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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 2026, 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 2026.
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) Medicare plan features a $0 prescription drug deductible, allowing your coverage to begin immediately. Under this plan, Tier 1 preferred generic drugs have no copay for one, two, or three-month supplies at standard pharmacies, as well as no copay for a three-month standard mail order supply. Tier 2 generic medications are also highly affordable, requiring just a $2 copay for a one-month supply at standard pharmacies or a $4 copay for a three-month standard mail order. For Tier 3 preferred brand drugs, you will pay a $25 copay for a one-month supply, while Tier 4 non-preferred drugs require a $100 copay for a one-month supply at standard pharmacies. Tier 5 specialty drugs require a 25% coinsurance for both standard retail and standard mail-order fills. Utilizing a three-month standard mail-order supply for Tiers 2, 3, and 4 can provide significant savings compared to standard retail pharmacies.
Additional Benefits
The Elderplan Select (HMO-POS I-SNP) offers comprehensive medical coverage featuring no copay for primary care physician visits and home health services. Specialist office visits range from no copay to a $45 copay, while emergency department services carry a $115 copay that is waived upon hospital admission. For hospital stays, inpatient acute care requires a $320 daily copay for days one through six, and outpatient hospital services carry a $185 copay, with both options featuring no coinsurance. Beyond standard medical care, the plan provides robust supplemental coverage, including preventive and comprehensive dental services with no copay up to a $1,500 annual limit. Routine vision and hearing exams are also covered with no copay, offering annual allowances of $150 and $1,000 respectively to help cover eyewear and hearing aids. Members also receive a $175 monthly allowance for over-the-counter items and up to $1,000 in plan-approved transportation every three months with no copay.
Inpatient Hospital See details
Elderplan Select (HMO-POS I-SNP) partially covers inpatient hospital services with no coinsurance, excluding upgrades, additional days, and non-Medicare-covered stays. Medicare-covered acute stays require a $320 daily copay for days 1 to 6, while psychiatric stays require a $250 daily copay for days 1 to 6, with no copay for days 7 to 90 on both.
Outpatient Services See details
Elderplan Select (HMO-POS I-SNP) covers outpatient hospital services with a $185 copay and no coinsurance, and observation services with a $200 copay per stay and no coinsurance. Ambulatory surgical center services require a referral and carry a $100 copay with no coinsurance, while outpatient substance abuse services have no copay with a 20% coinsurance, and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Elderplan Select (HMO-POS I-SNP) covers partial hospitalization services with a $70.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Elderplan Select (HMO-POS I-SNP) covers ground ambulance services with a $100 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, offering plan-approved trips with no copay or coinsurance up to $1,000 every three months, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services under Elderplan Select (HMO-POS I-SNP) are covered with a $115 copay and no coinsurance, while urgently needed services require a $40 copay and no coinsurance. Both copays are waived if you are admitted to the hospital within 24 hours, but worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
Elderplan Select (HMO-POS I-SNP) covers primary care physician services with no copay and no coinsurance, while specialist visits range from a $0 to $45 copay with no coinsurance. Other covered benefits feature no coinsurance, including physical, occupational, and speech therapies ($35 to $40 copay), mental health services ($45 to $50 copay), and partially covered chiropractic care, while opioid treatment requires no copay and a 20% coinsurance.
Preventive Services See details
Elderplan Select (HMO-POS I-SNP) preventive services are partially covered, offering Medicare-covered preventive care, alternative therapies, and a fitness activity tracker with no copay and no coinsurance. Kidney disease education is covered with no copay and a 20% coinsurance, but several services including annual physical exams, health education, and personal emergency response systems are not covered.
Hearing Services See details
Elderplan Select (HMO-POS I-SNP) partially covers hearing services with no copay, no coinsurance, and no deductible up to a $1,000 annual maximum for exams and prescription hearing aids. Over-the-counter (OTC) hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are partially covered by Elderplan Select (HMO-POS I-SNP), offering routine eye exams and eyewear—including contacts, lenses, frames, and upgrades—with no copay, no coinsurance, and no deductible. Other eye exam services are not covered, and eye exams are subject to a maximum annual plan benefit of $150.00.
Dental Services See details
Dental services are covered by Elderplan Select (HMO-POS I-SNP), which offers Medicare-covered dental care with no copay and a 20% coinsurance. Preventive and comprehensive dental services, including cleanings, x-rays, endodontics, and implants, are covered with no copay and no coinsurance up to a $1,500 annual maximum.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Elderplan Select (HMO-POS I-SNP) with no copay, though prior authorization is required. Under this benefit, covered Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Elderplan Select (HMO-POS I-SNP) with a $55 copay and no coinsurance.
Medical Equipment See details
Elderplan Select (HMO-POS I-SNP) covers durable medical equipment (DME) with no copay and 0% to 20% coinsurance, and prosthetics or medical supplies with no copay and 20% coinsurance. Diabetic equipment is also covered with no coinsurance, though diabetic supplies and therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Elderplan Select (HMO-POS I-SNP) covers diagnostic and radiological services with no coinsurance and no copay for lab services, diagnostic procedures, diagnostic radiology, and outpatient X-rays. A $75 copay applies to therapeutic radiological services, and referrals and prior authorizations are required for radiological services.
Home Health Services See details
Home Health Services are covered by Elderplan Select (HMO-POS I-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Elderplan Select (HMO-POS I-SNP) with no coinsurance and require prior authorization, though only some services are covered. In practice, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Elderplan Select (HMO-POS I-SNP) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $214 daily copay for days 21 through 100, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Elderplan Select (HMO-POS I-SNP) with no copay and no coinsurance, including therapeutic leave, up to 20 acupuncture treatments yearly, and a $175 monthly reimbursement for over-the-counter items. Meal benefits are not covered under this plan.
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* 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.
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