Centers Plan for Dual Coverage Care (HMO D-SNP)
Centers Plan for Dual Coverage Care (HMO D-SNP) was designed to offer those who are eligible, the convenience of combining the benefits of both Medicare and Medicaid into one comprehensive health plan. The plan includes prescription drug coverage.
This section will provide you with all the information you need to get the most out of your Centers Plan for Dual Coverage Care benefits
D-SNP Frequently Asked Questions
D-SNP Eligibility Requirements / Plan Highlights 2023
D-SNP Eligibility Requirements/Plan Highlights 2023
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, Nassau, New York, Queens, Richmond and Rockland Counties)
- You are a United States citizen or are lawfully present in the United States.
Plan Highlights:
- $0 per month for Part C; and $38.90 per month for Part D Premium (If not paid for you by Medicaid or Extra Help).
- $150 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
D-SNP Eligibility Requirements / Plan Highlights 2024
D-SNP Eligibility Requirements/Plan Highlights 2024
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, Nassau, New York, Queens, Richmond and Rockland Counties)
- You are a United States citizen or are lawfully present in the United States.
Plan Highlights:
- $0 per month for Part C; and $48.70 per month for Part D Premium (If not paid for you by Medicaid or Extra Help).
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$190 monthly Over the Counter (OTC) allowance. Please note: This benefit is a Special Supplemental Benefit for the Chronically Ill (SSBCI), and not all members will qualify.The $190 monthly OTC allowance is a combined (i.e., OTC and SSBCI benefits) monthly allowance which can be used towards your utilities (if you qualify). This means that there is only one monthly allowance of $190 for both benefits. If you do not qualify for the utilities benefit, the $190 monthly allowance can only be used on OTC items.
- Vision and Hearing services
- Transportation
- Prescription drug coverage
- Personal Care Manager
D-SNP Materials 2023
D-SNP Materials 2024
DSNP Important Member Forms
Important Member Forms
Member Reimbursement Form (last updated 10/2023)
How to Appoint a Representative - Last updated 03/07/19
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 below:
CMS1696: Appointment of Representative | CMS
CMS Appointment of Representative Form – Last updated 07/2023
CMS Appointment of Representative Form_Spanish - Last updated 07/2023
CMS Appointment of Representative Form_Large Print - Last updated 07/2023
CMS Electronic Complaint Form – Last updated 11/19/2014
Best Available Evidence (BAE) – Last updated 11/19/2014
Part D Prescription Drug Program
- Part D Overview
- MedImpact Member Portal
- Medication Therapy Management MTM
- OTC List
- Benefit Highlights, Drug Pricing & Pharmacy Search
- 2023 Formulary Look Up
- 2024 DSNP 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
For any pharmacy-related and medication-related benefit questions or to request a prior authorization or a coverage determination, call toll-free 1-888-807-5717 (TTY users call 711) 24 hours a day, 7 days a week or email: customerservice@medimpact.com.
D-SNP Find a Provider
D-SNP Service Areas
- Centers Plan for Dual Coverage Care serves the following 7 counties in New York State:
- Bronx
- Kings (Brooklyn)
- Nassau
- New York (Manhattan)
- Queens
- Richmond (Staten Island)
- Rockland counties
Over-the-Counter (OTC) Important Information
Rights and Responsibilities Upon Disenrollment
For information on your and Centers Plans’ rights and responsibilities upon your disenrollment from our plan, please see Chapter 10 of the Evidence of Coverage (EOC).
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