NY Medicare Advantage Plus Enrollment Diagram

Alternate text version:

  1. You complete the application.
  2. SWH confirms your Medicare and Medicaid eligibility.
    Medical eligibility for SWH’s Medicaid Advantage Plus program is determined through assessment, and by an individual’s primary care physician and their county’s Department of Social Services’ clinical care division.
  3. SWH submits your application and the clinical assessment to your county’s Department of Social Services’ clinical care division for medical authorization.
  4. Your county’s Department of Social Services’ clinical care division notifies SWH that you are medically eligible to participate in SWH Plus.*
  5. SWH submits your approved application and clinical assessment to your county’s Department of Social Services’ Medicaid Enrollment Office for enrollment into SWH Plus.
  6. Your county’s Department of Social Services’ Medicaid Enrollment Office notifies SWH that you are eligible for SWH Plus and of your effective date in the program.*
  7. SWH sends you a welcome letter and ID card.
  8. You receive a welcome call from a SWH coordinator.
  9. A plan of care will be developed for you by your Care Manager.
  10. You visit your primary care physician.

* Based on an individual’s Medicaid eligibility, the enrollment process may take longer than 30 days. During this time, SWH will work with you and your county’s Department of Social Services to continue to arrange for existingservices until your SWH enrollment is complete.

Senior Whole Health of NY is voluntary health plan with Medicare Advantage and
NYS Medicaid contracts. The benefit information provided herein is a brief summary, not a
comprehensive description of benefits. For more information contact the plan. Benefits,
formulary, pharmacy network, premium and/or co-payments may change on an annual
basis. Eligible beneficiaries may enroll in our plan at any time of year. You must have
Medicare Part A and Part B to enroll.