CenterLight Healthcare Direct

CenterLight Healthcare Total Plan Eligibility and Basics

As a Medicare beneficiary who has full Medicaid (is dual eligible), you can enroll in the CenterLight Healthcare Total Plan (HMO SNP). Because you are dual eligible, you may join or leave a plan at any time.

Am I Eligible?

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

Are entitled to Medicare Part A and enrolled in Medicare Part B

Have full Medicaid and are eligible for the New York State Medicaid Advantage Plus (MAP) Program

*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 Total (HMO SNP) is a Special Needs Plan for Medicare beneficiaries who have full Medicaid (are dual eligible) and require a nursing home level of care in their own home and community. The plan coordinates all Medicare and Medicaid benefits, including prescription drugs, and your medical services through CenterLight Healthcare’s network of healthcare facilities and physicians. Members of CenterLight Healthcare Total must go to the doctors, specialists and hospitals in our large network of providers.

The Help You Need To Stay Safe & Comfortable At Home

CenterLight Healthcare Total 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, your physician and family to create an individual plan of care. Along with an interdisciplinary team of healthcare professionals, your Care Manager will visit you at home and monitor your well-being, coordinate care between all your healthcare providers and services and act as your advocate in the healthcare system.

You may also receive highly trained supervised staff to help with personal care, shopping, meal preparation, simple household needs, social work services, or modifications to your home to accommodate your disabilities.

Primary Care Physician: When you join CenterLight Healthcare Total, 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 Total (HMO SNP) Members must have full Medicaid and must enroll in the NYS Medicaid Advantage Plus (MAP) Program. Members will not be responsible for deductible, co-payments and coinsurance amounts with the exception of co-pays for prescription drugs. Members will be covered by Medicaid for all services covered by NYS under the MAP program.

To learn more about the CenterLight Healthcare Total 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.

CenterLight Healthcare Total (HMO SNP) is pending New York State Department of Health approval.