The Senior Whole Health of New York NHC (HMO SNP) Plan offers comprehensive care, including preventive services, physician services, hospital care, pharmacy, and support services.
- $0 Doctor appointments
- $0 Dental visits
- $0 Vision services
- In-home assessments
- Individual care plan
- Medicare prescription drug coverage (co-pays may apply)
- Eyeglasses (limitations apply)
- OTC Card to buy certain over-the-counter (OTC) medicines and health-related items up to $80 a month (up to $960 a year)
- Transportation to and from medical appointments
- Private duty nursing services
- Home health services
- Home delivered meals
- Adult day healthcare
- Personal care services
- Personal Emergency Response Services (PERS)
- Every member is assigned a Personal Care Team who helps members receive quality medical, social and community-based services
Who can join Senior Whole Health of New York NHC (HMO SNP)?Senior Whole Health of New York NHC (HMO SNP) is a program for people who have both Medicare and Medicaid. Your loved one is eligible to join if they are also enrolled in Senior Whole Health of New York for Medicare coverage and:
- Are age 65 and older;
- Reside in the plan's service area: Bronx, Kings, Nassau, New York, Queens and Westchester counties;
- Medically eligible for nursing home level of care, as of the time of enrollment;
- Capable at time of enrollment of returning or remaining in your home and community without jeopardy to your health and safety; AND
- Assessed as requiring at least one of the following long term care services and care management for more than 120 days from the effective date of enrollment:
- Nursing services in the home;
- Therapies in the home;
- Health Aide services in the home;
- Personal care services in the home;
- Adult day healthcare;
- Private Duty Nursing;
- Consumer Directed Personal Assistance Services.
- Determined by the New York City Human Resources Administration Medicaid office (HRA) or your Local Department of Social Services (LDSS) Office to be eligible for benefits under the Medicaid program.
- He/she does not meet the eligibility criteria listed above.
- He/she is diagnosed with End-Stage Renal Disease (ESRD). However, if he/she develops ESRD while a member of Senior Whole Health of New York NHC (HMO SNP) he/she can stay in the program.
- He/she cannot be maintained safely in their home.
- He/she does not need long term care services of the plan for more than 120 days.
- He/she is enrolled in one of the following: Another Managed Care Plan capitated by Medicaid, a Home and Community-Based Services waiver program, a Hospice, a State Office for People with Developmental Disabilities (OPWDD) facility or waiver program and does not want to disenroll.
Your loved one may be eligible for other products offered by Senior Whole Health of New York. Click here to learn more about our other products.
Last Updated 01/01/2019
H5992_2018_099 Pending CMS Review