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Elderplan Plus Long Term Care (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Elderplan Plus Long Term Care (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 Plus Long Term Care (HMO-POS D-SNP) in 2025, please refer to our full plan details page.
Elderplan Plus Long Term Care (HMO-POS D-SNP) is a HMO-POS D-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 2025.
It's important to know that Elderplan Plus Long Term Care (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 Plus Long Term Care (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 Plus Long Term Care (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 Plus Long Term Care (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $72.30. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $3.00. You must continue to pay paying your reduced 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:
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Drug Coverage
The Elderplan Plus Long Term Care (HMO-POS D-SNP) plan has a $590 deductible for prescription drugs. After meeting your deductible, you will pay the costs for your drugs, but the exact costs are not specified in the provided information. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase. If you qualify for the low-income subsidy (LIS), your monthly premium will be $72.30.
Additional Benefits
The Elderplan Plus Long Term Care (HMO-POS D-SNP) plan offers a variety of benefits with varying cost-sharing. Many services, such as outpatient blood services, outpatient x-rays, eyewear, and dental services, have no copay. Some services, like ambulance, emergency services, and primary care, have a 20% coinsurance, while home health services have no copay or coinsurance. This plan also includes coverage for hearing aids up to $3,000 annually, along with other services like acupuncture and over-the-counter items. Home infusion services include a $35 copay for Medicare Part B Insulin Drugs, with other drug costs varying between 0% and 20% coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric services, are covered under the Elderplan Plus Long Term Care plan; however, additional days, non-Medicare covered stays, and upgrades for both are not covered. The copay information is available elsewhere.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, have a 20% coinsurance. Ambulatory Surgical Center (ASC) Services, Individual Sessions for Outpatient Substance Abuse, and Group Sessions for Outpatient Substance Abuse also have a coinsurance of 20%. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Elderplan Plus Long Term Care (HMO-POS D-SNP) plan. All Ambulance Services are covered with a 20% coinsurance for both ground and air ambulance services, and Transportation Services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Urgently Needed Services have a 20% coinsurance, while Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The Elderplan Plus Long Term Care (HMO-POS D-SNP) plan covers 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. Primary care physician services, chiropractic services, physician specialist services, physical therapy and speech-language pathology services, individual and group mental health sessions, individual and group psychiatric sessions, and opioid treatment program services have a 20% coinsurance. Other health care professional services have a 0-20% coinsurance, while additional telehealth benefits have a 0-20% coinsurance. Podiatry services have a 20% coinsurance and no copay. Chiropractic routine care is not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered services with no copay. 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, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered. Alternative therapies and fitness benefits are covered with no copay. Kidney disease education services, glaucoma screenings, 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 services include coverage for hearing exams with a coinsurance of at most 20%, and prescription hearing aids with no copay, up to a maximum of $3,000 every year. Routine hearing exams, fitting/evaluation for hearing aids, inner ear hearing aids, outer ear hearing aids, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with 20% coinsurance, and eyewear including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades with no copay. Routine eye exams are not covered.
Dental Services See details
Dental Services include coverage for Medicare dental services with a 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 and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by Elderplan Plus Long Term Care (HMO-POS D-SNP), with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered under the Elderplan Plus Long Term Care (HMO-POS D-SNP) plan, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has no copay and a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts all have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Diagnostic Procedures/Tests and Diagnostic/Therapeutic Radiological Services have a coinsurance of at most 20%, while Lab Services have no copay.
Home Health Services See details
Home Health Services are covered by the Elderplan Plus Long Term Care (HMO-POS D-SNP) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays. Prior authorization is required, and the cost sharing is the same as Original Medicare.
Other Services See details
Other Services includes acupuncture and over-the-counter (OTC) items. Acupuncture has no copay and is limited to 40 treatments per year, and OTC items have no copay with a maximum benefit coverage amount of $900 every three months, including nicotine replacement therapy and naloxone. Meal Benefit, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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