average drug plan quality score of 3.9 stars.

Plan Benefits and Coverage Details

Monthly Premium
$45
Health Portion of Premium
$0
Drug Portion of Premium
$45
Health Plan Deductible
Coming soon
Health Plan Max Out-of-Pocket
$9,250 In and Out-of-network
$9,250 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
No
Doctor Lookup Link
http://www.elderplan.org
Plan Link
http://www.elderplan.org

Medical Benefits

Doctor Services

Primary doctor visit
In-network: $0 copay
Out-of-network: $0 copay
Specialist visit
In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance

Tests, labs, & imaging

Diagnostic tests & procedures
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Lab services
In-network: $0 copay
Out-of-network: $0 copay
Diagnostic radiology services (like MRI)
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient x-rays
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Emergency care
20% coinsurance
Urgent care
$0 copay

Hospital Services

Inpatient hospital coverage
In-network:
  Tier 1
  $0 per day for days 1-60
  $434 per day for days 61-90
  $868 per day for days 91-150
Out-of-network:
  $0 per day for days 1-60
  $434 per day for days 61-90
  $868 per day for days 91-150
Outpatient hospital coverage
In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Skilled nursing facility

Skilled nursing facility
In-network:
  Tier 1
  $0 per day for days 1-20
  $217 per day for days 21-100
Out-of-network:
  $ per stay

Preventive services

Preventive services
In-network: $0 copay
Out-of-network: $0 copay

Ambulance

Ground ambulance
In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Therapy services

Occupational therapy visit
In-network: $0 copay
Out-of-network: $0 copay
Physical therapy & speech & language therapy visit
In-network: $0 copay
Out-of-network: $0 copay

Mental health services

Outpatient group therapy with a psychiatrist
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient individual therapy with a psychiatrist
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient group therapy visit
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient individual therapy visit
In-network: 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 copay
Out-of-network: $0 copay
Prosthetics (like braces, artificial limbs)
In-network: $0 copay
Out-of-network: $0 copay
Diabetes supplies
In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Prescription Drug Benefits

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseCatastrophic coverage phase
Preferred Generic


Generic drugs :
25% coinsurance

Brand-name drugs :
25% coinsurance


Generic drugs :
0% coinsurance

Brand-name drugs :
0% coinsurance

Generic
Preferred Brand
Non-Preferred Drug
Specialty Tier

Part B Drugs

Chemotherapy drugs
In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance
Other Part B drugs
In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance

Extra Benefits

Hearing

Hearing exam
In-network: $0 copay
Out-of-network: $0 copay
Fitting/evaluation
In-network: $0 copay
Out-of-network: $0 copay
Hearing aids - prescription
In-network: $0 copay
Out-of-network: $0 copay
Hearing aids - over the counter
Not covered

Preventive Dental

Oral exam
Not covered
Cleaning
Not covered
Fluoride treatment
Not covered
Dental x-rays
Not covered

Comprehensive dental

Restorative services
Not covered
Endodontics
Not covered
Periodontics
Not covered
Prosthodontics, removable
Not covered
Prosthodontics, fixed
Not covered
Maxillofacial prosthetics
Not covered
Implant services
Not covered
Oral and maxillofacial surgery
Not covered
Orthodontics
Not covered
Adjunctive general services
Not covered

Vision

Routine eye exam
In-network: $0 copay
Out-of-network: $0 copay
Contact lenses
In-network: $0 copay
Out-of-network: $0 copay
Eyeglasses (frames & lenses)
In-network: $0 copay
Out-of-network: $0 copay
Eyeglass frames (only)
In-network: $0 copay
Out-of-network: $0 copay
Eyeglass lenses (only)
In-network: $0 copay
Out-of-network: $0 copay
Upgrades
In-network: $0 copay
Out-of-network: $0 copay

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