• Plans Detail

  • Affinity offers several Medicare Advantage Prescription Drug Plan options that allow Medicare beneficiaries to find the healthcare coverage that meets their needs. Our plans include all Medicare covered benefits including Part D Prescription Drug coverage, in addition to non-Medicare covered benefits. Our Medicare Plans are available to individuals who live in our service area, which may include the following New York counties: New York (Manhattan), Bronx, Kings (Brooklyn), Queens, Richmond (Staten Island), Orange, Rockland, Westchester, Nassau, and Suffolk.

    Compare our 2018 Plans

    For information regarding the 2017 benefits click here.

  • Plans

    Affinity Medicare Passport Essentials (HMO) Plan

    A Medicare Advantage Prescription Drug Plan with a $0 monthly premium. This plan includes all the Original Medicare covered benefits, as well as Part D Prescription Drug coverage.This plan is for Medicare beneficiaries who reside in Orange, Rockland, Westchester and Nassau counties.

    • $0 Premium
    • $5 PCP Copay
    • Maximum Out Of Pocket $5,400
    • 5 Tier Co-pays for prescription drug coverage
    • $0 Co-pay for Tier 1 Prescription Drugs during the Coverage Gap
    • Lower Out of Pocket Costs compared to Original Medicare
    • Dental, Vision and Hearing Coverage
    • Acupuncture
    • Fitness Program (Silver Sneakers)
    • Worldwide Emergency Coverage
    Affinity Medicare Passport Essentials NYC (HMO) Plan

    Affinity Medicare Passport Essentials NYC is a Medicare Advantage Prescription Drug Plan with a $0 monthly premium. This plan includes all the Original Medicare covered benefits, as well as Part D Prescription Drug coverage. This plan is for Medicare beneficiaries residing in New York, Bronx, Kings, Queens and Richmond counties.

    • $0 Premium
    • Maximum Out Of Pocket $5,700
    • 5 Tier Co-pays for prescription drug coverage
    • $0 Co-pay for Tier 1 Prescription Drugs during the Coverage Gap
    • Lower Out of Pocket Cost compared to Original Medicare
    • Dental, Vision and Hearing Coverage
    • Acupuncture
    • Fitness Program (Silver Sneakers)
    • Worldwide Emergency Coverage
    Affinity Medicare Passport Select (HMO) Plan (not available for 2018)

    The Affinity Medicare Passport Select Plan is a Medicare Advantage Prescription Drug Plan with $45 monthly premium for all Medicare Beneficiaries who are interested in a plan that offers all the Original Medicare covered benefits including Part D Prescription Drugs. This plan includes established out-of-pocket cost with reduced copayments and other non-Medicare covered benefits.

    • Affordable Premium ($45)
    • Maximum Out Of Pocket $5,900
    • $0 Deductible
    • 5 Tier Co-pays for prescription drug coverage
    • $0 Co-pay for Tier 1 Prescription Drugs during the Coverage Gap
    • Reduced Out of Pocket Cost vs. Original Medicare
    • Dental, Vision and Hearing Coverage
    • Acupuncture
    • Fitness Program (Silver Sneakers)
    • Worldwide Emergency Coverage
    Affinity Medicare Ultimate (HMO-SNP) Plan

    Affinity Medicare Ultimate is a Medicare Advantage Prescription Drug Special Needs Plan for Medicare beneficiaries who also have full New York State Medicaid benefits. This plan also includes Original Medicare covered benefits, Part D Prescription Drug coverage and other non-Medicare covered benefits, such as over-the-counter healthcare items.

    • $0 Premium
    • Dental, Vision and Hearing Coverage
    • Over-the-Counter (OTC) Card ($63 Per Month/$756 Per Year)
    • Worldwide Emergency Coverage
    Affinity Medicare Solutions (HMO-SNP) Plan

    Affinity Medicare Solutions is a Medicare Advantage Prescription Drug Special Needs Plan with a $0 monthly premium for Medicare beneficiaries who have partial and/or full New York State Medicaid benefits or receive help from New York State with paying Medicare Part B Premiums. This plan includes Original Medicare covered benefits, Part D Prescription Drug coverage and other non-Medicare covered benefits, such as routine transportation to healthcare providers. Out-of- pocket costs depend on New York State Medicaid coverage level.

    • $0 Premium
    • Dental, Vision and Hearing Coverage
    • Acupuncture
    • Routine Transportation
    • Worldwide Emergency Coverage
  • Summary of Benefits

    2018

    Affinity Medicare Passport Essentials (HMO) and Affinity Medicare Passport Essentials NYC (HMO): English | Spanish | Chinese

    Affinity Medicare Ultimate (HMO-SNP) and Affinity Medicare Solutions (HMO-SNP): English | Spanish | Chinese

    2017

    Affinity Medicare Passport Essentials (HMO), and Affinity Medicare Passport Essentials NYC (HMO) and Affinity Medicare Passport Select (HMO): English | Spanish | Chinese

    Affinity Medicare Ultimate (HMO-SNP) and Affinity Medicare Solutions (HMO-SNP): English | Spanish | Chinese

  • Annual Notice of Change and Evidence of Coverage

  • Enrollment Process

    Forms

    2018
    Affinity Medicare Passport Plans Enrollment Form: English | Spanish | Chinese

    2017
    Enrollment Form for Affinity Medicare Ultimate (HMO-SNP) and Affinity Medicare Solutions (HMO-SNP) Plans: English | Spanish

    Enrollment Form for Affinity Medicare Passport Essentials (HMO), Affinity Medicare Passport Essentials NYC (HMO), Affinity Medicare Passport Select (HMO) Plans: English | Spanish

    Assistance

    If you have any questions while filling out your enrollment form, please call us toll-free at 888.543.9096 (TTY 711), Monday to Sunday, 8:00 am - 8:00 pm.

  • Important Information for Our Medicare Members

    To find forms, instructions on how to file a complaint, listings of member rights and responsibilities, instructions on how to request a disenrollment, and information on the Case Management Program, visit the Plans Resource page.

    Please contact our Customer Service number at 877.234.4499 for additional information. (TTY users should call 711). Hours are Monday through Sunday, 8:00 am - 8:00 pm.

    Por favor comuníquese con nuestro departamento de servicio al cliente en el 877.234.4499 para obtener información adicional. (Los usuarios del TTY deben llamar al 711). El horario es de lunes a domingo 8:00 am - 8:00 pm.

  • H5991_AffinityMedicarePlanWebsite2018 Pending Last updated 10/02/2017


  • Affinity Health Plan is an HMO and HMO-SNP Plan with a Medicare contract and a contract with the New York State Medicaid Managed Care Program. Enrollment in Affinity Health Plan depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/co-insurance and restrictions may change on January 1 of each year. You must continue to pay your Medicare Part B premium. Premiums, Part D co-pays, coinsurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. This plan is available to anyone who has both Medical Assistance from the State and Medicare. Affinity Health Plan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 877.234.4499 (TTY: 711). 注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 877.234.4499 (TTY: 711) 。