CenterLight Healthcare Direct

CenterLight Healthcare Direct Complete Plan Eligibility and Basics

As a Medicare beneficiary, you can choose to enroll in the CenterLight Healthcare Direct Complete Plan (HMO SNP).

Am I Eligible?

You may qualify for CenterLight Healthcare’s Direct Complete Plan (HMO SNP) if you:

Are entitled to Part A of Medicare and are also enrolled in Part B of Medicare and continue to pay your Medicare Part B premium

*Live in our service area: Bronx, Kings (Brooklyn), New York (Manhattan), Queens, Richmond (Staten Island), Nassau, Suffolk and Westchester counties

Individuals with End Stage Renal Disease generally are not eligible to enroll unless they have been members since before their dialysis began.

Plan Basics

CenterLight Healthcare Direct Complete Plan is a Medicare Advantage Health Maintenance Organization Special Needs Plan (HMO SNP). Members of CenterLight Healthcare Direct Complete Plan must go to the doctors, specialists and hospitals in our large network of providers.

In The Nursing Home: Nursing home residents are provided with their own Clinical Care Supervisor, a Nurse Practitioner who can coordinate care on-site. Your Clinical Care Supervisor works with your primary care physician and other healthcare professionals as part of a collaborative team dedicated to your health and well-being, and acts as a liaison with family and loved ones. Having a Nurse Practitioner on-site allows the patient to be treated in residence whenever possible, avoiding transfers to a hospital.

At Home/In the Community: For those still living in their own home, CenterLight Healthcare Direct Complete Plan will provide a Care Manager who will coordinate all of your care needs. When you enroll, your Care Manager will do a complete health history to identify any medical problems and care management issues and work with you to create your individual plan of care. Your Care Manager will help coordinate care between all your healthcare providers and any services you may have as well as act as your advocate in the healthcare system.

Primary Care Physician: When you join CenterLight Healthcare Direct Complete Plan, you will select a Primary Care Physician (PCP) in your area from our participating provider directory, who will provide all preventive services and help to coordinate your overall healthcare.

Specialists: You do not need a referral from your Primary Care Physician (PCP) to see a participating CenterLight Healthcare Specialist. Your PCP can assist you in finding the right Specialist for your condition, and will ensure you receive appropriate medical care.

Medicaid: CenterLight Healthcare members receiving Medicaid assistance will not be responsible for the deductible, co-payments and co-insurance amounts listed in the plan, which are covered by Medicaid. All your care providers except your Primary Care Physician will have to bill Medicaid directly.

To learn more about CenterLight Healthcare Direct Complete Plan, please call
1-877-226-8500
TTY 711
8:00 a.m. to 8:00 p.m. EST, 7 days a week

*Please note that this service area is subject to change if CenterLight Healthcare's contract with Medicare is terminated in one or more counties. We will tell you in advance if this happens.