Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP)
H3347 - 002 - 0
(5 / 5)
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) is a Medicare Advantage (Part C) Special Needs Plan by Elderplan.
This page features plan details for 2024 Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) H3347 – 002 – 0 available in Brx, Ki, Na, NY, Qu, Wes.
IMPORTANT: This page has been updated with plan and premium data for 2024.
Locations
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) is offered in the following locations.
Plan Overview
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) offers the following coverage and cost-sharing.
| Special Needs Plan Type: | Dual-Eligible |
| Conditions Covered: |
| Insurer: | Elderplan |
| Health Plan Deductible: | Coming soon |
| MOOP: | $8,850 In and Out-of-network $8,850 In-network |
| Drugs Covered: | Yes |
Please Note:
- This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.
- Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.
Ready to sign up for Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) ?
Premium Breakdown
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) has a monthly premium of $33.90. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.| Part B | Part C | Part D | Part B Give Back | Total |
|---|---|---|---|---|
| $174.70 | $0.00 | $33.90 | $0.00 | $208.60 |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
- You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.
Drug Info
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
| Drug Deductible: | $545.00 |
| Initial Coverage Limit: | $5,030.00 |
| Catastrophic Coverage Limit: | $8,000.00 |
| Drug Benefit Type: | Basic |
| Additional Gap Coverage: | No |
| Formulary Link: | Formulary Link |
Part D Premium Reduction
The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.
The table below shows how the LIS impacts the Part D premium of this plan.
| Part D | LIS Full |
|---|---|
| $33.90 | $0.00 |
NOTE: The Inflation Reduction Act of 2022 has expanded full subsidy eligibility under the LIS program to individuals with incomes up to 150% of the Federal Poverty Level. People who qualify for Extra Help generally will pay no more than $4.50 for each generic drug and $11.20 for each brand-name drug.
Initial Coverage Phase
After you pay your $545.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00. Once you reach that amount, you will enter the next coverage phase.
30 Day
60 Day
90 Day
30 Day
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 25% |
60 Day
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
90 Day
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 25% | 25% |
Gap Coverage Phase
After your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00, you will pay no more than the amounts below for any drug tier until you reach $8,000.00.
30 Day
90 Day
30 Day
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| Generic drugs | ||||
| Brand-name drugs |
90 Day
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| Generic drugs | ||||
| Brand-name drugs |
| Tier | Cost |
|---|---|
| All other tiers (Generic) | 25% |
| All other tiers (Brand-name) | 25% |
Catastrophic Coverage Phase
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $8,000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) also provides the following benefits.
| Coming soon |
| In-network | No |
| $8,850 In and Out-of-network $8,850 In-network |
| No |
| In-network | Yes, contact plan for further details |
| In-network | 0% or 20% coinsurance per visit (Authorization is not required.) (Referral is not required.) |
| In-network Primary | 0% or 20% coinsurance per visit (Not applicable.) (Not applicable.) |
| In-network Specialist | 0% or 20% coinsurance per visit (Authorization is not required.) (Referral is not required.) |
| out-of-network Specialist | 20% coinsurance per visit (Authorization is not required.) (Referral is not required.) |
| In-network | $0 copay (Authorization is not required.) (Referral is not required.) |
| Emergency | 0% or 20% coinsurance per visit (always covered) (Not applicable.) (Not applicable.) |
| Urgent care | 0% or 20% coinsurance per visit (always covered) (Not applicable.) (Not applicable.) |
| In-network Diagnostic tests and procedures | 0% or 20% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Lab services | $0 copay (Authorization is not required.) (Referral is not required.) |
| In-network Diagnostic radiology services (e.g., MRI) | 0% or 20% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network Outpatient x-rays | 0% or 20% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network Hearing exam | 0% or 20% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Fitting/evaluation | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Hearing aids | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| In-network Office visit | $0.00 (Authorization is not required.) (Referral is not required.) |
| out-of-network Office visit | $0 copay (Authorization is not required.) (Referral is not required.) |
| Oral exam | Covered under office visit (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Cleaning | Covered under office visit (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Fluoride treatment | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Dental x-ray(s) | Covered under office visit (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Non-routine services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Diagnostic services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| In-network Restorative services | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Restorative services | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Endodontics | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Endodontics | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Periodontics | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Periodontics | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Extractions | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| In-network Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Routine eye exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| In-network Contact lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Eyeglass frames | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Eyeglass lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Upgrades | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Occupational therapy visit | 0% or 20% coinsurance (Authorization is required.) (Referral is not required.) |
| out-of-network Occupational therapy visit | 20% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network Physical therapy and speech and language therapy visit | 0% or 20% coinsurance (Authorization is required.) (Referral is not required.) |
| out-of-network Physical therapy and speech and language therapy visit | 20% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network | 0% or 20% coinsurance (Not applicable.) (Not applicable.) |
| In-network | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Foot exams and treatment | 0% or 20% coinsurance (Authorization is not required.) (Referral is not required.) |
| out-of-network Foot exams and treatment | 20% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Routine foot care | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Durable medical equipment (e.g., wheelchairs, oxygen) | 0% or 20% coinsurance per item (Authorization is required.) (Not applicable.) |
| In-network Prosthetics (e.g., braces, artificial limbs) | 0% or 20% coinsurance per item (Authorization is required.) (Not applicable.) |
| In-network Diabetes supplies | $0 copay per item (Authorization is not required.) (Not applicable.) |
| Covered (Authorization is not required.) (Referral is not required.) |
| In-network Chemotherapy | 0% or 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| In-network Other Part B drugs | 0% or 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| In-network Part B Insulin drugs | $0 or $35 copay (Authorization is required.) (Not applicable.) |
| In-network | Coming soon (Authorization is required.) (Referral is not required.) |
| out-of-network | Not Applicable (Authorization is required.) (Referral is not required.) |
| In-network Inpatient hospital – psychiatric | Coming soon (Authorization is required.) (Referral is not required.) |
| out-of-network Inpatient hospital – psychiatric | Not Applicable (Authorization is required.) (Referral is not required.) |
| In-network Outpatient group therapy visit with a psychiatrist | 0% or 20% coinsurance (Authorization is not required.) (Referral is not required.) |
| out-of-network Outpatient group therapy visit with a psychiatrist | 20% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Outpatient individual therapy visit with a psychiatrist | 0% or 20% coinsurance (Authorization is not required.) (Referral is not required.) |
| out-of-network Outpatient individual therapy visit with a psychiatrist | 20% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Outpatient group therapy visit | 0% or 20% coinsurance (Authorization is not required.) (Referral is not required.) |
| out-of-network Outpatient group therapy visit | 20% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Outpatient individual therapy visit | 0% or 20% coinsurance (Authorization is not required.) (Referral is not required.) |
| out-of-network Outpatient individual therapy visit | 20% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network | Coming soon (Authorization is required.) (Referral is not required.) |
| out-of-network | Not Applicable (Authorization is required.) (Referral is not required.) |
Ready to sign up for Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) ?
Table of Contents
SMID: MULTIPLAN_HCIHNDOGMED01_M
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