Integrated Care Plans for Dual Eligible New Yorkers

Generated from the gc-benefits catalog. It lists what the owner record states. It is not an eligibility decision; confirm current rules with the program.

An Integrated Care Plan is one that provides you with both your Medicaid and Medicare services from the same health plan. Integrated Care Plans are designed to help dual-eligible beneficiaries meet their health care needs within their own community, instead of going to a nursing home or other facility for care. There are three types of Integrated Care Plans in New York. Depending upon your care needs and whether you qualify as a dual-eligible, you may be eligible for an Integrated Care Plan. Both Medicaid Advantage Plus (MAP) and the Program of All Inclusive Care for the Elderly (PACE) are also known as Managed Long Term Care (MLTC) plans. These plans will pay for all your Medicare health services at little to no additional cost to you and include benefits such as home care and other long term services and supports (LTSS) you may need. As a member of an Integrated Care Plan, you must use the plan's network of doctors, although your existing doctor(s) may agree to participate with the plan. IB-Dual provides you with Medicaid and Medicare covered services through the same health plan.

• Owner record: ny/integrated-care-for-dual-eligibles
• Jurisdiction code: NY
• Frame: care_recipient
• Review by: 2026-11-13
• Authority: New York State Department of Health
• Also called: Integrated Care for Dual Eligibles

Offering 1: Integrated Benefits for Dually Eligible Enrollees (IB-Dual)

The Integrated Benefits for Dually Eligible Enrollees (IB-Dual) is the newest integrated care plan option available for individuals who have both Medicare and Medicaid coverage. The IB-Dual program is for individuals who do not require long term care services and supports. The program allows an individual who is becoming newly Medicare eligible to remain in their Mainstream Medicaid Managed Care Plan or Health and Recovery Plan (MMC/HARP) and enroll in the aligned Medicare D-SNP.

• Availability (owner codes): {"intake": "unknown", "type": "unknown"}

Conditions:

• All of these:
• Stated condition, not checked automatically: "individuals who have both Medicare and Medicaid coverage"
• Stated condition, not checked automatically: "do not require long term care services and supports"
• Stated condition, not checked automatically: "Enrollment in the IB-Dual program occurs when an individual in MMC/HARP is also enrolled in the Medicare D-SNP of the same healthcare organization that provides one's Medicaid services"
• Any one of these:
  • All of these:
  • Stated condition, not checked automatically: "a MMC/HARP member becomes newly eligible for Medicare"
  • Stated condition, not checked automatically: "the individual will be enrolled into the aligned Medicare D-SNP"
  • All of these:
  • Stated condition, not checked automatically: "dual eligibles who are not newly Medicare eligible"
  • Any one of these:
    • Stated condition, not checked automatically: "voluntary enrollment into the MMC/HARP from Medicaid Fee-for-Service (FFS) after they have joined the aligned D-SNP"
    • Stated condition, not checked automatically: "joining the aligned D-SNP if they are still in MMC/HARP"
• Stated condition, not checked automatically: "the plan is available in your county"

Access route 1.1

• Where: New York Medicaid Choice
• How: Contact New York Medicaid Choice or reach out to the plan you would like to join for information about joining or changing to another IB-Dual program.
• Url: https://www.nymedicaidchoice.com/

Owner confirmations

• /offerings/0/access/0: sha256:43e1962f42e7539a143a6ab7034a0624eeaba33386ec0c8596de4ad9f21c9fc5

Evidence

• /name: "# Integrated Care Plans for Dual Eligible New Yorkers" (source, capture 8beca801dd1a1364611a828fc41798b0b283aa406afff1461f8b808061b09d93)
• /caregiving_effect: "An Integrated Care Plan is one that provides you with both your Medicaid and Medicare services from the same health plan. Integrated Care Plans are designed to help dual-eligible beneficiaries meet their health care needs within their own community, instead of going to a nursing home or other facility for care. There are three types of Integrated Care Plans in New York. Depending upon your care needs and whether you qualify as a dual-eligible, you may be eligible for an Integrated Care Plan." (source, capture 8beca801dd1a1364611a828fc41798b0b283aa406afff1461f8b808061b09d93)
• /caregiving_effect: "Both Medicaid Advantage Plus (MAP) and the Program of All Inclusive Care for the Elderly (PACE) are also known as Managed Long Term Care (MLTC) plans. These plans will pay for all your Medicare health services at little to no additional cost to you and include benefits such as home care and other long term services and supports (LTSS) you may need. As a member of an Integrated Care Plan, you must use the plan's network of doctors, although your existing doctor(s) may agree to participate with the plan." (source, capture 8beca801dd1a1364611a828fc41798b0b283aa406afff1461f8b808061b09d93)
• /caregiving_effect: "* IB-Dual - Integrated Benefits for Dually-Eligible Enrollees Program \n * This new program replaces the former Medicaid Advantage product. It provides a more complete set of benefits and services for those dual-eligible beneficiaries who do not require long term services and supports.\n * IB-Dual provides you with Medicaid and Medicare covered services through the same health plan.\n * IB-Dual allows members who are Medicare eligible to remain in their Mainstream Medicaid Managed Care health plan. You will receive both your Medicaid services and Medicare benefits through your current health plan as a dual-eligible beneficiary. \n * Upon becoming Medicare eligible, you must enroll in the Medicare D-SNP (Dual Eligible Special Needs Plan) through the same health plan that is providing your Medicaid services to join the IB-Dual program.\n * Additional information about IB-Dual can be found in the dedicated section below." (source, capture 8beca801dd1a1364611a828fc41798b0b283aa406afff1461f8b808061b09d93)
• /offerings/0/summary: "The Integrated Benefits for Dually Eligible Enrollees (IB-Dual) is the newest integrated care plan option available for individuals who have both Medicare and Medicaid coverage. The IB-Dual program is for individuals who do not require long term care services and supports. The program allows an individual who is becoming newly Medicare eligible to remain in their Mainstream Medicaid Managed Care Plan or Health and Recovery Plan (MMC/HARP) and enroll in the aligned Medicare D-SNP." (source, capture 8beca801dd1a1364611a828fc41798b0b283aa406afff1461f8b808061b09d93)
• /offerings/0/rules: "The Integrated Benefits for Dually Eligible Enrollees (IB-Dual) is the newest integrated care plan option available for individuals who have both Medicare and Medicaid coverage. The IB-Dual program is for individuals who do not require long term care services and supports. The program allows an individual who is becoming newly Medicare eligible to remain in their Mainstream Medicaid Managed Care Plan or Health and Recovery Plan (MMC/HARP) and enroll in the aligned Medicare D-SNP." (source, capture 8beca801dd1a1364611a828fc41798b0b283aa406afff1461f8b808061b09d93)
• /offerings/0/rules: "Enrollment in the IB-Dual program occurs when an individual in MMC/HARP is also enrolled in the Medicare D-SNP of the same healthcare organization that provides one's Medicaid services. When a MMC/HARP member becomes newly eligible for Medicare, the individual will be enrolled into the aligned Medicare D-SNP through a Centers for Medicare and Medicaid Services (CMS) procedure called \"default enrollment\". The following describes the default enrollment process for newly dual eligibles." (source, capture 8beca801dd1a1364611a828fc41798b0b283aa406afff1461f8b808061b09d93)
• /offerings/0/rules: "In addition to Default Enrollment, and even if a plan's Default Enrollment is paused, dual eligibles who are not newly Medicare eligible, have options for enrollment into IB-Dual. This includes voluntary enrollment into the MMC/HARP from Medicaid Fee-for-Service (FFS) after they have joined the aligned D-SNP or joining the aligned D-SNP if they are still in MMC/HARP." (source, capture 8beca801dd1a1364611a828fc41798b0b283aa406afff1461f8b808061b09d93)
• /offerings/0/rules: "A. If you would like more information about joining or changing to another IB-Dual program, please contact New York Medicaid Choice (NYMC) or reach out to the plan that you would like to join from the chart located in the IB-Dual section. . If you choose to change IB-Dual plans, you will be required to join the new plan's Medicare DSNP. Please be sure to check the service area to make sure the plan is available in your county." (source, capture 8beca801dd1a1364611a828fc41798b0b283aa406afff1461f8b808061b09d93)
• /offerings/0/access/0: "A. If you would like more information about joining or changing to another IB-Dual program, please contact New York Medicaid Choice (NYMC) or reach out to the plan that you would like to join from the chart located in the IB-Dual section. . If you choose to change IB-Dual plans, you will be required to join the new plan's Medicare DSNP. Please be sure to check the service area to make sure the plan is available in your county." (source, capture 8beca801dd1a1364611a828fc41798b0b283aa406afff1461f8b808061b09d93)