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Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP)

New York Medicare-Medicaid Dual Eligible D-SNP Plan (2025 Plan)

Monthly Premium

Your Cost
$31
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
$31
Annual Deductible
Coming soon
Max Out-of-Pocket
$9,350
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 $31 per month, with an annual deductible of Coming soon and a maximum out of pocket cost sharing of $9,350 In and Out-of-network $9,350 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 2025, 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
 3.6
Managing chronic (long term) conditions
 3
 3.5
Member experience with health plan
 4
 3.1
Member complaints & changes in the health plan's performance
 4
 3.6
Health plan customer service
 4
 3.7
Summary rating of drug plan quality
 3.5
 3.4
Drug plan customer service
 3
 4.2
Member complaints & changes in the drug plan's performance
 4
 3.5
Member experience with the drug plan
 4
 3.0
Drug safety & accuracy of drug pricing
 4
 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 3.5 stars for its drug plan quality score which is better than the New York State average drug plan quality score of 3.4 stars.

Plan Benefits and Coverage Details

Monthly Premium
$31
Health Portion of Premium
$0
Drug Portion of Premium
$31
Health Plan Deductible
Coming soon
Health Plan Max Out-of-Pocket
$9,350 In and Out-of-network
$9,350 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes
Doctor Lookup Link
http://www.elderplan.org
Plan Link
http://www.elderplan.org

Medical Benefits

Doctor Services

Primary doctor visit
In-network: 0% or 20% coinsurance per visit
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
Lab services
In-network: $0 copay
Diagnostic radiology services (like MRI)
In-network: 0% or 20% coinsurance
Outpatient x-rays
In-network: 0% or 20% coinsurance
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: Coming soon
Out-of-network: Not Applicable
Outpatient hospital coverage
In-network: 0% or 20% coinsurance per visit

Skilled nursing facility

Skilled nursing facility
In-network: Coming soon
Out-of-network: Not Applicable

Preventive services

Preventive services
In-network: $0 copay

Ambulance

Ground ambulance
In-network: 0% or 20% coinsurance

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 0-20% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: 0% or 20% coinsurance per item
Diabetes supplies
In-network: $0 copay per item

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% or 0-20% coinsurance
Other Part B drugs
In-network: 0% or 0-20% coinsurance

Extra Benefits

Hearing

Hearing exam
In-network: 0% or 20% coinsurance
Fitting/evaluation
In-network: $0 copay
Hearing aids - All types
In-network: $0 copay

Preventive Dental

Oral exam
In-network: $0 copay
Out-of-network: $0 copay
Cleaning
In-network: $0 copay
Out-of-network: $0 copay
Fluoride treatment
Not covered
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay

Comprehensive dental

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
Prosthodontics, removable
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, fixed
In-network: $0 copay
Out-of-network: $0 copay
Maxillofacial prosthetics
In-network: $0 copay
Out-of-network: $0 copay
Implant services
In-network: $0 copay
Out-of-network: $0 copay
Oral and maxillofacial surgery
In-network: $0 copay
Out-of-network: $0 copay
Orthodontics
Not covered
Adjunctive general services
In-network: $0 copay
Out-of-network: $0 copay

Vision

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

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