Enjoy Having All Your Benefits in One Simple Plan 1
- An ideal plan for dual Medicare and Medicaid beneficiaries who seek medical, hospital and prescription drug coverage all under one umbrella.
- Receive assistance from a dedicated care manager who will help you navigate your benefits, ensuring that you get the care and services you need.
- Available in the Bronx, Manhattan, Queens, and Brooklyn, as well as Westchester and Nassau counties.
Benefits at a Glance
Premium: Zero monthly plan premium2
Primary Care: Zero copay3 for in-person or telehealth primary care visits
Specialist: Freedom to choose any specialist or dentist, giving you greater access to care
Flex Card: $500 allowance per year for out-of-pocket on dental, vision, hearing and fitness expenses
Learn more about the Flex card benefit
Transportation: Zero-cost transportation to and from medical appointments – up to 24 one-way trips
Acupuncture: Zero copay on acupuncture, acupressure and reflexology visits — up to 20 visits per year
Emergency Coverage: $50,000 coverage for worldwide emergencies
NEW increased for 2025! OTC: $6604quarterly towards Traditional OTC. Eligible members5 can also use allowance toward Expanded OTC benefits such as rent/mortgage, utilities, internet, groceries or home-delivered meals
NEW FOR 2025! Dentist: No limit on supplemental, comprehensive dental services, including crowns, dentures, implants and root canals
Vision: Zero copay on routine eye exam + up to $350 for eyewear like contacts or eyeglasses, including lenses and frames – every year
Gym Membership: Zero cost gym membership to help keep you fit and active, plus over 15,000 online videos6
Wellness Incentives: Earn rewards for doing preventative screenings and immunizations through our Wellness Incentive Program
BrainHQ: Improve brain function through a memory fitness program with games, puzzles and other fun exercises
Sign up for BrainHQ
Member-to-Member: Connect with other members with membership in our award-winning program
Learn more about Member-to-Member
All cost sharing is based on your level of Medicaid eligibility.
Premiums, copays, co-insurance and deductibles may vary based on the level of Extra Help you receive. Please get in touch with Elderplan for further details.
Explore our network
Our network includes over 40,000 Specialists, Primary Care Doctors, Pharmacies and Dentists!
Interested in joining this plan?
Or call our Enrollment Center at 1-866-360-1934 (TTY: 711).
Our Benefits Advisors are available to assist you 8 a.m. to 8 p.m., seven days a week.
Did you know that now even more people qualify for Medicaid?
Because Medicaid is designed for low-income families, income limits apply. Learn more about Medicaid Spend-down and Medically Needy Income Level (MNIL) in New York State.
Download plan details (PDF)
- Elderplan for Medicaid Beneficiaries is a dual eligible Special Needs Plan available to Medicare beneficiaries who receive New York State Medicaid or other assistance through New York State medical assistance programs. Premiums, copays, co-insurance, and deductibles may vary based on the level of Medicaid assistance and/or Low-Income Subsidy (LIS) (Extra Help) you may receive. Please get in touch with the Elderplan for further details.[↩]
- You pay a $31.30 monthly plan premium; however if you are eligible for Medicare cost-sharing assistance under Medicaid, you pay a $0 monthly plan premium.[↩]
- You pay 20% co-insurance for in-person office primary care and specialist doctor visits; however, if you are eligible for Medicare cost-sharing assistance under Medicaid, you pay 0% co-insurance. There is no co-insurance or copayment for telehealth primary care services. You pay 20% co-insurance for telehealth specialist services; however, if you are eligible for Medicare cost-sharing assistance under Medicaid, you pay 0% co-insurance.[↩]
- Your OTC card balance cannot be carried over to the next month. The OTC card is not a debit or credit card and cannot be converted to cash.[↩]
- Eligibility is determined by whether you have a chronic condition associated with SSBCI benefit (expanded OTC). Examples of SSBCI conditions include but are not limited to, Cardiovascular Disorders, Diabetes, Arthritis, Chronic Lung Disorders and Cancer. There are other eligible conditions not listed. Standards may vary for this benefit.[↩]
- No-cost gym membership is available at all fitness centers and select YMCAs in the Silver&Fit® network.[↩]
