AgeWell New York Advantage Plus Benefits*
| A Medicaid Advantage Plus (MAP) Plan | |
|---|---|
| Monthly Plan Premium | $0* copay |
| Part B/C/D Yearly Deductible | $0* copay |
| Maximum out-of-pocket (MOOP) | $0 or $3,650* |
| PCP/Specialist/Telehealth | $0* copay |
| Acupuncture | $0 copay per visit, 30 additional visits per year to the Medicare-covered acupuncture |
| Dental | $2,000 per year Comprehensive |
| Diabetic | $0 copay Precision, OneTouch and FreeStyle preferred brands. (No prior authorization required.) Plus $150 diabetic healthy food card per month. |
| Emergency Room/ Urgent Care | $0* copay |
| Hearing | $1,000 every 2 years for Hearing Aids |
| Hospital Inpatient/SNF | $0* copay |
| Lab/X-Ray/ Test & Procedures | $0* copay |
| Over-the-Counter (OTC) | $225 per month ($2,700 per year) |
| Outpatient Surgery | $0* copay |
| Physical Therapy | $0* copay |
| Screening & Immunization | $0 copay |
| Telemonitoring Services | $0 copay |
| Transportation | Medicaid covered services |
| Vision | One pair of eyeglass frames and lenses |
| Worldwide Emergency/Urgent Care | $50,000 per year |
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.
2023 MAP Summary of Benefitsopens PDF file
* Must maintain eligibility requirements for $0 cost share
This plan uses a formulary. Limitations may apply.