CareWell (HMO SNP) ( Medicare Medicare Advantage Health Maintenance Organization (HMO)) H4922_004_AWNY0011C File and Use 09252014

CareWell (HMO SNP) ( Medicare Medicare Advantage Health Maintenance Organization (HMO)) 2015 1 1-2015 12 31 National Committee for Quality Assurance (NCQA) Special Needs Plan (SNP) 2017 12 31 H4922_004_AWNY0011C File and Use 09252014

CareWell (HMO SNP) 2015 Medicare Original Medicare Medicare Medicare Original Medicare Medicare : CareWell (HMO SNP) Medicare Medicare CareWell (HMO SNP) Medicare http://www.medicare.gov Medicare Plan Finder Medicare Original Medicare "Medicare & You" Medicare http://www.medicare.gov 1-800-MEDICARE (1-800-633-4227) 7 24 (TTY) 1-877-486-2048 CareWell (HMO SNP) (866) 586-8044 (800) 662-1220 CareWell (HMO SNP) 10 1 2 14 8 8 2 15 9 30 8 8 CareWell (HMO SNP) (866) 586-8044 (800) 662-1220 (866) 586-8044 (800) 662-1220 http://www.agewellnewyork.com CareWell (HMO SNP) Medicare Part A Medicare Part B (Bronx) (Kings) (Nassau) (New York) (Queens) (Suffolk) (Westchester) 2

CareWell (HMO SNP) 2015 CareWell (HMO SNP) Part D (http://www.agewellnewyork.com/provider-list/) (http://www.agewellnewyork.com/) Medicare Original Medicare Original Medicare Original Medicare Original Medicare Part D Part B Part D http://www.agewellnewyork.com/ 3

CareWell (HMO SNP) 2015 1 2 $36.90 Medicare Part B Part D $320 Medicare Medicare $6,700 Part D 1 20% 1 $20 20% 4

CareWell (HMO SNP) 2015 1 X 1 1 20% 20% 20% X 1 : (MRI) (CT scan) 20% 20% 20% X 20% $35 20% $50 20% 1 20% $65 20% 24 1 / 20% 1 20% $500 5

CareWell (HMO SNP) 2015 1 1 190 (SNF) SNF 60 SNF 90 60 90 60 90 2014 1 60 $1,216 61 90 $304 60 $608 2015 20% 20% 1 36 36 20% $40 20% $40 20% 1 20% 20% 1 20% 20% 6

CareWell (HMO SNP) 2015 1 20% 1 20% 20% 1 10 $65 20% 1 1 $100 7

CareWell (HMO SNP) 2015 X HIV (PSA) B Medicare (Welcome to Medicare) Medicare Medicare 8

CareWell (HMO SNP) 2015 1 (SNF) 1 (SNF) SNF 60 SNF 90 60 90 60 90 2014 1 60 $1,216 61 90 $304 60 $608 2015 SNF 100 2014 1 20 21 100 $152 2015 9

CareWell (HMO SNP) 2015 Part B 20% Part B 20% 25% $2,960 Part D Medicare $2,960 45% 65% $4,700 $4,700 5% $2.65 $6.60 10

1-866-586-8044 (TTY) (TDD) 1-800-662-1220 info@agewellnewyork.com www.agewellnewyork.com Medicare HMO / / 1 1 Medicare PartB (866)586-8044 TTY 1-800-662-1220 7 8:00 8:00 (SNF) ISNP Medicare (Extra Help)