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Elderplan Select (HMO-POS I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Elderplan Select (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 Select (HMO-POS I-SNP) in 2025, please refer to our full plan details page.
Elderplan Select (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 2025.
It's important to know that Elderplan Select (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 Select (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 Select (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 Select (HMO-POS I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $2.50. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $7500.00 (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 $7500.00 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 Select (HMO-POS I-SNP) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions depending on the drug tier and the pharmacy you use. For example, you will pay $2 for preferred generic drugs at a standard pharmacy, $25 for standard generic drugs at a standard pharmacy, and $100 for preferred brand drugs at a standard pharmacy. If you reach $2000 in total drug costs, you enter the catastrophic coverage phase, where you will pay nothing for your drugs.
Additional Benefits
The Elderplan Select (HMO-POS I-SNP) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services have copays or coinsurance depending on the service. Primary care, preventive, hearing, vision, and dental services, as well as home health and medical equipment, are covered with no or low copays. Additional benefits include coverage for ambulance and transportation, emergency services, and home infusion services. There is also coverage for partial hospitalization, skilled nursing facilities, and diagnostic services. The plan also covers acupuncture and over-the-counter items with no copay, with the plan having a maximum monthly benefit for OTC items.
Inpatient Hospital See details
Inpatient hospital services, including acute and psychiatric care, are covered. For Inpatient Hospital-Acute, you will pay a $320 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you will pay a $250 copay for days 1-6, and no copay for days 7-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a $185 copay, observation services with a $200 copay, and ambulatory surgical center services with a $100 copay. Outpatient substance abuse services are covered with a 20% coinsurance, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Elderplan Select (HMO-POS I-SNP) plan, with a $70 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Elderplan Select (HMO-POS I-SNP) plan. Ground ambulance services have a $100 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered with no copay, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered under the Elderplan Select (HMO-POS I-SNP) plan, with a copay of $110, and no coinsurance. Urgently Needed Services are also covered, with a $45 copay and no coinsurance, while Worldwide Emergency Services are not covered.
Primary Care See details
The Elderplan Select (HMO-POS I-SNP) plan covers primary care physician services and chiropractic services with no copay, as well as occupational therapy services with a $35 copay. Physician specialist services have a copay between $0 and $45, while mental health specialty services have a $50 copay for individual or group sessions. This plan also covers podiatry services with a $10 copay and other health care professional services with no copay, as well as psychiatric services with a $45 copay for individual or group sessions. Physical therapy and speech-language pathology services have a $40 copay, and additional telehealth benefits have a copay between $0 and $50. The plan also covers opioid treatment program services with a 20% coinsurance.
Preventive Services See details
Preventive services are covered, including services not usually covered by Medicare plans. Additional preventive services have a copay, while glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit have no copay. Alternative therapies and fitness benefits have no copay. Kidney Disease Education Services have a 20% coinsurance.
Hearing Services See details
Hearing exams are covered with no copay, as well as Routine Hearing Exams and Fitting/Evaluation for Hearing Aid with no copay. Prescription Hearing Aids (all types) are covered with a maximum plan benefit coverage of $2000 every three years, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered. OTC Hearing Aids are not covered.
Vision Services See details
Vision services, including routine eye exams and eyewear, are covered with no copay. Eyewear has a combined maximum plan benefit coverage of $500 every two years.
Dental Services See details
Dental services include coverage for Medicare Dental Services with a 20% coinsurance, and Other Dental Services with no copay. This plan also covers Orthodontic Services and has a maximum benefit of $1500 per year.
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 with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Elderplan Select (HMO-POS I-SNP) plan. The copay for dialysis services is between $55.00 and $55.00.
Medical Equipment See details
Medical equipment benefits are covered by Elderplan Select (HMO-POS I-SNP). Durable Medical Equipment (DME) has no copay and a coinsurance between 0% and 20%, while DME for use outside the home is not covered. Prosthetic devices and medical supplies have no copay and a 20% coinsurance, and diabetic supplies and therapeutic shoes/inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with no copay, and lab services with no copay. Diagnostic radiological services and therapeutic radiological services have a copay of at most $75, and outpatient x-ray services have no copay.
Home Health Services See details
Home Health Services are covered by Elderplan Select (HMO-POS I-SNP) with no copay and no coinsurance, but 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 any specific services, including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Elderplan Select (HMO-POS I-SNP) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Under the Elderplan Select (HMO-POS I-SNP) plan, acupuncture has no copay, and over-the-counter (OTC) items also have no copay with a maximum benefit coverage amount of $175.00 per month. Meals, 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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