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Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) Costs & Coverage — Orleans County, New York

CMS Rating:☆☆☆☆☆(3.5 out of 5 stars*)

Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) is a Institutional Medicare Special Needs Plan identified by CMS Plan-ID H3347-003-0 offered by Elderplan for the 2026 plan year.

The most recent CMS enrollment data shows an estimated 1,079 beneficiaries enrolled in this plan, with 0 in Orleans County.

Last update:

Elderplan Advantage For Nursing Home Residents Overview

2026 Medicare Special Needs Plan Overview for H3347-003-0
Plan Overview for H3347-003-0
CMS Plan ID: H3347-003-0
Plan Type: HMO-POS I-SNP
Plan Year: 2026
Monthly Premium: $44.80
Plus your Medicare Part B premium.
Medical Deductible: $0.00
Maximum Out-of-Pocket: $9250.00 (In-Network)
Part B Give Back: Not offered
Prescription Drug Coverage: Basic, $615.00 deductible
Additional Benefits: Dental, Vision, Hearing
Service Area: Orleans County, NY
Enrollment (Nationwide): 1,079 beneficiaries
Enrollment (CMS – Local)0 beneficiaries in Orleans County
Provided By: Elderplan
If you qualify for Original Medicare and a Medicare Advantage Plan but don't know where to begin, our HealthCompare licensed insurance agents[1] are available at 1-833-748-3201 (TTY 711) to answer your questions (M-F 8AM-10PM, Sat 9AM-8PM EST) and help you enroll. There's no obligation.

To learn more about your plan options, costs, and enrollment periods without agent assistance, try our helpful Medicare Resources below (click to open).

Medicare Plan Decision Resources

Eligibility and Plan Network

Eligibility Requirements

  1. Elderplan Advantage For Nursing Home Residents is an Institutional Special Needs Plan (I-SNP) for individuals living in an institution or requiring nursing-level care at home.
  2. This plan is for individuals living in a long-term care facility.
Eligibility requirements for Elderplan Advantage For Nursing Home Residents HMO-POS I-SNP (H3347-003-0)
Special Needs Plan Type: Institutional Special Needs Plan (I-SNP)
Medicare Requirement: Must have both Medicare Part A and Part B
Special Needs Requirement: This plan is for individuals living in a long-term care facility.
Service Area Requirement: Must live in the plan's designated service area
Prescription Drug Coverage: Prescription drug coverage is included.

Plan Network

Elderplan Advantage For Nursing Home Residents operates on a Health Maintenance Organization Point-of-Service (HMO-POS) network. Members usually access care through in-network providers, with referrals often needed for specialty services. Limited out-of-network care may be available, typically at higher out-of-pocket costs. Emergency services and out-of-area dialysis are covered.

5-Star Rating Marks

Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates Medicare Advantage HMO-POS I-SNPs across nine broad categories using a 5-star rating system. These star ratings provide insight into the quality of care and service you can expect from this Elderplan plan.

2026 Medicare Star Ratings for Contract H3347
CMS Measure Star Rating
2026 Overall Rating ☆☆☆☆☆
Staying Healthy: Screenings, Tests, Vaccines ☆☆☆☆☆
Managing Chronic (Long Term) Conditions ☆☆☆☆☆
Member Experience with Health Plan ☆☆☆☆☆
Complaints and Changes in Plans Performance ☆☆☆☆☆
Health Plan Customer Service ☆☆☆☆☆
Drug Plan Customer Service ☆☆☆☆☆
Complaints and Changes in the Drug Plan ☆☆☆☆☆
Member Experience with the Drug Plan Not enough data available
Drug Safety and Accuracy of Drug Pricing ☆☆☆☆☆

Covered Services & Costs

Office Visits

This plan lists in-network cost sharing for primary care and specialist visits, along with related office-based services.

Primary care and specialist visit costs for this plan.
Covered Service In-Network Cost
Primary: In-network: $0 copay | Out-of-network: $0 copay
Specialist: In-network: 0%-20% coinsurance | Out-of-network: 0%-20% coinsurance

Preventive and Wellness Services

Preventive and wellness benefits may include routine exams, telehealth, fitness programs, health education, and other in-network services.

Preventive and wellness service costs and benefits for this plan.
Covered Service In-Network Cost
Annual wellness exam: Not covered
Telehealth benefit: In-network: $0 copay, 20% coinsurance
Routine chiropractic: Not covered
Fitness benefits: Not covered
Health education: Not covered
Counseling services: Not covered
Over-the-counter drug benefits: In-network: $0 copay
Health transportation (non-emergency): In-network: $0 copay

Diagnostic, Lab, and Imaging Services

Diagnostic coverage includes in-network cost sharing for lab tests, x-rays, radiology, and other diagnostic procedures used to evaluate health conditions.

Diagnostic, laboratory, and imaging service costs for this plan.
Covered Service In-Network Cost
Diagnostic radiology services: In-network: 20% coinsurance | Out-of-network: 20% coinsurance
Lab services: In-network: $0 copay | Out-of-network: $0 copay
Outpatient x-rays: In-network: 20% coinsurance | Out-of-network: 20% coinsurance
Diagnostic tests and procedures: In-network: 20% coinsurance | Out-of-network: 20% coinsurance

Emergency and Urgent Care Services

Emergency and inpatient coverage includes cost sharing for urgent care, emergency room visits, ambulance transportation, hospital stays, and skilled nursing facility care.

Emergency, urgent care, hospital, ambulance, and skilled nursing costs for this plan.
Covered Service In-Network Cost
Emergency room care: 20% coinsurance
Worldwide emergency care: Not covered
Urgent care: $0 copay
Inpatient hospital care: In-network: | Tier 1 | $0 per day for days 1-60 | $419 per day for days 61-90 | $838 per day for days 91-150 | Out-of-network: | $0 per day for days 1-60 | $419 per day for days 61-90 | $838 per day for days 91-150
Skilled Nursing Facility: In-network: | Tier 1 | $0 per day for days 1-20 | $209.5 per day for days 21-100
Ground ambulance: In-network: 20% coinsurance

Mental Health Services

Mental health coverage includes in-network cost sharing for outpatient individual and group therapy, as well as inpatient psychiatric hospital care.

Mental health therapy and inpatient psychiatric care costs for this plan.
Covered Service In-Network Cost
Outpatient individual therapy: In-network: 20% coinsurance | Out-of-network: 20% coinsurance
Outpatient group therapy: In-network: 20% coinsurance | Out-of-network: 20% coinsurance
Inpatient psychiatric hospital care: In-network: | Tier 1 | $0 per day for days 1-60 | $419 per day for days 61-90 | $838 per day for days 91-150 | Out-of-network: | $0 per day for days 1-60 | $419 per day for days 61-90 | $838 per day for days 91-150

Rehabilitation Services

Rehabilitation coverage includes in-network cost sharing for physical therapy, speech and language therapy, and occupational therapy services.

Physical, speech, and occupational therapy costs for this plan.
Covered Service In-Network Cost
Physical therapy and speech and language therapy: In-network: $0 copay
Occupational therapy: In-network: $0 copay

Medical Equipment and Supplies

Medical equipment coverage includes in-network cost sharing for diabetes supplies, durable medical equipment, prosthetics, and related supplies.

Diabetes supplies, durable medical equipment, and prosthetic costs for this plan.
Covered Service In-Network Cost
Diabetes supplies: In-network: 20% coinsurance
Durable medical equipment: In-network: $0 copay
Prosthetics: In-network: $0 copay

Medicare Part B Drugs

Medicare Part B drug coverage includes in-network cost sharing for chemotherapy and other medications covered under Medicare Part B.

Chemotherapy and other Medicare Part B-covered drug costs for this plan.
Covered Service In-Network Cost
Chemotherapy: In-network: 0%-20% coinsurance
Other Part B drugs (Medicare-covered): In-network: 0%-20% coinsurance

Dental Services

Dental coverage includes in-network cost sharing for preventive care, exams, x-rays, cleanings, and comprehensive dental procedures.

Preventive and comprehensive dental service costs for this plan.
Covered Service In-Network Cost
Oral exam: Not covered
Dental x-rays: Not covered
Cleaning: Not covered
Periodontics: Not covered
Endodontics: Not covered
Restorative services: Not covered
Implant services: Not covered
Orthodontics: Not covered
Oral/Maxillofacial surgery: Not covered

Vision Services

Vision coverage includes in-network cost sharing for routine eye exams, contact lenses, eyeglass frames and lenses, and related eyewear services.

Routine eye exams, contact lenses, and eyewear costs for this plan.
Covered Service In-Network Cost
Routine eye exam: In-network: $0 copay
Contact lenses: In-network: $0 copay
Eyeglass frames only: In-network: $0 copay
Eyeglass lenses only: In-network: $0 copay
Eyeglasses (frames & lenses): In-network: $0 copay
Upgrades: In-network: $0 copay

Hearing Services

Hearing coverage includes in-network cost sharing for hearing exams, fittings and evaluations, prescription hearing aids, and over-the-counter hearing aids.

Hearing exams, fittings, and hearing aid costs for this plan.
Covered Service In-Network Cost
Hearing exam: In-network: $0 copay
Fitting/evaluation: In-network: $0 copay
Prescription hearing aids: In-network: $0 copay
OTC hearing aids: Not covered

Additional and Special Needs Services

Additional benefits may include in-network services for adult day health, palliative care, personal emergency response systems, weight management, alternative therapies, and home safety needs.

Additional and special needs service costs and benefits for this plan.
Covered Service In-Network Cost
Adult day health services: Not covered
Home-based palliative care: Not covered
Personal emergency response system: Not covered
Weight management programs: Not covered
Wigs for chemotherapy-related hair loss: Not covered
Alternative therapies: In-network: $0 copay | Out-of-network: $0 copay
Massage therapy: Not covered
Home/bathroom safety devices: Not covered

Elderplan Advantage For Nursing Home Residents covers 100% of certain preventive services as a required Part B benefit.

Prescription Drug Coverage

Part D Coverage Level (Benefit Design)

Elderplan Advantage For Nursing Home Residents includes a basic benefit Medicare Part D plan (PDP). This simply means that the plan covers the minimum amount required by the Centers for Medicare & Medicaid Services, whereas enhanced benefit plans cover more.

Plan Premium

The following table outlines the prescription drug plan premium details of this plan.

Medicare Part D Premium Breakdown for Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP)
Part D Premium Component Amount
Basic Part D Premium: $44.80
Supplemental Part D Premium: $0.00
Total Part D Premium: $44.80
Low Income Premium Subsidy: $58.82
Low Income Premium Subsidy CMS Pays: $44.80
Low Income Subsidy Premium: $0.00

For more information about the Low Income Subsidy, refer to the Social Security Extra Help page.

Plan Deductible

The Medicare Part D annual deductible with this plan is $615.00. This is the amount you must pay at the pharmacy before Elderplan begins paying its share.

Out-of-Pocket Costs

In addition to the plan's monthly premium and deductible, Elderplan Advantage For Nursing Home Residents has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.

Prescription Drug Tier Pricing for Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP)
Drug Tier Retail Mail Order
Brand-name drugs25% coinsuranceComing soon
Generic drugs25% coinsuranceComing soon
*Deductible does not apply.

Contact Elderplan

Call 833-748-3201 (TTY 711) to speak with a licensed HealthCompare insurance agent (M-F 8AM-10PM, Sat 9AM-8PM EST) and learn more about this plan and other plans on this site. You may also Enroll Online .

Elderplan Plan Contact Details for Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP)
Contact Type Details
Website: Elderplan Plan Page
New Members: 1-866-695-8101
Existing Members: 1-800-353-3765
Plan Address: Elderplan, Inc. | 55 Water St., Floor 46 | New York, NY 10041
Medicare Plan Data Sources and Methodology
Primary CMS datasets used to compile information about Plan ID H3347-003-0
Data Source Publisher CMS Version
Landscape Source Files Centers for Medicare & Medicaid Services 202608
Medicare Part C & D Performance Centers for Medicare & Medicaid Services 2026
Plan Benefits Package Centers for Medicare & Medicaid Services 2026
Monthly Enrollment by Contract/Plan/State/County Centers for Medicare & Medicaid Services 2026-08
Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
Elderplan (official source) http://www.elderplan.org October 13, 2025
CMS.gov Institutional Special Needs Plans (I-SNPs) September 20, 2025
Medicare.gov Understanding Medicare Advantage Plans 25 May, 2025
Medicare.gov Joining a plan 5 May, 2025

Medicare.org independently compiles and interprets Medicare plan information using data published by the Centers for Medicare & Medicaid Services (CMS), official plan information, and other authoritative Medicare sources. The sources used for this plan are documented below.

Medicare.org is an independent Medicare information and enrollment resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program. Enrollment assistance is provided through HealthCompare, an Allstate company.