Elmhurst: D-SNPs, IB-Dual, and the “default enrollment” letter

Elmhurst is one of the most linguistically mixed neighborhoods in the country, and many of its older residents have Medicaid managed care and are now reaching Medicare age. Many live in the walk-ups and mid-rise buildings between Broadway and Queens Boulevard, and many have used NYC Health + Hospitals / Elmhurst as their main source of care for years. When the Medicaid plan’s default enrollment letter arrives, the first question is usually whether the hospital is still covered.

This page is for Elmhurst residents who received that letter, for people who already have both Medicare and Medicaid and want to understand IB-Dual or Medicaid Advantage Plus, and for the relatives and neighbors who help them read the mail. It is educational only and cannot enroll you in or remove you from any plan.

Elmhurst is in Queens County, and Medicaid is administered citywide by the NYC Human Resources Administration (HRA); there is no separate Elmhurst Medicaid office. ZIP 11373 covers most of the neighborhood (approximate; verify with USPS), roughly from Roosevelt Avenue south to the Long Island Expressway and east to Woodhaven Boulevard. If a form asks for your county, write “Queens.”

The most important local fact is the hospital. NYC Health + Hospitals / Elmhurst, at 79th Avenue and Broadway, is a public hospital whose emergency room serves people regardless of insurance. Even so, whether a particular D-SNP lists the hospital and its outpatient practices as in-network affects referrals, specialist visits, and paperwork. Before the effective date, ask a HIICAP counselor how the plan on your letter treats the hospital.

The Elmhurst Avenue and Grand Avenue–Newtown stations on the M and R, and the 7 along Roosevelt Avenue, put most of the neighborhood a short ride from the Corona and Sunnyside HIICAP sites.

Not every Medicaid plan sends a default enrollment letter, so in a building on Broadway two neighbors with different Medicaid plans may have very different experiences: one gets a notice 60 days before Medicare starts, the other gets nothing. No letter is not a mistake to fix; it usually means your plan does not use default enrollment. Call HIICAP anyway to learn your options.

If you did get one, read it for the date the D-SNP would begin and the name of the plan. Then check whether NYC Health + Hospitals / Elmhurst and the pharmacy you use on Broadway or Queens Boulevard are in that plan’s Medicare network, and bring those answers to the counselor; it makes the call shorter and more useful.