Click here to view Dual Coverage Care Frequently Asked Questions

D-SNP Eligibility Requirements/Plan Highlights

Eligibility Requirements:

• You must be enrolled in Medicare Part A and B
• You must be Medicaid eligible
• You must live in our contracted service area (Bronx, Kings, New York, Queens, and Richmond Counties)

Plan Highlights:

• $0 per month for Part C; and $42.30 per month for Part D Premium (If not paid for you by Medicaid or Extra Help).
• $144 over-the-counter monthly benefit card (cannot be carried over from month to month)
• Preventive and comprehensive dental coverage
• Vision and Hearing services
• Transportation
• Prescription drug coverage
• Personal Care Manager

Click here for D-SNP Materials 2021

Important Member Forms

Member Reimbursement Form (last updated 1/25/17)

In the event that you need to appoint a representative regarding a grievance, request a coverage determination or an appeal, or to make complaints, the following form is also available on the Medicare and Medicaid Services (CMS) website:

How to Appoint a Representative - Last updated 03/07/19

CMS Appointment of Representative Form  – Last updated 03/05/2019

CMS Appointment of Representative Form -Spanish - Last updated 03/05/2019

CMS Appintment of Representative Form- Large Print - Last updated 03/05/2019

CMS Electronic Complaint Form – Last updated 11/19/2014

Best Available Evidence (BAE) – Last updated 11/19/2014

• Part D Overview 2021
• OTC List
• Benefit Highlights, Drug Pricing & Pharmacy Search
• 2021 Formulary Look Up
• Medicare Prescription Drug Coverage Determination Information
• Request for Redetermination of Medicare Prescription Drug Denial form
• Prescription Drug Transition Policy
• How to Submit a Prescription Drug Reimbursement Claim Form
  • • Prescription Drug Claim Form 

Click here to find a provider

• Centers Plan for Dual Coverage Care serves the following 5 counties in New York State:
  • Bronx
  • Kings (Brooklyn)
  • New York (Manhattan)
  • Queens
  • Richmond (Staten Island)