MLTC Covered Services

Joining AgeWell New York improves the coordination of your health care coverage and services. You will continue to receive the same types of services usually paid for by Medicaid and Medicare such as;

• Care coordination and management
• Home health care including nursing, home health aide, and medical social services
• Rehabilitation therapies (such as physical, occupational and speech therapies) whether at home or in the community
• Adult Day Health Care
• Personal care (such as assistance with bathing, eating or dressing)
• Durable medical equipment and medical surgical supplies
• Personal Emergency Response Systems (PERS)
• Medical transportation (non-emergency)
• Podiatry (foot care)
• Optometry/eyeglasses
• Audiology/hearing aids
• Dental services
• Respiratory therapy
• Private-duty nursing=
• Nutrition counseling and supplements
• Prosthetics and orthotics
• Home-delivered meals or meals in a group setting, such as day care
• Social/environmental support (such as chore services or home modifications)
• Social day care
• Nursing home care (if necessary)
• Consumer Directed Personal Assistance Services (CDPAS)

Nursing Home Placement

There may be instances in which your condition requires permanent placement in a nursing home. Your Care Manager will work with you and others involved in your plan of care to facilitate placement in a network participating facility. You must be eligible for institutional Medicaid. Limitations apply if you are eligible for community Medicaid only. If you choose placement in an out-of-network facility, you must be disenrolled from AgeWell New York.

Dental Services

AgeWell New York members benefit from high quality care given by our network of caring providers. Dental services are covered in the AgeWell New York plan, which means you must use a dentist within our network.

The providers shown in the Provider List are paid directly by AgeWell New York for the covered services they provide to you. Services are covered when they are medically necessary, which means the service or item is needed to diagnose or treat a medical condition.

Non-covered services are paid for by Medicaid and/or Medicare fee-for-service. You can go to a provider of your choice for non-covered services.

What services are not covered by AgeWell New York?

If you have Medicare benefits, your membership in AgeWell New York does not affect your Medicare eligibility. You can continue to receive non-covered services through your current providers. In addition, you do not need prior authorization to receive services covered by Medicare. Even though these services are not covered by AgeWell New York, your Care Manager can help you arrange for them, if they are necessary.

The following services are NOT covered by AgeWell New York, but are covered by Medicaid or Medicare on a fee-for-service basis:

  • Inpatient/outpatient hospital services
  • Physician services
  • Laboratory services
  • Chiropractic care
  • Emergency transportation
  • Chronic renal dialysis
  • Medication (prescription and nonprescription)
  • OPWDD services (Office for People With Developmental Disabilities)
  • X-ray/radiology services
  • Rural health clinic services
  • Mental health services
  • Alcohol and substance abuse services
  • Family planning services

Although these services are not part of the AgeWell New York benefit package, your Care Manager will help arrange and coordinate them, as needed.