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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 2026, 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, Put, Qu, Rich, Wes. This plan received an overall rating of 3.5 out of 5 stars in 2026.
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 $22.70. 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 $615.00 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 $9250.00 (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 $9250.00 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:
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Drug Coverage
The Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) has an annual prescription drug deductible of $615. This deductible is the amount you must pay out-of-pocket for your medications before the plan begins to cover its share of the costs. Specific drug coverage tier details, including individual copays and coinsurance rates, are not available for this plan. To understand your exact prescription costs, you should review the plan's formulary to verify how your specific medications are covered.
Additional Benefits
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) offers robust coverage with no copays for major medical needs, including inpatient hospital stays, home health care, and skilled nursing facility services. For outpatient care, emergency services, and primary or specialist visits, members will generally pay no copay alongside a standard 20% coinsurance. Supplemental benefits are also highly accessible, featuring routine dental care, vision eyewear up to a $350 annual maximum, and prescription hearing aids up to $1,300 every three years with no copays or coinsurance. Additionally, the plan includes up to 24 one-way transportation trips to approved locations and a $660 over-the-counter quarterly allowance, both available with no copay and no coinsurance.
Inpatient Hospital See details
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) covers inpatient acute and psychiatric hospital stays with no copayment and no coinsurance, though prior authorization is required. This benefit is partially covered, as upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) covers outpatient hospital, ambulatory surgical center, and outpatient substance abuse services with no copay and a 20% coinsurance. Outpatient blood services are also covered with no copay and no coinsurance.
Partial Hospitalization See details
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) covers ambulance services with a 20% coinsurance and no copay, though prior authorization is required. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay, which is waived if you are admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance, up to a maximum benefit of $50,000.
Primary Care See details
Primary Care services under the Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) are covered with no copay and a 20% coinsurance for primary care, specialists, psychiatric, and therapy services. Telehealth features no copay and a coinsurance ranging from no coinsurance to 20%, while chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered under Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP), offering Medicare-covered zero-dollar preventive services, fitness benefits, and up to 20 alternative therapy visits with no copay and no coinsurance. A 20% coinsurance applies to kidney disease education, diabetes self-management, and glaucoma screenings, while several services such as annual physical exams, health education, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are partially covered by Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP), including routine exams with a 20% coinsurance and no copay, and hearing aid fittings with no copay or coinsurance. Prescription hearing aids are covered up to $1,300 every three years with no copay or coinsurance, but OTC hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) partially covers vision services, offering one routine eye exam per year with no copay, a 20% coinsurance, and no deductible, while other eye exam services are not covered. Covered eyewear, including contacts, eyeglasses, lenses, frames, and upgrades, has no copay, no coinsurance, and no deductible up to a $350 annual maximum.
Dental Services See details
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) provides partially covered dental services, featuring Medicare-covered dental care with no copay and a 20% coinsurance. Other covered preventive and comprehensive dental services require no copay and no coinsurance, though fluoride treatments and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) with no copay and no coinsurance, requiring prior authorization. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copays for covered items. Coinsurance for these benefits ranges from no coinsurance up to 20% depending on the specific equipment or supplies required.
Diagnostic and Radiological Services See details
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) covers diagnostic and radiological services, with diagnostic tests requiring a copay and a minimum 20% coinsurance. Lab services feature no copay but carry a coinsurance, while radiological services require prior authorization, have no copay, and carry a minimum 20% coinsurance.
Home Health Services See details
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) covers home health services with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) covers Cardiac Rehabilitation Services with no copay and prior authorization, meaning some services are covered, but cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) covers standard Medicare Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization and a three-day prior inpatient hospital stay are required. Additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) covers acupuncture for up to 20 treatments per year and over-the-counter items with a maximum reimbursement of $660 every three months, both with no copay and no coinsurance. Meal benefits and other additional services are not covered.
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