A non-government entity
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) in 2025, please refer to our full plan details page.
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) is a HMO-POS D-SNP plan offered by Elderplan, Inc. available for enrollment in 2025 to people living in Brx, Ki, Na, NY, Qu, Wes. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $31.30. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $9350.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $9350.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
Sign up for Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) plan has a defined standard for drug coverage. The plan has a deductible of $590.00. If you qualify for the low-income subsidy (LIS), you will pay $31.30 for Part D. After your deductible, you will pay the costs for your drugs in each tier until your total drug costs reach $2000. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) plan offers coverage for a wide range of services. Many services have a 20% coinsurance, including outpatient services, partial hospitalization, ambulance services, and many primary care services. The plan also offers benefits with no copay, such as transportation to health-related locations (limited to 24 one-way trips per year), emergency services, hearing exams, and many dental services. This plan provides coverage for hearing aids with a maximum benefit, as well as vision and dental benefits.
Inpatient Hospital See details
Inpatient Hospital benefits cover Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a copay that is determined by Medicare. Additional days, non-Medicare-covered stays, and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services, both with a 20% coinsurance. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services are also covered, with a coinsurance of 20%. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP), but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services includes coverage for ground and air ambulance services with a 20% coinsurance, while transportation services to a plan-approved health-related location have no copay and are limited to 24 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. For Emergency Services and Urgently Needed Services, there is a 20% coinsurance, and for Worldwide Emergency Services, there is no copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered under the plan. Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services have a 20% coinsurance, while Occupational Therapy Services, Individual and Group Sessions for Mental Health Specialty Services, and Individual and Group Sessions for Psychiatric Services have a 20% coinsurance. Podiatry Services have a 20% coinsurance and no copay, and Other Health Care Professional services have a 0-20% coinsurance. Additional Telehealth Benefits have a 0-20% coinsurance, and Opioid Treatment Program Services have a 20% coinsurance. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive services are covered, including services not usually covered by Medicare plans. Annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, and therapeutic massage are not covered. Alternative therapies and fitness benefits have no copay. Kidney disease education services, glaucoma screening, and diabetes self-management training have a 20% coinsurance. Barium enemas, digital rectal exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing exams and prescription hearing aids are covered by the Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) plan, with routine hearing exams and fitting/evaluation for hearing aids covered with no copay and no coinsurance. Prescription hearing aids have a maximum benefit of $1300 every three years, and all types of prescription hearing aids are covered with no copay.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have no copay. Eyewear has a combined maximum plan benefit coverage of $350 every year.
Dental Services See details
Dental services include coverage for Medicare Dental Services with 20% coinsurance, and Other Dental Services with no copay. Oral exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, removable, Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, and Oral and Maxillofacial Surgery are covered with no copay. Fluoride Treatment and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) plan, including Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetics/Medical Supplies with no copay and coinsurance for Medicare-covered items, and Diabetic Equipment, including Diabetic Supplies with no copay and Diabetic Therapeutic Shoes/Inserts with a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a coinsurance of up to 20%, and lab services with no copay. Radiological Services are covered, including diagnostic and therapeutic radiological services, and outpatient X-ray services, each with a coinsurance of up to 20%.
Home Health Services See details
Home Health Services are covered by the Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP). Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required, and the copay is the same as the Medicare-defined cost share for tier 1.
Other Services See details
Other services include acupuncture and over-the-counter (OTC) items. Acupuncture has no copay and is limited to 20 treatments per year, while OTC items have no copay and a maximum benefit of $660 every three months.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved