A non-government entity
Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) in 2026, please refer to our full plan details page.
Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) is a HMO-POS I-SNP plan offered by Elderplan, Inc. available for enrollment in 2025 to people living in Select Counties In New York State. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Elderplan Advantage For Nursing Home Residents (HMO-POS I-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 Advantage For Nursing Home Residents (HMO-POS I-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 Advantage For Nursing Home Residents (HMO-POS I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $44.80. 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:
Sign up for Elderplan Advantage For Nursing Home Residents (HMO-POS I-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 Advantage For Nursing Home Residents (HMO-POS I-SNP) features an annual prescription drug deductible of $615. You must pay this deductible amount out-of-pocket for your covered medications before the Medicare plan begins to pay its share. Specific tier-level details regarding copayments and coinsurance are not available for this plan. To determine your actual out-of-pocket costs for specific prescriptions, you will need to consult the plan's comprehensive drug formulary. Understanding this initial deductible is an essential step in evaluating if this plan fits your personal healthcare budget and medication needs.
Additional Benefits
The Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) offers comprehensive healthcare coverage featuring no copays for primary care, therapy, and dialysis services. Most outpatient, specialist, and emergency services are covered with no copays, though they generally require a 20% coinsurance. Inpatient hospital and skilled nursing facility stays are covered with no coinsurance, although standard Medicare-defined cost-sharing applies. This plan also provides valuable supplemental benefits, including routine vision exams and eyewear with no copays, alongside up to $1,000 annually for hearing aids with no copays or coinsurance. Additionally, members benefit from a $175 monthly over-the-counter reimbursement allowance, up to $1,000 quarterly for plan-approved transportation, and acupuncture treatments with no copays or coinsurance.
Inpatient Hospital See details
Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) partially covers inpatient acute and psychiatric hospital services with no coinsurance, though Medicare-defined cost-sharing applies and prior authorization is required. Additional days, upgrades, and non-Medicare-covered stays are not covered under this benefit.
Outpatient Services See details
Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) covers outpatient services with no copays, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, and outpatient substance abuse services. Outpatient blood services are fully covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Elderplan Advantage For Nursing Home Residents (HMO-POS I-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 Advantage For Nursing Home Residents (HMO-POS I-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation to plan-approved health-related locations is covered with no copay and no coinsurance up to a $1,000 limit every three months, while transportation to any health-related location is not covered.
Emergency Services See details
Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) covers emergency services with a 20% coinsurance and no copay, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no copay and no coinsurance, while worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) covers primary care, physical, occupational, and speech therapy with no copay and no coinsurance. Specialist visits, mental health, psychiatric, and opioid treatment services feature no copay and up to 20% coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP), featuring Medicare-covered zero-dollar preventive services and alternative therapies with no copay and no coinsurance. Other covered services, such as kidney disease education and diabetes self-management training, require a 20% coinsurance and no copay, while services like annual physical exams, fitness benefits, and health education are not covered.
Hearing Services See details
Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) partially covers hearing services with no deductible, offering routine exams with no copay and 20% coinsurance, and fittings with no copay or coinsurance. Prescription hearing aids are covered up to a $1,000 annual maximum with no copay or coinsurance, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) provides partially covered vision services with no deductibles, featuring routine eye exams with no copay, 20% coinsurance, and a $150 annual limit, while other eye exam services are not covered. Covered eyewear, including contact lenses, eyeglasses, frames, lenses, and upgrades, is available with no copay and no coinsurance.
Dental Services See details
Dental services are partially covered under the Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP), which covers Medicare-covered dental services with no copay and a 20% coinsurance. Other dental services, including oral exams, cleanings, x-rays, and restorative or orthodontic services, are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) with no copay, although prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) with no copay and no coinsurance.
Medical Equipment See details
Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) covers durable medical equipment with no copay and no coinsurance, and prosthetic devices with no copay. Medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are covered with a 20% coinsurance and no copay, with diabetic supplies limited to specified manufacturers.
Diagnostic and Radiological Services See details
Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) covers diagnostic and radiological services, with outpatient X-rays and diagnostic procedures requiring a copayment and 20% coinsurance. Lab services and therapeutic radiological services feature no copay but require coinsurance, while diagnostic radiological services carry a 20% coinsurance and all radiological services require prior authorization and a referral.
Home Health Services See details
Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) covers Cardiac Rehabilitation Services with no copay and prior authorization, though only some services are covered. Specifically, standard 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 Advantage For Nursing Home Residents (HMO-POS I-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, though Medicare-defined copays and prior authorization are required. This benefit requires a three-day prior inpatient hospital stay and does not cover additional days beyond the standard Medicare-covered limit.
Other Services See details
Other services are partially covered by Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) with no copay and no coinsurance, which includes up to 20 acupuncture treatments per year, therapeutic leave, and a $175 monthly over-the-counter reimbursement allowance. Meal benefits are not covered under this plan.
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