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ElderServe MAP (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for ElderServe MAP (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on ElderServe MAP (HMO D-SNP) in 2026, please refer to our full plan details page.
ElderServe MAP (HMO D-SNP) is a HMO D-SNP plan offered by CareSource available for enrollment in 2025 to people living in Counties: Brx, Ki, Na, NY, Qu, Ri, Wes. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that ElderServe MAP (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
ElderServe MAP (HMO 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 ElderServe MAP (HMO 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 ElderServe MAP (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $58.80. 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 Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 ElderServe MAP (HMO D-SNP) Medicare plan features an annual prescription drug deductible of $615. This deductible represents the amount you must pay out-of-pocket for your covered medications before the plan begins to pay its share. Understanding this upfront cost is a key factor when evaluating if this plan fits your personal budget and healthcare needs. Specific drug coverage tier details, including individual copayments and coinsurance rates for different medication levels, are not currently available for this plan. To get a complete picture of your potential medication costs, you may want to contact the plan provider directly to verify how your specific prescriptions are categorized and covered.
Additional Benefits
ElderServe MAP (HMO D-SNP) provides comprehensive coverage for major medical needs, offering no copay and no coinsurance for inpatient hospital stays, skilled nursing facility care, home health services, and preventive dental care. Eligible members also benefit from an over-the-counter allowance of up to $302 per month with no copay and no coinsurance. For outpatient services, specialist visits, emergency care, diagnostic testing, and durable medical equipment, members will generally pay no copay and a 20% coinsurance. While many of these medical services require prior authorization, it is important to note that routine vision, routine hearing exams, and transportation services are not covered by this plan.
Inpatient Hospital See details
Inpatient hospital services are partially covered by ElderServe MAP (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required for acute and psychiatric stays. Additional days, upgrades, and non-Medicare-covered stays are not covered under this benefit.
Outpatient Services See details
ElderServe MAP (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services, with no copay and a 20% coinsurance. Prior authorization is required for outpatient hospital and observation services.
Partial Hospitalization See details
Partial hospitalization is covered by ElderServe MAP (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to access these services.
Ambulance and Transportation Services See details
ElderServe MAP (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance, no copay, and required prior authorization. Transportation services are not covered in practice; although some services are covered, trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
ElderServe MAP (HMO 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 three days. These costs count toward your plan-level deductible, but worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
ElderServe MAP (HMO D-SNP) covers primary care, specialist, therapy, mental health, and psychiatric services with no copay and 20% coinsurance. Chiropractic services are partially covered, excluding routine and other chiropractic care, while podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by ElderServe MAP (HMO D-SNP), offering Medicare-covered zero-dollar services with no copay and no coinsurance, while kidney disease education, glaucoma screenings, diabetes training, digital rectal exams, and EKGs have no copay and a 20% coinsurance. Annual physical exams and additional benefits like health education, fitness programs, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by ElderServe MAP (HMO D-SNP), featuring diagnostic hearing exams with no copay, no coinsurance, and no deductible, subject to prior authorization. Routine hearing exams, fitting evaluations, and over-the-counter hearing aids are not covered, and while some prescription hearing aid services are covered, no specific types—including inner ear, outer ear, and over-the-ear models—are covered in practice.
Vision Services See details
ElderServe MAP (HMO D-SNP) vision services are covered with no copay, a 20% coinsurance, and no deductible, though prior authorization is required for eye exams. While some services are covered, routine eye exams, other eye exams, contact lenses, eyeglasses, and upgrades are not covered in practice.
Dental Services See details
ElderServe MAP (HMO D-SNP) provides partially covered dental services with no copay and no coinsurance for preventive and comprehensive treatments, including cleanings, exams, X-rays, and oral surgery. While most dental benefits are covered, orthodontic services are not covered under this plan.
Home Infusion bundled Services See details
ElderServe MAP (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under ElderServe MAP (HMO D-SNP) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
ElderServe MAP (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and a 20% coinsurance. Prior authorization is required for these covered services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
ElderServe MAP (HMO D-SNP) covers diagnostic and radiological services with no copay and a 20% coinsurance for Medicare-covered diagnostic procedures, lab services, therapeutic radiology, and outpatient X-rays. Prior authorization is required for all of these covered diagnostic and radiological services.
Home Health Services See details
ElderServe MAP (HMO D-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
ElderServe MAP (HMO D-SNP) provides Cardiac Rehabilitation Services with no copay under prior authorization, though only some services are covered. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by ElderServe MAP (HMO D-SNP) with no copay and no coinsurance, as additional days beyond the standard Medicare-covered limit are not covered. Prior authorization and a three-day inpatient hospital stay are required prior to SNF admission.
Other Services See details
ElderServe MAP (HMO D-SNP) partially covers other services, offering acupuncture with no copay and 20% coinsurance for up to 40 treatments per year, and over-the-counter items with no copay and no coinsurance up to $302 per month. Meal benefits, nicotine replacement therapy, and naloxone are not covered.
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