Elderplan Frequently Asked Questions

Elderplan provides health plans for at-risk New Yorkers. Our Medicare Advantage Plans provide you with the benefits covered under Original Medicare plus additional benefits like prescription drugs, hearing, vision, dental and more. Learn more about our health plan options.

No, Elderplan is a 35-year-old, not-for-profit health plan that provides Medicare Advantage and Managed Long-Term Care plans (MLTCP) for Medicare, Medicaid and Dual Medicare and Medicaid beneficiaries across the greater New York area.

Elderplan is a not-for-profit health plan. That means we reinvest our earnings into providing more benefits and services for our valued members at little or no additional cost.

Elderplan is also part of MJHS, a not-for-profit health system. So should you require access to additional support over time and choose to receive services from MJHS, the Elderplan team can work together with their colleagues from across the system to better coordinate your care and make it easier for you.

We are proud to be the only health plan that offers a 5-star Medicaid Advantage Plus (MAP) plan and a 5-star Managed Long-Term Care plan in New York State*.

Depending on your health plan, we can provide coverage if you live in the Bronx, Dutchess, Kings, Monroe, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Westchester, Ontario, Orleans, Seneca, Yates, and Livingston counties.

Browse our health plan options to ensure the plan you are interested in is covered in your area.

Original Medicare covers a lot of important medical needs like hospital insurance, inpatient care and hospice care through Part A and Medical (Part B). However, it does not provide coverage for other essential benefits such as; comprehensive dental, vision, hearing, gym membership, and Over-the-Counter (OTC) and prescription drug coverage. Enrolling in Elderplan will lower out-of-pocket costs like deductibles and the 20% cost sharing you are responsible for under traditional Original Medicare.

是的！In most cases, Elderplan can save you money on your Medicare coverage. Elderplan lowers your out-of-pocket expenses like deductibles and the 20% cost-sharing you are responsible for under traditional Original Medicare. Most of our plans have no premium (you continue to pay your Medicare Part B premium) but include extra benefits and coverage that you can’t get with Original Medicare alone. For detailed cost information, please see each plan’s Summary of Benefits.

No, when you become a member of Elderplan, you are simply telling Medicare that you prefer to have your medical needs taken care of by Elderplan and our extensive network of doctors, hospitals, and pharmacies. If you continue to pay your Medicare Part B premium and Part A premium, if applicable, you will always be entitled to Medicare.

If your doctor is in the Elderplan provider network, you may continue to see them. As an HMO (Health Maintenance Organization), Elderplan’s extensive network includes more than 150,000 locations across the New York metropolitan area.

If your doctor is not part of the Elderplan network, don’t hesitate to contact Elderplan so that we can work with you to find an in-network provider.

No, you do not need a referral to see in-network specialists, such as cardiologists, gynecologists, dentists, or optometrists. Authorization rules do apply for some specialist services. Call Member Services for more details.

• You must have Medicare Part A and B
• Live in the service area for your plan. Please check the service area for the plan you feel best meets your needs.
• Fall within one of the three enrollment periods for Medicare Advantage. Learn more about Medicare Advantage enrollment periods.
• Because our plans are tailored to fit your specific needs, additional eligibility requirements may be required for selected plans.

The timeframe for enrolling in a Medicare Advantage plan is called an enrollment period. You have three enrollment periods during which you can choose or switch plans each calendar year. Most people become eligible for a Medicare Advantage Plan three months before turning 65. Learn more about Medicare Advantage enrollment periods.

You can enroll in most of our plans online or by phone. Once you have viewed our health plan options and are ready to enroll, visit the Elderplan enrollment page to see how to enroll in your plan of choice.