New York Medicaid plan benefits

As an Anthem Blue Cross and Blue Shield HP Medicaid plan member in New York, you get many benefits with little to no costs or copays.

Who’s eligible for Medicaid in NY?

 

You or your child(ren) may be eligible for Medicaid through Anthem if you:

 

 Live in the Bronx, Brooklyn (Kings), Manhattan (New York), Nassau, Putnam, Queens, Staten Island (Richmond), Suffolk, Westchester, Orange, Dutchess, Ulster, or Rockland County.

 

 Meet certain income, resources, age, or disability requirements.

 

Find out if you qualify 

Medical care is just the beginning

 

With an Anthem Medicaid plan, you'll have access to a wide range of services including dental and vision care, family planning, childbirth education, and our Healthy Rewards program.

What you get with Anthem

 


Doctor visits
 

 


Dental checkups
 

 


Eye exams and glasses
 

 


Low-cost prescriptions
 

 


$0

 

 

$0

 

 

$0

 

 

$0 - $3

 


Doctor visits 
 

 


$0

 


Dental checkups 
 

 


$0

 


Eye exams and glasses

 


$0

 


Low-cost prescriptions

 


$0 - $3

 

There are no copays for covered medical services, including:

  • Primary care provider (PCP) visits
  • Immunizations and wellness visits
  • Specialist visits
  • Urgent care
  • Emergency care
  • Lab and X-ray services
  • Pregnancy services
  • Family planning
  • Hospital care
  • Physical therapy
  • Speech and hearing services
  • Behavioral healthcare (mental and substance abuse services)
  • Smoking cessation services
  • Home healthcare services
  • Disease management for asthma, diabetes, and more

 

Check your member handbook for a full list of benefits in your plan.

 

Find care 

 

Dental benefits are provided through LIBERTY Dental. There are no copays for covered dental services, including:

  • Dental exams
  • Teeth cleaning (twice a year)
  • X-rays
  • Extractions
  • Fillings
  • Emergency care
  • Dentures (removable or partial)
  • Orthodontics

 

To find or change your dentist, call LIBERTY Dental at 833-276-0847, or visit their website.

 

Find a dentist 

There are no copays for covered vision services, including:

  • One eye exam every two years
  • Prescription glasses every two years

 

Check your member handbook for a full list of vision benefits in your plan.

 

 Provider Directory – Vision Plan

You can get no-cost rides to your doctor visits. You or your provider should call to schedule your ride at least three days before your appointment:

  • The Bronx, Brooklyn (Kings), Manhattan (New York), Queens, Staten Island (Richmond), Delaware, Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, and Westchester County: Call Medical Answering Services (MAS) at 1-800-850-5340.
  • Nassau and Suffolk County: Call ModivCare (formerly LogistiCare) at 1-844-678-1103 (TTY 1-866-288-3133).

 

You’ll need:

  • Your Medicaid/Anthem ID number
  • Your appointment date and time
  • The address of where you’re going
  • The name of the doctor you’re seeing

These services are provided for Anthem Medicaid members under age 21 who have mental health and/or substance use needs. Children and Family Treatment and Support Services include:

  • Assessments to help identify mental health and/or substance use needs early.
  • Individual, group, and family therapy in a comfortable setting.
  • Rehab services to improve behavioral, emotional, and social skills.
  • Support for parents and guardians.

Starting April 1, 2023, your prescriptions will not be covered by Anthem. They will be covered by Medicaid NYRx, the Medicaid pharmacy program.

 

Some services need a referral from your primary care provider (PCP). You will need to get a signed referral form from your PCP before:

  • Going to a hospital for nonemergency care
  • Seeing another doctor in your plan for a prescription

 

You do not need a referral for:

  • Women’s healthcare
  • Pregnancy services
  • Family planning services
  • Emergency services
  • School-based health center services
  • Adult dental care (age 21 and over)
  • Adult vision care (age 21 and over)
  • Behavioral health and substance use disorder services
  • Certain doctors for children with special healthcare needs

Some services need preapproval or prior authorization. This means you or your doctor must ask Anthem to approve those services or benefits before you get them. These services include:

  • Ambulance transportation (emergency air and nonemergency)
  • Chiropractic services (Essential Plan only)
  • Diagnostic testing
  • Durable medical equipment
  • End-stage renal disease services
  • Vision care (age 20 and younger)
  • Home health extended services (age 20 and younger)
  • Home health services (age 21 and over)
  • Hospice services
  • Inpatient acute care hospitalization
  • Certain physician administered drugs
  • Mental health rehab services
  • Nurse-midwifery services
  • Organ transplant services
  • Outpatient hospital services including physical therapy, occupational therapy, speech therapy, and surgical procedures
  • Pediatric Day Health Care (PDHC) (age 20 and older)
  • Personal Care Services (PCS) (age 20 and older)
  • Physician services including medical assessments, treatments, and surgical services
  • Podiatry services
  • Post-stabilization care services
  • Radiology services
  • Rehabilitation services: physical therapy, occupational therapy, and speech therapy

In Lieu of Services (ILS) are other physical and behavioral health services you may receive instead of those covered by your Medicaid plan. ILS services:

  • Are cost-effective substitutes for covered services and settings.
  • Are approved by New York State.
  • Help us give you more options for your care.

 

To learn more about ILS and what we offer, visit the New York State Department of Health website.

Healthy Rewards is a no-cost optional program for eligible Anthem members. It pays you for completing healthy activities like:

  • Yearly well-child and childhood dental visits.
  • Prenatal and postpartum visits for pregnant members.
  • Screenings for diabetes management.

 

To redeem your Healthy Rewards, visit the Benefit Reward Hub. To learn about other value-added benefits, visit the Extra Benefits page.

New York never sleeps, and neither do we. Get 24-hour phone advice from a registered nurse anytime, day or night:

Not yet a member? Choose Anthem.

We can help you apply. Call 844-430-1699 (TTY 711), or visit us in person. Find a Community Service Center near you.

Enroll

Already a member? We’re glad you chose Anthem.

 

We want you to understand your benefits and receive the best possible care. Here are some resources to help.

The member handbook: Everything you need to know

 

Your member handbook is your go-to guide for health services. It contains complete benefit information about your plan. Read it to find out about:

 

 How to use your benefits.

 

 How to choose your PCP.

 

 How to get help if your doctor’s office is closed.

 

 How to reach Member Services if you have questions.

 

 Your rights and responsibilities as an Anthem member.

 

 Member Handbook - New York Medicaid (English) *

 

 Member Handbook - New York Medicaid (Spanish) *

 

* Anthem versions of materials will be coming soon.

 

Pharmacy Benefits Guide

 

 Pharmacy and prescription benefits guide (English) 

 

 Pharmacy and prescription benefits guide (Spanish)

Need a handbook mailed to you?

You can request a handbook via live chat with Member Services.