CenterLight Healthcare Direct

CenterLight Healthcare Total Plan

CenterLight Healthcare Total (HMO SNP) is a Medicare Advantage Health Maintenance Organization Special Needs Plan for Medicare beneficiaries who receive full Medicaid/are dual eligible and require a nursing home level of care in their own home and community.

CenterLight Healthcare Total Members must have full Medicaid and enroll in the New York State Medicaid Advantage Plus (MAP) Program. All deductible co-payments and co-insurance costs are covered except for a minimal co-payment for prescription drugs. The Total plan coordinates all of your Medicare and Medicaid benefits, including prescription drugs.

Medicare benefits are divided into three parts: Part A, Part B, and Part D:

Part A is called hospital insurance and covers most hospital stay costs, as well as some follow-up costs.

Part B, medical insurance, pays doctor and outpatient medical care costs.

Part D covers prescription drug costs. Medicare has a standard program for Part D coverage.

Medicaid benefits include, but are not limited to, the following:

Personal care workers and nursing care at home

Social day centers

Other services, including dentistry and medical equipment, that qualify for Medicaid coverage.

Members receive services from their primary care physicians and inpatient hospital services using their Medicaid and/or Medicare cards.

CenterLight Healthcare Total will provide a Care Manager who will work with you, your physician and family to coordinate all of your care needs. When you enroll, your Care Manager will do a complete health history and develop a plan of care with specific goals dealing with your health concerns. Your Care Manager will also coordinate care between all your providers and act as your advocate in the healthcare system.

For more information, please call our Member Services Department at 1-877-226-8500 (TTY 711). We are here seven days a week from 8:00 a.m. to 8:00 p.m. EST to answer any questions you may have.

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