For many dual-eligible seniors in New York, the biggest fear isn’t a diagnosis — it’s losing the ability to stay in their own home. Elderplan’s Medicaid Advantage Plus (MAP) plan, officially called Elderplan Plus Long-Term Care (HMO-POS D-SNP), is built to solve exactly that problem. It combines Medicare, Medicaid, and long-term care into one coordinated plan so seniors who qualify for nursing-home-level care can keep living at home instead.
Here’s what brokers and consumers need to know about the plan in 2026, including the eligibility changes, lock-in rules, faster authorization timelines, and appeals-process update that took effect this year.
Table of Contents
- What Is the Elderplan MAP Plan?
- Who Qualifies for the Elderplan MAP Plan?
- What Benefits Does It Actually Provide Seniors?
- Why This Matters for Seniors in the Community
- How Enrollment Works
- Lock-In Rules and Switching Plans
- What Changed for MAP Members in 2026
- Important Note for Brokers: MAP Plans Require Special Training
- What Brokers Should Do Now
- Frequently Asked Questions
- Sources
What Is the Elderplan MAP Plan?
MAP (Medicaid Advantage Plus) is New York State’s model for a Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP), defined under 42 CFR 422.2. In practice, that means one plan — administered by one carrier — handles everything a dual-eligible member needs:
- Medicare Parts A, B, and D
- Medicaid acute and behavioral health care
- Medicaid Long-Term Services and Supports (LTSS), such as home care and personal care
Elderplan’s version of this product, Elderplan Plus Long-Term Care (HMO-POS D-SNP), gives members one ID card, one care manager, and one drug formulary instead of juggling separate Medicare and Medicaid plans (Elderplan). Statewide, MAP is one of three MLTC product types — alongside MLTCP and PACE — with 12 MAP plans and an estimated 25,000–30,000 members enrolled across New York in 2026 (Brevy Care).
Who Qualifies for the Elderplan MAP Plan?
To enroll, a member generally must:
- Be 18 years or older
- Have both Medicare (Parts A and B) and full New York State Medicaid
- Be assessed as eligible for Nursing Home Level of Care (NHLOC)
- Be capable of safely remaining at home or in the community at the time of enrollment
- Require at least one community-based long-term care service — such as home nursing, home therapy, or personal care — for more than 120 continuous days (Elderplan Member Handbook)
2026 update: Under the Minimum Needs Requirement (MLTC Policy 25.04 and 25 OHIP/ADM-03), which took effect September 1, 2025 and remains in force for 2026, new MAP and MLTC enrollees must also show either:
| Requirement track | Threshold |
|---|---|
| Standard track | Limited assistance with 3 or more activities of daily living (ADLs) |
| Documented Alzheimer’s/dementia diagnosis on file | Supervisory assistance with 2 or more ADLs |
Members who enrolled before September 1, 2025 keep Legacy Status under the old, lower threshold as long as they stay continuously enrolled — a coverage gap forfeits Legacy Status and requires re-qualifying under the new rule (NY Health Access; Brevy Care).
Elderplan’s Plus Long-Term Care plan is available in Bronx, Kings (Brooklyn), Nassau, Manhattan, Queens, Richmond (Staten Island), Westchester, Dutchess, Orange, Putnam, and Rockland counties (Elderplan).
What Benefits Does It Actually Provide Seniors?
Personal care and in-home support
Members get access to a Personal Care Worker (PCW) who helps with daily activities like bathing, dressing, meal prep, and mobility — the kind of support that’s often the difference between staying home and moving to a nursing facility.
One dedicated care manager
Instead of coordinating separately with Medicare providers, Medicaid case workers, and home care agencies, members get a single care management team that oversees medical, behavioral health, and long-term care needs together.
Extra benefits at no added cost
Because the plan is capitated by both Medicare and Medicaid, members typically pay $0 in premium. On top of core medical coverage, Elderplan’s dual-eligible plans include:
- Comprehensive dental coverage
- An Over-the-Counter (OTC) allowance that now also covers groceries and home-delivered meals
- A free gym membership
- Free transportation to medical appointments
Why This Matters for Seniors in the Community
Nursing-home placement is disruptive and expensive, and most seniors would rather age in place. MAP plans exist specifically to make that possible for people who technically qualify for nursing-home-level care but can safely remain home with the right support. By folding personal care, medical coverage, and behavioral health into a single coordinated plan, Elderplan’s MAP product removes a lot of the friction that normally causes people to fall through the cracks between Medicare and Medicaid.
How Enrollment Works
Enrollment in a MAP plan isn’t a single step — it requires Exclusively Aligned Enrollment, a federal requirement since January 1, 2025:
- The member first enrolls in the plan’s Medicare product (call 1-800-MEDICARE or the plan directly).
- The member then enrolls in the same parent organization’s Medicaid Managed Long-Term Care (MLTC) product through New York Medicaid Choice (1-888-401-6582).
- Once both pieces are active with the same carrier, the member is fully enrolled in the MAP plan.
A member cannot enroll in Elderplan’s MAP Medicaid product while keeping a different company’s Medicare plan — the two sides must be aligned under 42 CFR 422.514(h) (Brevy Care).
Lock-In Rules and Switching Plans
Once enrolled, MAP members are not free to switch plans at any time. Under MLTC Policy 21.04, members get a 90-day grace period after enrollment to change plans freely, then are locked in for 9 months. Mid-lock-in switches are allowed only for an approved Good Cause reason, such as:
- The plan doesn’t adequately meet the member’s care needs
- The plan terminates or drops the member’s provider without an adequate continuity-of-care plan
- The member moves out of the plan’s service area
- The member’s preferred provider is only in-network with a different plan
After a Good Cause switch, a new 90-day grace period and 9-month lock-in begin again. After month 13 of continuous enrollment, members may switch plans at any time (Brevy Care).
Broker takeaway: Set expectations with clients at enrollment — explain the lock-in window up front so it doesn’t come as a surprise if their needs change a few months in.
What Changed for MAP Members in 2026
Two significant process changes took effect for MAP members heading into 2026:
- Appeals process split (effective January 1, 2026): The integrated appeals process that MAP members used since 2020 — where one appeal covered both Medicare and Medicaid denials — was phased out as of December 31, 2025. MAP members now go through separate, parallel Medicare and Medicaid appeal tracks instead of a single combined process (NY Health Access).
- Faster authorization decisions (effective January 1, 2026): Under the CMS Interoperability and Prior Authorization Final Rule, MAP plans must now decide standard service authorization requests within 7 calendar days, down from 14. Expedited requests remain on a 72-hour timeline (Brevy Care).
Brokers should flag both changes to clients and caregivers so they know which appeal track to use if a service gets denied, and can expect quicker turnaround on new authorization requests.
Important Note for Brokers: MAP Plans Require Special Training
Brokers can still sell Elderplan’s MAP product, but it isn’t covered by standard AHIP certification alone. Because MAP is a Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP), CMS requires organizations to separately train and test every agent and broker on the specific benefits and rules of each Special Needs Plan they sell, on top of standard Medicare Advantage certification (CMS Agent and Broker Training & Testing Guidelines). In practice, that means completing Elderplan’s plan-specific D-SNP/FIDE-SNP certification and Model of Care attestation before you can market or enroll members into MAP — in addition to holding an active New York State insurance license.
If you’re already appointed with us and want access to this training, or you’re not yet contracted with Elderplan, our contracting team can get you set up. Brokers new to Medicare certification can also get a discount on AHIP Medicare training through ACA at www.ahipmedicaretraining.com/client/oim.
Contact Our Contracting Team
Shella – Contracting Specialist
📧 Email: [email protected]
📞 Phone: 315-998-3189
What Brokers Should Do Now
- Confirm you hold an active New York State insurance license and current AHIP/Medicare Advantage certification
- Complete Elderplan’s plan-specific FIDE-SNP/D-SNP certification and Model of Care attestation before marketing MAP
- Review the 9-month lock-in rule with clients at enrollment so expectations are set from day one
- Flag the new parallel Medicare/Medicaid appeals tracks to clients so they know which one applies if a service is denied
- Confirm a prospect’s county is in Elderplan’s MAP service area before starting the Exclusively Aligned Enrollment process
- Contact ACA’s contracting team for access to MAP-specific training if you’re not yet set up to sell it
Frequently Asked Questions
Is the Elderplan MAP plan the same as regular Medicare Advantage?
No. A MAP plan is a Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) that combines Medicare and Medicaid, including long-term care, under one carrier. Regular Medicare Advantage plans do not include Medicaid LTSS.
Does the MAP plan cost anything?
For most full-benefit dual-eligible members, the premium is $0 because Medicaid covers the Medicare cost-share.
Can someone keep their own doctor on a MAP plan?
Generally, no — MAP plans use a closed network, so members must use providers contracted with that specific plan, unlike Original Medicare.
What if someone doesn’t meet the new 2026 ADL requirement?
They may still qualify for a partial-capitation MLTC plan (Medicaid only, no integrated Medicare) if they don’t meet the higher long-term-care threshold required for MAP.
Can a MAP member switch plans whenever they want?
No. After a 90-day grace period following enrollment, members are locked in for 9 months under MLTC Policy 21.04 and can only switch mid-lock-in for an approved Good Cause reason.
Where is Elderplan’s MAP plan available?
Bronx, Kings, Nassau, Manhattan, Queens, Richmond, Westchester, Dutchess, Orange, Putnam, and Rockland counties as of 2026.
Do brokers need special training to sell MAP plans?
Yes. In addition to an active New York insurance license, brokers must complete Elderplan’s plan-specific FIDE-SNP/D-SNP certification and Model of Care attestation before marketing or enrolling members in the MAP product. Contact our contracting team above for access to this training.
Ready to Offer MAP Plans to Your Clients?
Affordable Care Agents helps licensed brokers and agencies grow through carrier contracting, national market access, training, back-office support, compliance education, and technology resources. Partner with Affordable Care Agents today to get set up with Elderplan’s plan-specific MAP training, or contract now to get started. Questions? Reach our contracting team at [email protected] or 315-998-3189.
Sources
- 42 CFR 422.2 — Definition of FIDE-SNP
- Elderplan — Dual-Eligible Plan Options
- Elderplan Plus Long-Term Care Member Handbook (2025)
- NY Health Access — MAP/MLTC Eligibility and Appeals Updates
- Brevy Care — New York Managed Long Term Care in 2026
- Brevy Care — MAP/FIDE-SNP Exclusively Aligned Enrollment
- CMS — CY2027 Agent and Broker Training & Testing Guidelines
CMS Disclaimer
The Centers for Medicare & Medicaid Services (CMS) and the New York State Department of Health do not endorse any particular agent, broker, or organization. Enrollment assistance is available at no cost through New York Medicaid Choice and from licensed brokers who have completed the required plan-specific FIDE-SNP training. This article is for educational purposes only and does not replace official CMS or NYS DOH guidance.
