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Elderplan Plus Long Term Care (HMO-POS D-SNP)

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

Monthly Premium

Your Cost
$0
by Elderplan

Additional Coverage

HearingVisionDental

Overall Government Star Rating

 3.5
out of 5 stars

Ready to Enroll Online?

Plan Overview

Plan Name
Elderplan Plus Long Term Care (HMO-POS D-SNP)
Insurance Carrier
Elderplan
Plan Type
Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP)
Network Type
HMO

Elderplan Plus Long Term Care (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
$0
Annual Deductible
$0
Max Out-of-Pocket
$9,350
Primary doctor visit
$0 copay
Specialist visit
$0 copay
ER visit
$0 copay
Ambulance
$0 copay

Elderplan Plus Long Term Care (HMO-POS D-SNP) has a monthly premium cost of $0 per month, with an annual deductible of $0 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 Plus Long Term Care (HMO-POS D-SNP) are defined below.

Additional Benefits and Coverage

Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

Elderplan Plus Long Term Care (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 Plus Long Term Care (HMO-POS D-SNP) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. Elderplan Plus Long Term Care (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 Plus Long Term Care (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 Plus Long Term Care (HMO-POS D-SNP) received an overall government quality rating of 3.5 stars out of 5 stars.

Elderplan Plus Long Term Care (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 Plus Long Term Care (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 Plus Long Term Care (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
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
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 copay
Specialist visit
In-network: $0 copay
Out-of-network: 20% coinsurance per visit

Tests, labs, & imaging

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

Hospital Services

Inpatient hospital coverage
In-network: $0 copay
Out-of-network: Not Applicable
Outpatient hospital coverage
In-network: $0 copay

Skilled nursing facility

Skilled nursing facility
In-network: $0 copay
Out-of-network: Not Applicable

Preventive services

Preventive services
In-network: $0 copay

Ambulance

Ground ambulance
In-network: $0 copay

Therapy services

Occupational therapy visit
In-network: $0 copay
Out-of-network: 20% coinsurance
Physical therapy & speech & language therapy visit
In-network: $0 copay
Out-of-network: 20% coinsurance

Mental health services

Outpatient group therapy with a psychiatrist
In-network: $0 copay
Outpatient individual therapy with a psychiatrist
In-network: $0 copay
Outpatient group therapy visit
In-network: $0 copay
Outpatient individual therapy visit
In-network: $0 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
In-network: $0 copay
Prosthetics (like braces, artificial limbs)
In-network: $0 copay
Diabetes supplies
In-network: $0 copay

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 copay
Other Part B drugs
In-network: $0 copay

Extra Benefits

Hearing

Hearing exam
In-network: $0 copay
Fitting/evaluation
Not covered
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
Not covered
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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