Elderplan

What Elderplan does

Elderplan, Inc. is a not-for-profit Medicare Advantage and Managed Long-Term Care (MLTC) health plan serving New York State residents, operating as part of the MJHS (Metropolitan Jewish Health System) health system. The company offers a portfolio of HMO-POS plans including D-SNP products for dual Medicare/Medicaid beneficiaries, I-SNP products for nursing home and assisted living residents, Extra Help plans for Low-Income Subsidy recipients, and the HomeFirst MLTC plan for Medicaid recipients needing home-based long-term care. Coverage is sold across 15+ New York counties spanning the NYC metro area, Long Island, Hudson Valley, and parts of Western and Central New York. Elderplan generates revenue primarily through capitated per-member-per-month payments from Medicare and Medicaid, plus Part D payments for prescription drug coverage, with most plans carrying no additional premium beyond the standard Medicare Part B premium.

The company's operational platform combines a member services call center (operating 8 a.m. to 8 p.m. seven days a week), community offices, a multilingual website (English, Spanish, Chinese), an online enrollment portal, and an electronic member-noticing system. Care management is delivered through dedicated care managers for complex-needs and MLTC members, supported by an OTC+Flex Visa card program, telehealth services, a 24/7 nurse hotline, and a Medication Therapy Management program run in coordination with CVS/Caremark. Elderplan sells through a direct-to-consumer model (phone, web, in-person) supplemented by provider referrals, member-to-member community events, and partnerships with five Social Care Networks that address housing, food, utility, and transportation insecurity.

Distribution is anchored by a contracted provider network of more than 40,000 clinicians and facilities, with vendor partnerships covering dental (DentaQuest starting January 1, 2026), vision (Superior Vision), hearing (Hear USA), non-emergency medical transportation (Medical Answering Services), and Consumer Directed Personal Assistance Services (Public Partnerships LLC). As a not-for-profit, Elderplan reinvests earnings into supplemental member benefits; the HomeFirst MLTC plan holds a 5-Star rating from the New York State Department of Health, a distinction shared by only one other plan in the state.

Name

Elderplan

Legal name

Elderplan, Inc.

Website

https://elderplan.org

Company type

Private

Founded year

1984

Operating status

Operating

Headcount range

251–500 employees

Short description

Elderplan is a not-for-profit New York health plan, part of the MJHS system, offering Medicare Advantage, D-SNP, I-SNP, and HomeFirst MLTC plans to Medicare, Medicaid, and dual-eligible beneficiaries across 15+ counties.

Ownership category

akta.pro rank

Product category

Medicare Advantage Health Insurance

NAICS

Services for the Elderly and Persons with Disabilities (624120), Continuing Care Retirement Communities and Assisted Living Facilities for the Elderly (62331)

SIC

Services-Nursing & Personal Care Facilities (8050)

akta.pro primary industry

Assisted Living with Enhanced Care / High-Acuity (Aging-in-Place) (HLADABAC)

akta.pro secondary industries

Medicaid Waiver / PACE-Partnered Adult Day Programs (HLADAIAM), Elder Services & Aging Support (BPAGAEAF)

Keywords

• Medicare Advantage Plans
• Managed Long-Term Care
• Dual-Eligible Health Plans
• Healthcare Benefits Administration
• Senior Care Coverage

Headquarters

HQ city

Brooklyn

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2C

Offering type

Services

Cost components

Operations, Personnel, Infrastructure, Marketing or Sales

Revenue model

1. Medicare Advantage Capitated Payments: Elderplan receives capitated (per-member-per-month) payments from Medicare to provide all Medicare-covered benefits to enrolled Medicare Advantage plan members. As an HMO with Medicare contract, the company assumes financial risk for providing comprehensive care.
2. Medicaid Capitated Payments: For dual-eligible members (Medicare and Medicaid) and MLTC (Managed Long-Term Care) members, Elderplan receives capitated payments from Medicaid to cover long-term care services and coordination.
3. Medicare Part D Prescription Drug Coverage: As a Medicare Advantage Part D (MA-PD) plan, Elderplan includes prescription drug coverage, generating revenue through Medicare Part D payments and pharmacy network management.
4. Plan Premiums: Most Elderplan Medicare Advantage plans have no additional premium beyond the Medicare Part B premium, but some specialized plans may have associated costs. The not-for-profit model reinvests earnings into member benefits.

Pricing tiers

Go-to-market motion2 records

Distribution channels5 records

Marketing channels7 records

Core offering

Elderplan is a not-for-profit health plan providing Medicare Advantage Plans (HMO-POS) and a Managed Long-Term Care Plan (HomeFirst MLTCP) to Medicare, Medicaid, and Dual-Eligible beneficiaries across New York State. It delivers comprehensive health coverage including prescription drugs, dental, vision, hearing, OTC/Flex benefits, care management, and long-term services, operating as an HMO under Medicare and Medicaid contracts.

Product overview

Elderplan is a not-for-profit health plan offering affordable Medicare Advantage and Long-Term Care health plans exclusively for New Yorkers. The company provides a portfolio of Medicare Advantage Plans including Elderplan Plus Long-Term Care (HMO-POS D-SNP), Elderplan for Medicaid Beneficiaries (HMO-POS D-SNP), Elderplan Flex (HMO-POS), Elderplan Extra Help (HMO-POS), Elderplan Select (HMO-POS I-SNP/IE-SNP), and Elderplan Advantage for Nursing Home Residents (HMO-POS I-SNP), alongside the HomeFirst Managed Long-Term Care Plan (MLTCP) for Medicaid recipients needing home-based care. Elderplan's 2026 product lineup offers coverage starting January 1, 2026, with options tailored for dual-eligible beneficiaries, long-term care needs, nursing home residents, and those requiring extra help with prescription costs. Elderplan operates as an HMO plan with Medicare and Medicaid contracts, serving beneficiaries across multiple New York counties with an extensive provider network of over 40,000 healthcare professionals.

Differentiator

Problem solved

Functional benefit

Brands

• HomeFirst Managed Long-Term Care Plan (MLTCP): Managed Long-Term Care Plan designed for people who qualify for Medicaid and need ongoing care at home. Available in the 5 boroughs of NYC and surrounding counties.

Products and services

• Elderplan Plus Long-Term Care (HMO-POS D-SNP) Medicare Advantage plan for Medicare and Medicaid beneficiaries who need assistance at home with personal care services. Covers medical, hospital, prescription drugs, and long-term care in one integrated plan.
• Elderplan for Medicaid Beneficiaries (HMO-POS D-SNP) Medicare Advantage plan for beneficiaries who have both Medicare and Medicaid. Covers medical, hospital, and prescription drugs in one integrated plan.
• Elderplan Flex (HMO-POS) Medicare Advantage plan offering beneficiaries freedom to choose benefits that best fit individual needs, including prescription drugs, dental, vision, hearing, and gym membership.
• Elderplan Extra Help (HMO-POS) Medicare Advantage plan for beneficiaries receiving Extra Help (LIS/Low-Income Subsidy), with reduced prescription drug costs and enhanced OTC benefits usable for groceries and home-delivered meals.
• Elderplan Select (HMO-POS I-SNP/IE-SNP) Institutional Special Needs Plan for members living in nursing homes, assisted living, or independent living facilities, with dedicated NP or RN care support.
• Elderplan Advantage for Nursing Home Residents (HMO-POS I-SNP) Medicare Advantage special needs plan for nursing home residents who have both Medicare and Medicaid, with facility-specific coordinated care.
• HomeFirst Managed Long-Term Care Plan (MLTCP) Managed Long-Term Care plan for Medicaid recipients who need ongoing care at home. Available in the 5 boroughs of NYC and surrounding counties. Rated 5-Star by NY State DOH Consumer Guide (one of only two such plans in New York State).

Quantifiable outcome

• Most Elderplan plans can save members money on Medicare coverage through lower out-of-pocket expenses like deductibles and 20% cost-sharing
• +2 more outcomes

Named customers5 records

Segments5 records

Ideal customer profiles4 records

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration10 records

Feature5 records

Partnerships

Ten partnerships are on record, tiered core and minor.

• SPS Community SolutionscoreStrategic or Co-development PartnerSPS Community Solutions is Elderplan's trusted partner offering free, one-on-one assistance to help members apply for public programs. Services include checking eligibility, applying for benefits (Medicaid, Medicare Savings Programs, Extra Help/LIS, EPIC, SNAP, Lifeline, LIHEAP), gathering documents, and tracking application status. Staff speak multiple languages and may offer in-home support.
• DentaQuestcoreTechnology or IntegrationDentaQuest is Elderplan's dental provider partner providing access to a broad network of dentists for Elderplan members. Starting January 1, 2026, DentaQuest replaces Healthplex as the dental administrator. Members can find dentists through DentaQuest's directory.
• CVS/CaremarkcoreTechnology or IntegrationCVS/Caremark provides mail-order prescription pharmacy services for Elderplan members. Members can call 1-866-490-2102 for mail-order prescriptions 24/7. CVS/Caremark also conducts Medication Therapy Management (MTM) Program calls with members.
• Medical Answering Services (MAS)coreStrategic or Co-development PartnerMAS provides non-emergency medical transportation directly through Medicaid for HomeFirst members. Members in NYC boroughs, Nassau, Westchester, Putnam call 1-844-666-6270; those in Dutchess, Orange, Rockland, Sullivan, Ulster call 1-866-932-7740. No cost for medical appointment transportation.
• Health Equity Alliance of Long IslandminorStrategic or Co-development PartnerSocial Care Network (SCN) partner serving Nassau County. Connects HomeFirst members to community services addressing health-related social needs including housing, utilities, transportation, and food access.
• Hudson Valley Care CoalitionminorStrategic or Co-development PartnerSocial Care Network (SCN) partner serving Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, and Westchester counties. Connects HomeFirst members to community services including housing support, utilities, transportation, and food access.
• Public Health SolutionsminorStrategic or Co-development PartnerSocial Care Network (SCN) partner serving Manhattan, Queens, and Brooklyn. Connects HomeFirst members to community services addressing health-related social needs.
• Staten Island Performing Provider SystemminorStrategic or Co-development PartnerSocial Care Network (SCN) partner serving Richmond (Staten Island). Beginning 4/1/26, serves only for specified follow-up services. Connects HomeFirst members to community services.
• Public Partnerships LLC (PPL)coreTechnology or IntegrationPPL is the fiscal intermediary for Consumer Directed Personal Assistance Services (CDPAS). Members and their personal care assistants must register with PPL for CDPAS services, allowing members to choose friends, neighbors, or family members as caregivers.
• MJHS Health SystemcoreStrategic or Co-development PartnerMJHS (Metropolitan Jewish Health System) is the parent health system for Elderplan and HomeFirst. Elderplan/HomeFirst are part of the MJHS healthcare system providing comprehensive health services to New Yorkers.

Scale indicators4 records

Recent moves6 records

Expansion highlights6 records

Direct peers

• EmblemHealth: NY-based regional not-for-profit health plan offering MA, D-SNP, and Medicare Supplement plans with deep Brooklyn/Queens presence overlapping Elderplan's core service counties.
• VillageCareMAX: NY-focused MLTC and D-SNP health plan serving Medicaid long-term care and dual-eligible populations in NYC — directly comparable to HomeFirst MLTC and Elderplan Plus LTC.
• Fidelis Care: NY Statewide health plan offering Medicare Advantage, D-SNP, Medicaid managed care, and MLTC products across the same regional markets as Elderplan, with comparable dual-eligible focus.
• AgeWell New York: NY-centric D-SNP and MLTC health plan targeting dual-eligible and long-term care populations — competes head-to-head with Elderplan in the downstate senior care segment.
• Healthfirst: NY-based not-for-profit health plan serving Medicare, Medicaid, and dual-eligible members across a multi-county NY footprint — the closest direct competitor to Elderplan in MA, MLTC, and D-SNP products for the same populations.
• Centers Plan for Healthy Living: NY-based managed care plan focused on D-SNP, MLTC, and nursing-home-level I-SNP products overlapping Elderplan Select and HomeFirst MLTC offerings in the same geography.

Broad incumbents

• UnitedHealthcare: Largest national Medicare Advantage insurer with deep NY presence including D-SNP and institutional products; competes broadly with Elderplan and pressures pricing, broker commissions, and Star benchmarks.
• Humana: Major national MA player with a growing D-SNP and senior-focused care footprint; competes in NY MA and MLTC adjacent markets and sets competitive benchmarks for Star and quality investment.
• Aetna (CVS Health): National MA and D-SNP insurer with cross-LOB integration through CVS retail and Caremark PBM; competes with Elderplan in NY MA and acts as an indirect counterparty through the Caremark partnership.

Others

• MJHS Health System: Parent organization providing home health, hospice, and post-acute services to Elderplan members — an ecosystem partner rather than a competitor, but a structural anchor in Elderplan's operating model.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

Compliance4 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Elderplan