AgeWell New York Advantage Plus Benefits*

AgeWell New York Advantage Plus (HMO D-SNP) (MAP) H4922-010
Monthly Plan Premium $0* copay
Part B/C/D Yearly Deductible $0* copay
MOOP $0 or $3,450*
PCP/Specialist/Telehealth $0* copay
Acupuncture $0 copay per visit, 30 additional visits per year to the Medicare-covered Acupuncture
Dental Medicaid covered services
Diabetic Supplies $0 copay Precision, OneTouch and FreeStyle preferred brands.  (No prior auth. required.)
Emergency Room/ Urgent Care $0* copay
Hearing $1,500 every 2 years for Hearing Aids 
Hospital Inpatient/SNF $0* copay
Lab/X-Ray/ Test & Procedures $0* copay (Prior authorization is required for Genetic testing.)
OTC $150 per month ($1,800 per year)
Outpatient Surgery $0* copay
Physical Therapy $0* copay
Screening & Immunization $0 copay
Telemonitoring Services $0 copay
Transportation Medicaid covered services
Vision Medicaid covered services
Worldwide Emergency/Urgent Care $50,000 per year towards emergency and urgent care (including transportation)

The above describes benefits that you are entitled to based on your Medicare & full Medicaid eligibility.  Please Refer to the AgeWell New York Advantage Plus (HMO D-SNP) Member materials for additional information in regards to benefits available under the Medicaid Advantage Plus Plan.

2022 MAP Summary of Benefitsopens PDF file

*Must maintain eligibility requirements for $0 cost share

This plan uses a formulary. Limitations may apply.