Get All Your Benefits Plus Long-Term Care in One Simple Plan 1
- For Medicare and Medicaid (Duals), beneficiaries who qualify for Long-Term Care
- Combines all your benefits, including medical, behavioral health, hospital prescription drugs and long-term care, into one simple plan.
- Provides a personal care worker (PCW) to help you with daily activities, plus attention from a Care Management team to help coordinate all your benefits.
- Available in the Bronx, Kings, Nassau, New York, Queens, Richmond, Westchester, Dutchess, Orange, Putnam and Rockland Counties.
Benefits at a Glance
Premium: Zero monthly plan premium
Primary Care: Zero copay for in-person or telehealth primary care visits
Specialist: The freedom to choose any specialist or dentist in or out-of-network, giving you greater access to care 2
Dental: Includes preventative and comprehensive care, including root canals and crowns
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 Member- to-Member program
Learn more about Member-to-Member
NEW Increased & Expanded for 2025! OTC: $900 3quarterly towards Traditional OTC. Eligible members4 can use the allowance toward Expanded OTC benefits – including community rides!
NEW FOR 2025! Community Rides: Eligible members5 You have the freedom to use your OTC allowance toward community rides, which include grocery stores, farmers’ markets, places of worship, or visiting a friend. It can also be applied to gas, tolls, and parking.
new increased for 2025! Flex Card: $750 allowance per year annual for out-of-pocket on dental, vision, hearing and fitness expenses
Learn about the Flex Card Benefit
NEW Increased for 2025! Hearing: Zero copay for routine hearing exams + $3,000 on hearing aids – every year
NEW increased for 2025! Vision: Zero copay for routine eye exams + $600 on eyewear like contacts or eyeglasses, including lenses and frames – every year
NEW for 2025! Acupuncture: Zero copay on acupuncture, acupressure and reflexology visits — up to 40 visits per year
Worldwide Emergency Coverage: Zero copay for up to $50,000 in worldwide emergency coverage
All cost sharing is based on your level of Medicaid eligibility.
Explore our network
Our network includes over 40,000 Specialists, Primary Care Doctors, Pharmacies and Dentists!
Interested in joining this plan?
To qualify for this plan, you must receive a health care assessment from one of our nurses.
Please call our Enrollment Center at 1-866-360-1934 (TTY: 711) to get started.
Representatives 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?
Learn more about Medicaid Spend-down and Medically Needy Income Level (MNIL) in New York State.
Download plan details (PDF)
- To be eligible for this plan, you must be 18 years or older, have Medicare and Medicaid, need community-based long-term care services for more than 120 days, and be assessed as nursing home eligible.[↩]
- Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our Member Services number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.[↩]
- 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.[↩]
- 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.[↩]
