Medical Deductible
$300 (New York City and Nassau County)
$450 (Orange, Rockland, Sullivan, and Westchester counties)
Eligible Age
65 or older (or under 65 with certain disabilities)
Eligible Service Areas
Reside within New York City’s five boroughs (The Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Nassau, Orange, Rockland, Sullivan, and Westchester counties.
Other Eligibility Requirements
Qualify for Medicare Part A
Enroll in and continue to pay for Medicare Part B
Maximum Out-of-Pocket
$9,250
Flex Card
$130 per year allowance for dental, vision, and hearing out-of-pocket costs, cost shares for Part A and Part B Medicare-covered services, cost shares for routine podiatry and routine chiropractic services, fitness equipment, activity trackers, and personal emergency response systems (PERS)
Annual Supplemental Physical Exam
$0 copay
Dental
$0 copay for covered preventive and comprehensive dental services; up to $1,000 maximum coverage per year
Vision
$0 copay for routine vision exams, including refraction
$200 eyewear allowance every year for contact lenses or one pair of glasses (lenses and frames)
Hearing
$0 copay for one routine hearing exam per year
$0‒$1,475 copay per hearing aid
Plan covers one hearing aid per ear, per year
Nutrition Counseling
$0 copay for up to six counseling visits per year
Acupuncture
$0 copay for up to 20 visits per year for chronic lower back pain, and 12 additional visits per year for any condition, including chronic lower back pain
Telemedicine
$0 copay for telemedicine services with network PCPs and mental health providers, or through Teladoc Health®
$0 copay for telemedicine services with network specialists, after deductible
Nurse Help Line Access
$0 copay
Meal Delivery
$0 copay for up to 84 meals delivered to your home for up to 28 days following a discharge from hospital to home or from a skilled nursing facility to home with a stay greater than two days, if recommended by a provider
Your Annual Checkup
$0 copay
Primary Care Provider (PCP) Visit
$0 copay
Specialist Visit
$40 copay, after deductible
Outpatient Lab Tests (including COVID-19)
20% coinsurance for genetic labs, after deductible
$0 for all other labs, after deductible
Retail Health Clinic
$15 copay
Emergency Room
$115 copay
Ambulance
$315 copay, after deductible
Ambulatory Surgery Visit
$0 copay for diagnostic colonoscopies and esophageal endoscopies, after deductible
$240 copay for all other ambulatory surgery center services, after deductible
Outpatient Facility
$0 copay for diagnostic colonoscopies and esophageal endoscopies, after deductible
20% coinsurance for all other outpatient hospital services, after deductible
Inpatient Hospital Stay
$611 copay per day for up to four days, after deductible;
$0 copay per day after four days
Skilled Nursing Facility
$0 copay per day for up to 20 days, after deductible;
$218 copay per day for days 21–100