Our Programs & Member Eligibility

Who we are

Senior Whole Health of New York is a Medicare Advantage health plan that keeps members secure and independent in their own homes.

Senior Whole Health of New York currently offers three programs in New York City. Eligible beneficiaries may enroll at any time of the year.

Senior Whole Health of New York Medicare Advantage (HMO SNP) Medicaid Advantage PLUS — NHC Plan

In addition to Medicare and Medicaid Managed Care services, members receive:

  • In-home assessments to evaluate individual needs
  • An individual care plan
  • $0 Doctor appointments
  • $0 Dental visits
  • $0 Vision services
  • Eyeglasses (limitations apply)
  • Medicare prescription drug coverage (co-pays may apply)
  • OTC card to buy over-the-counter (OTC) medicines and health-related items up to $80 a month (up to $960 a year)
  • Transportation to and from medical appointments
  • Private duty nursing services
  • Home health services
  • Home delivered meals
  • Adult day health care
  • Personal care services
  • Personal Emergency Response Services (PERS)
  • 24/7 phone access to a Senior Whole Health of New York Nurse Care Manager
  • Access to a Senior Whole Health of New York team member or interpreter who speaks their language
  • Personal Care Team who helps members receive quality medical, social and community-based services

Who can join the Senior Whole Health of New York NHC (HMO SNP) Plan?

Individuals are eligible to join if they are also enrolled in Senior Whole Health of New York for Medicare coverage and:

  • Are age 65 and older;
  • Reside in the plan's service area: Bronx, Kings, Nassau, New York, Queens and Westchester counties;
  • Medically eligible for nursing home level of care, as of the time of enrollment;
  • Capable at time of enrollment of returning or remaining in their home and community without jeopardy to their health and safety; AND
  • Assessed as requiring at least one of the following long term care services and care management for more than 120 days from the effective date of enrollment:
    • Nursing services in the home;
    • Therapies in the home;
    • Health Aide services in the home;
    • Personal care services in the home;
    • Adult day health care;
    • Private Duty Nursing;
    • Consumer Directed Personal Assistance Services.
  • Determined by the New York City Human Resources Administration Medicaid office (HRA) to be eligible for benefits under the Medicaid program.

SWH Whole Health FIDA Plan

FIDA is a new type of managed care plan for people who have both Medicare and Medicaid in New York State who require community or facility based Long-term services and supports (LTSS).

Benefits include:

Who can join the SWH Whole Health FIDA Plan?

Eligible individuals may join if they are:

  • Age 21 or older;
  • Entitled to benefits under Medicare Part A and enrolled under Parts B and D, and receiving full Medicaid benefits;
  • Reside in a SWH Whole Health FIDA Plan Demonstration County: Bronx, Kings, New York or Queens counties;
  • Individuals must also meet one of the following three criteria:
    • Are clinically eligible to reside in a nursing home and are receiving facility-based Long-term services and supports (LTSS);
    • Are eligible for the Nursing Home Transition and Diversion Waiver (NHTD); or
    • Require community-based Long-term services and supports (LTSS) for more than 120 days.

Senior Whole Health of New York Managed Long Term Care Program

The Senior Whole Health of New York Managed Long Term Care (MLTC) Program is for adults aged 21 or older who are Medicaid eligible, and need long term support and assistance with day-to-day activities but choose to remain living at home.

The MLTC Program has $0 co-pays and no deductibles for any of the services or benefits* we provide including:

In Home Care Services

  • Home assessments
  • Professional nursing
  • Home health care
  • Care coordination
  • 24/7 phone access to a Senior Whole Health Nurse Care Manager
  • Personal care
  • Chore services and housekeeping
  • Home delivered meals
  • Home safety modifications

Medical Supplies and Equipment

  • Personal Emergency Response Services (PERS)
  • Medical and surgical supplies
  • Oxygen
  • Prosthetics and orthotics

Specialty Care

  • Dental care
  • Eye exams
  • Foot care
  • Hearing exams

Rehabilitation Therapies

  • Physical therapy
  • Occupational therapy
  • Speech therapy
  • Respiratory therapy

Other Care & Services

  • Adult day health program
  • Transportation to doctor and health care related appointments 
  • Help with medication management
  • Nutritional counseling and dietary supplements
* All benefits provided are based on medical necessity.

Who can join the Senior Whole Health of New York MLTC Program?

Eligible individuals may enroll at anytime during the year if they are:

  • At least 21 years of age
  • A resident of Bronx, Kings, Queens, New York or Westchester County
  • Determined eligible for Managed Long Term Care by Senior Whole Health of New York using an eligibility assessment tool designated by the State Department of Health
  • Capable at time of enrollment of returning or remaining in their home and community without jeopardy to their health and safety
  • Assessed as requiring at least one of the following long term care services and care management for more than 120 days from the effective date of enrollment:
    • Nursing services in the home
    • Therapies in the home
    • Health aide services in the home
    • Personal care services in the home
    • Adult day health care
    • Private duty nursing
    • Consumer Directed Personal Assistance Services
  • Determined by the New York City Human Resource Administration (HRA) Medicaid Office to be eligible for benefits under the Medicaid program

Last Updated 1/01/2018