Elderplan Select (HMO-POS I-SNP)
Available to residents of Seneca County, NY for 2026. Contract H3347, plan 018, segment 0.
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- Plan health benefits
- Benefits in plain text
- Rx cost-sharing for all pharmacies and tiers
- Other plans in Seneca County
- Plan website
- Browse the Elderplan Select (HMO-POS I-SNP) formulary
Renewed for 2026. CMS carries this plan forward from 2025.
Plan details
| Monthly premium (Part C + D) | $0.00 |
|---|---|
| — medical (Part C) part | $0.00 |
| — drug (Part D) part | $0.00? |
| Monthly premium with full Extra Help (LIS) | $0.00? |
| Part B premium reduction (giveback) | $2.50 a month?You must continue to pay your Medicare Part B premium. |
| Health plan deductible (in-network) | None |
| In-network out-of-pocket maximum | $7,500.00? |
| In- and out-of-network out-of-pocket maximum | $7,500.00 |
| Drug deductible | $0.00 |
| Drug out-of-pocket threshold | $2,100.00 |
| Plan type | HMO-POS I-SNP? |
| Special needs plan | Institutional SNP |
| Contract / plan | H3347-018-0 |
| Offered by | Elderplan |
| Parent organization | Elderplan, Inc. |
| Formulary drugs | 3,428 |
| Formulary exception tier | 4? |
| Pharmacy search | www.caremark.com |
| Member services | (866)695-8101TTY 711 |
CMS star ratings
- Overall
- 3.5 out of 5 stars for Overall
- Health plan (Part C)
- 3 out of 5 stars for Health plan (Part C)
- Drug plan (Part D)
- 3.5 out of 5 stars for Drug plan (Part D)
Published per contract — every plan under contract H3347 shares this rating.
Plan health benefits
| Service | In-network |
|---|---|
| Doctor visits | |
| Primary care doctor | $0 copay |
| Specialist | $0–$45 copay(referral required) |
| Other health care professional | $0 copay(referral required) |
| Additional telehealth services | $0–$50 copay |
| Preventive care | |
| Medicare-covered preventive services | $0 copay |
| Annual physical exam | Not covered |
| Kidney disease education | 20% coinsurance |
| Glaucoma screening | $0 copay |
| Diabetes self-management training | $0 copay |
| Diagnostic tests, labs and imaging | |
| Diagnostic tests and procedures | $0 copay |
| Lab services | $0 copay |
| Diagnostic radiology (e.g. MRI, CT) | $0–$75 copay(authorization and referral required) |
| Therapeutic radiology | $75 copay(authorization and referral required) |
| Outpatient x-rays | $0 copay(authorization and referral required) |
| Emergency and urgent care | |
| Emergency room | $115 copay |
| Urgent care | $40 copay |
| Worldwide emergency coverage | Not covered |
| Worldwide urgent care | Not covered |
| Worldwide emergency transportation | Not covered |
| Hospital care | |
| Inpatient hospital stay | $320 per day for days 1–6; $0 per day for days 7–90(authorization required) |
| Outpatient hospital services | $185 copay |
| Outpatient observation | $200 copay |
| Ambulatory surgical center | $100 copay(referral required) |
| Outpatient blood services | $0 copay |
| Skilled nursing and home health | |
| Skilled nursing facility | $0 per day for days 1–20; $214 per day for days 21–100(authorization required) |
| Home health care | $0 copay(authorization required) |
| Kidney dialysis | $55 copay |
| Rehabilitation | |
| Occupational therapy | $35 copay(authorization required) |
| Physical therapy and speech-language therapy | $40 copay(authorization required) |
| Cardiac rehabilitation | $30 copay(authorization required) |
| Pulmonary rehabilitation | $25 copay(authorization required) |
| Mental health and substance use | |
| Inpatient psychiatric hospital stay | $250 per day for days 1–6; $0 per day for days 7–90(authorization required) |
| Outpatient mental health, individual session | $50 copay(authorization required) |
| Outpatient mental health, group session | $50 copay(authorization required) |
| Psychiatrist, individual session | $45 copay |
| Psychiatrist, group session | $45 copay |
| Partial hospitalization | $70 copay(authorization required) |
| Intensive outpatient program | $70 copay(authorization required) |
| Outpatient substance use, individual session | 20% coinsurance |
| Outpatient substance use, group session | 20% coinsurance |
| Opioid treatment program | 20% coinsurance |
| Ambulance and transportation | |
| Ground ambulance | $100 copay(authorization required) |
| Air ambulance | 20% coinsurance(authorization required) |
| Transportation to plan-approved locations | $0 copay(limits apply) |
| Medical equipment and supplies | |
| Durable medical equipment (e.g. wheelchairs, oxygen) | 0%–20% coinsurance(authorization required) |
| Prosthetics (e.g. braces, artificial limbs) | 20% coinsurance(authorization required) |
| Medical supplies | 20% coinsurance(authorization required) |
| Diabetes supplies | $10 copay |
| Diabetic therapeutic shoes or inserts | $10 copay |
| Chiropractic, acupuncture and foot care | |
| Chiropractic (Medicare-covered) | $0 copay |
| Routine chiropractic care | $0 copay(limits apply) |
| Acupuncture | $0 copay(limits apply) |
| Foot exams and treatment (Medicare-covered) | $10 copay |
| Routine foot care | $10 copay(limits apply) |
| Dental? | |
| Medicare-covered dental services | 20% coinsurance |
| Preventive dental plan limit | $1,500 plan limit every year |
| Restorative services (fillings, crowns) | $0 copay |
| Endodontics (root canals) | $0 copay |
| Periodontics (gum disease) | $0 copay |
| Dentures and other removable prosthodontics | $0 copay |
| Maxillofacial prosthetics | $0 copay |
| Implants | $0 copay |
| Bridges and other fixed prosthodontics | $0 copay |
| Oral and maxillofacial surgery | $0 copay |
| Orthodontics | $0 copay |
| Adjunctive general services | $0 copay |
| Vision? | |
| Eye exam (Medicare-covered) | $0 copay(limits apply) |
| Routine eye exam | $0 copay(limits apply) |
| Eyewear after cataract surgery (Medicare-covered) | $0 copay(limits apply) |
| Contact lenses | $0 copay(limits apply) |
| Eyeglasses (frames and lenses) | $0 copay(limits apply) |
| Eyeglass lenses | $0 copay(limits apply) |
| Eyeglass frames | $0 copay(limits apply) |
| Eyewear upgrades | $0 copay(limits apply) |
| Hearing? | |
| Hearing exam (Medicare-covered) | $0 copay(limits apply) |
| Routine hearing exam | $0 copay(limits apply) |
| Hearing aid fitting and evaluation | $0 copay(limits apply) |
| Hearing aids (all types) | $0 copay(limits apply) |
| Hearing aids, inner ear | Not covered |
| Hearing aids, outer ear | Not covered |
| Hearing aids, over the ear | Not covered |
| Medicare Part B drugs | |
| Part B insulin | $35 copay(authorization required) |
| Chemotherapy and radiation drugs | 0%–20% coinsurance(authorization required) |
| Other Part B drugs | 0%–20% coinsurance(authorization required) |
| Other extra benefits? | |
| Over-the-counter (OTC) allowance | $175 allowance every month |
| Meals after a hospital stay or for a chronic condition | Not covered |
| Fitness benefit | $0 copay |
| Health education | Not covered |
| Nutritional / dietary benefit | Not covered |
| Extra smoking and tobacco cessation counseling | Not covered |
| Enhanced disease management | Not covered |
| Telemonitoring | Not covered |
| Remote access technologies (web/phone, nurse line) | Not covered |
| Home and bathroom safety devices | Not covered |
| Counseling services | Not covered |
| In-home safety assessment | Not covered |
| Personal emergency response system (PERS) | Not covered |
| Medical nutrition therapy | Not covered |
| Post-discharge in-home medication reconciliation | Not covered |
| Re-admission prevention | Not covered |
| Wigs for hair loss from chemotherapy | Not covered |
| Weight management programs | Not covered |
| Alternative therapies | $0 copay |
| Therapeutic massage | Not covered |
| Adult day health services | Not covered |
| Home-based palliative care | Not covered |
| In-home support services | Not covered |
| Support for caregivers | Not covered |
In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2026). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed. Contact the plan for the full Evidence of Coverage.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 | $0.00 |
| Tier 2 | $2.00 |
| Tier 3 | $25.00 |
| Tier 4 | $100.00 |
| Tier 5 | 25% |
Rx cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | n/a | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $2.00 | $2.00 | n/a | $6.00 | $6.00 | $4.00 |
| Tier 3: Preferred Brand | $25.00 | $25.00 | n/a | $75.00 | $75.00 | $50.00 |
| Tier 4: Non-Preferred Drug | $100.00 | $100.00 | n/a | $300.00 | $300.00 | $200.00 |
| Tier 5: Specialty Tier | 25% | 25% | n/a | 25% | 25% | 25% |
| Catastrophic coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 4: Non-Preferred Drug | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 5: Specialty Tier | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Also available in 17 other NY counties
Benefits in plain text
Elderplan Select (HMO-POS I-SNP) (H3347-018-0) is a 2026 HMO-POS I-SNP Medicare Advantage plan offered by Elderplan, available to residents of Seneca County, NY.
The monthly premium is $0.00 (Part C and Part D together).
The plan reduces the member's Medicare Part B premium by $2.50 a month (a "giveback"); the Part B premium itself must still be paid.
With full Extra Help (the Low-Income Subsidy), the total monthly premium is $0.00.
There is no in-network deductible for health services.
Its in-network out-of-pocket maximum is $7,500.00.
The combined in- and out-of-network out-of-pocket maximum is $7,500.00.
The drug deductible is $0.00.
It is a special needs plan (Institutional SNP).
The plan's formulary lists 3,428 drugs.
At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1: $0.00; tier 2: $2.00; tier 3: $25.00; tier 4: $100.00; tier 5: 25%.
CMS gives the plan's contract (H3347) an overall rating of 3.5 out of 5 stars.
Email a copy of the plan benefit details
Plan facts come from the CMS quarterly prescription drug plan public use files; the premium split, Extra Help premium, MOOP and plan type from the CMS Landscape file; the Part B giveback and health benefits from the CMS plan benefit package (PBP) files.