There are 107 Medicare Advantage plans meeting your criteria.
2014 / 2015 Medicare Advantage Plan Information
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Plan Name |
Monthly Premium |
Part A&B Maximum Out-Of Pocket |
Part D Deduct- ible |
(Donut Hole) Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Formulary Drugs |
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 ActiveSaver MSA (MSA)
| $0.00 |
n/a |
No Rx Coverage |
H9788 -004 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2015 ActiveSaver MSA (MSA)
| $0.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2014 AARP MedicareComplete Essential (HMO)
| $0.00 |
$5,900 |
No Rx Coverage |
H3307 -018 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2015 AARP MedicareComplete Essential (HMO)
| $0.00 |
$5,200 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2014 AARP MedicareComplete Mosaic (HMO)
| $0.00 |
$3,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3307 -015 -0 | $3.00 | $6.00 | $44.00 | $44.00 | 3,604
2014 Formulary |
|
|
|
|
2015 AARP MedicareComplete Mosaic (HMO)
| $0.00 |
$3,900 |
$150 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $6.00 | $44.00 | $44.00 | 3,649 2015 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 AARP MedicareComplete Plan 2 (HMO)
| $0.00 |
$4,200 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3379 -001 -0 | $3.00 | $10.00 | $45.00 | $45.00 | 3,604
2014 Formulary |
-- |
|
|
|
2015 AARP MedicareComplete Plan 2 (HMO)
| $0.00 |
$6,700 |
$260 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $9.00 | $45.00 | $45.00 | 3,649 2015 Formulary |
|
2014 CPHL Advantage Care (HMO)
| $0.00 |
$6,700 |
$310 | No additional gap coverage, only the Donut Hole Discount |
H6988 -001 -0 | 25% | | | | 3,193
2014 Formulary |
-- |
-- |
-- |
|
2015 Advantage Care (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $35.00 | $85.00 | $85.00 | 3,161 2015 Formulary |
|
2014 Advantage Health NYC - SNP (HMO SNP)
| $0.00 |
n/a |
$0 | Some Generics |
H2773 -017 -0 | $0.00 | $10.00 | $30.00 | $30.00 | 2,885
2014 Formulary |
-- |
-- |
|
|
2015 Advantage Health NYC - SNP (HMO SNP)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $25.00 | $25.00 | tbd |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 Advantage Silver - Queens (HMO)
| $0.00 |
$3,400 |
$0 | Some Generics |
H2773 -013 -0 | $4.00 | $15.00 | $30.00 | $30.00 | 2,885
2014 Formulary |
-- |
-- |
|
|
2015 Advantage Silver - Queens (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $30.00 | $30.00 | tbd |
|
2014 Aetna Medicare Value Plan (HMO)
| $0.00 |
$6,700 |
$0 | Few Generics |
H3312 -060 -0 | $6.00 | $45.00 | $95.00 | $95.00 | 2,800
2014 Formulary |
-- |
|
|
|
2015 Aetna Medicare Value Plan (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $8.00 | $45.00 | $45.00 | 2,911 2015 Formulary |
|
-- This plan not offered in 2014 --
|
H5991 -003 -0 | | | | | |
-- |
|
|
|
2015 Affinity Medicare Passport Essentials (HMO)
| $0.00 |
$5,800 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $45.00 | $45.00 | 2,885 2015 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 AlphaCare Renew (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H9122 -001 -0 | $2.00 | $8.00 | $40.00 | $40.00 | 3,193
2014 Formulary |
-- |
-- |
-- |
|
2015 AlphaCare Renew (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $40.00 | $40.00 | 3,161 2015 Formulary |
|
2014 Amerivantage Balance + Rx (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H6181 -009 -0 | $4.00 | $4.00 | $45.00 | $45.00 | 2,885
2014 Formulary |
-- |
|
|
|
2015 Amerivantage Balance + Rx (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $40.00 | $40.00 | 3,025 2015 Formulary |
|
2014 Amerivantage Specialty + Rx (HMO SNP)
| $37.20 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H6181 -007 -0 | 0% | 0% | 0% | 0% | 2,885
2014 Formulary |
-- |
|
|
|
2015 Amerivantage Specialty + Rx (HMO SNP)
| $0.00 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 3,025 2015 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 Amida Care True Life Plus (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H6745 -001 -0 | $0.00 | $45.00 | 33% | | 3,124
2014 Formulary |
-- |
-- |
-- |
|
2015 Amida Care True Life Plus (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $33.00 | $45.00 | $45.00 | 3,172 2015 Formulary |
|
2014 Easy Choice Diamond Rewards (HMO SNP)
| $0.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H9285 -003 -0 | $0.00 | $35.00 | $79.00 | $79.00 | 2,770
2014 Formulary |
-- |
-- |
|
|
2015 Easy Choice Diamond Rewards (HMO SNP)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $35.00 | $90.00 | $90.00 | 2,830 2015 Formulary |
|
2014 Easy Choice Rewards (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H9285 -001 -0 | $0.00 | $39.00 | $79.00 | $79.00 | 2,770
2014 Formulary |
-- |
-- |
|
|
2015 Easy Choice Rewards (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $39.00 | $85.00 | $85.00 | 2,830 2015 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 Elderplan Classic: Zero Premium (HMO)
| $0.00 |
$6,700 |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3347 -005 -0 | $4.00 | $40.00 | $95.00 | $95.00 | 2,966
2014 Formulary |
-- |
|
|
|
2015 Elderplan Classic: Zero Premium (HMO)
| $0.00 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $40.00 | $95.00 | $95.00 | 3,088 2015 Formulary |
|
-- This plan not offered in 2014 --
|
H3347 -012 -0 | | | | | |
-- |
|
|
|
2015 Elderplan Diabetes Care (HMO SNP)
| $0.00 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $40.00 | $95.00 | $95.00 | 3,088 2015 Formulary |
|
2014 EmblemHealth Essential (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3330 -032 -1 | $2.00 | $10.00 | $35.00 | $35.00 | 3,204
2014 Formulary |
|
|
|
|
2015 EmblemHealth Essential (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $40.00 | $40.00 | 3,208 2015 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2014 --
|
H3370 -028 -0 | | | | | |
|
|
|
|
2015 Empire Dual Advantage (HMO SNP)
| $0.00 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 3,025 2015 Formulary |
|
-- This plan not offered in 2014 --
|
H3370 -033 -0 | | | | | |
|
|
|
|
2015 Empire MediBlue Essential (HMO)
| $0.00 |
$5,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2014 --
|
H3370 -029 -2 | | | | | |
|
|
|
|
2015 Empire MediBlue Plus (HMO)
| $0.00 |
$5,600 |
$257 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $22.00 | $40.00 | $40.00 | 3,016 2015 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 Fidelis Medicare $0 Premium (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3328 -019 -0 | $0.00 | $18.00 | $45.00 | $45.00 | 4,682
2014 Formulary |
|
|
|
|
2015 Fidelis Medicare $0 Premium (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $18.00 | $45.00 | $45.00 | 3,712 2015 Formulary |
|
2014 Fidelis Medicare Advantage without Rx (HMO-POS)
| $0.00 |
$6,700 |
No Rx Coverage |
H3328 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2015 Fidelis Medicare Advantage without Rx (HMO-POS)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2014 Healthfirst 65 Plus Plan (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3359 -001 -0 | $0.00 | $45.00 | $90.00 | $90.00 | 2,885
2014 Formulary |
|
|
|
|
2015 Healthfirst 65 Plus Plan (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $45.00 | $45.00 | 2,885 2015 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 Healthfirst Coordinated Benefits Plan (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H3359 -027 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2015 Healthfirst Coordinated Benefits Plan (HMO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2014 Humana Gold Plus H3533-009 (HMO)
| $0.00 |
$6,700 |
$0 | Few Generics, Few Brands |
H3533 -009 -0 | $5.00 | $11.00 | $45.00 | $45.00 | 3,711
2014 Formulary |
-- |
-- |
|
|
2015 Humana Gold Plus H3533-009 (HMO)
| $0.00 |
$6,700 |
$320 | Yes, some additional gap coverage. | $8.00 | $18.00 | $45.00 | $45.00 | 3,630 2015 Formulary |
|
2014 Liberty Health Advantage Preferred Choice (HMO)
| $0.00 |
$5,500 |
$0 | All Generics |
H3337 -001 -0 | $0.00 | $10.00 | $25.00 | $25.00 | 2,995
2014 Formulary |
-- |
|
|
|
2015 Liberty Health Advantage Preferred Choice (HMO)
| $0.00 |
$5,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $40.00 | $40.00 | 3,057 2015 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 Touchstone Health Medicare Clear (HMO-POS)
| $0.00 |
$3,400 |
No Rx Coverage |
H3327 -039 -0 | This plan does NOT include Prescription Drug coverage. | |
-- |
|
|
|
2015 Touchstone Health Medicare Clear (HMO-POS)
| $0.00 |
$3,400 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2014 Touchstone Health Medicare Freedom (HMO-POS)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3327 -038 -0 | $6.00 | $40.00 | $80.00 | $80.00 | 3,307
2014 Formulary |
-- |
|
|
|
2015 Touchstone Health Medicare Freedom (HMO-POS)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $45.00 | $45.00 | 3,064 2015 Formulary |
|
2014 Touchstone Health Medicare Power (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3327 -001 -0 | $5.00 | $45.00 | $80.00 | $80.00 | 3,307
2014 Formulary |
-- |
|
|
|
2015 Touchstone Health Medicare Power (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $45.00 | $45.00 | 3,064 2015 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 UnitedHealthcare MedicareComplete Choice (Regional PPO)
| $0.00 |
$5,200 |
$0 | No additional gap coverage, only the Donut Hole Discount |
R5342 -001 -0 | $4.00 | $8.00 | $45.00 | $45.00 | 3,604
2014 Formulary |
|
|
|
|
2015 UnitedHealthcare MedicareComplete Choice (Regional PPO)
| $0.00 |
$6,700 |
$225 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $8.00 | $45.00 | $45.00 | tbd |
|
2014 UnitedHealthcare MedicareComplete Choice Essential (Regional PPO)
| $0.00 |
$5,200 |
No Rx Coverage |
R5342 -002 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2015 UnitedHealthcare MedicareComplete Choice Essential (Regional PPO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2014 VNSNY CHOICE Medicare Enhanced (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5549 -004 -0 | $0.00 | $0.00 | $30.00 | $30.00 | 4,779
2014 Formulary |
-- |
|
|
|
2015 VNSNY CHOICE Medicare Enhanced (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $9.00 | $45.00 | $45.00 | 3,325 2015 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 WellCare Choice (HMO-POS)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3361 -106 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 2,844
2014 Formulary |
|
|
|
|
2015 WellCare Choice (HMO-POS)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $14.00 | $43.00 | $43.00 | 2,946 2015 Formulary |
|
2014 Fidelis Long Term Care Advantage (HMO SNP)
| $44.50 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3328 -018 -0 | 25% | 25% | 25% | 25% | 4,682
2014 Formulary |
|
|
|
|
2015 Fidelis Long Term Care Advantage (HMO SNP)
| $3.00 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,712 2015 Formulary |
|
2014 Access Medicare Gold (HMO)
| $0.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H4866 -003 -0 | $3.00 | $6.00 | $35.00 | $35.00 | 3,267
2014 Formulary |
-- |
|
|
|
2015 Access Medicare Gold (HMO)
| $12.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $8.00 | $35.00 | $35.00 | 3,325 2015 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 Humana Gold Plus HMO-SNP-DE H3533-004 (HMO SNP)
| $12.20 |
n/a |
$125 | No additional gap coverage, only the Donut Hole Discount |
H3533 -004 -0 | $0.00 | $13.00 | $45.00 | $45.00 | 3,711
2014 Formulary |
-- |
-- |
|
|
2015 Humana Gold Plus SNP-DE H3533-004 (HMO SNP)
| $28.70 |
$6,700 |
$125 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 3,630 2015 Formulary |
|
2014 AARP MedicareComplete Plan 1 (HMO)
| $0.00 |
$5,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3307 -002 -0 | $4.00 | $8.00 | $44.00 | $44.00 | 3,604
2014 Formulary |
|
|
|
|
2015 AARP MedicareComplete Plan 1 (HMO)
| $29.00 |
$5,200 |
$230 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $8.00 | $45.00 | $45.00 | 3,649 2015 Formulary |
|
2014 EmblemHealth PPO I (PPO)
| $25.00 |
$3,400 |
No Rx Coverage |
H5528 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2015 EmblemHealth PPO I (PPO)
| $30.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 WellCare Rx (HMO)
| $22.90 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3361 -130 -0 | $5.00 | $15.00 | $35.00 | $35.00 | 2,844
2014 Formulary |
|
|
|
|
2015 WellCare Rx (HMO)
| $30.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $29.00 | $40.00 | $40.00 | 2,947 2015 Formulary |
|
2014 UnitedHealthcare Nursing Home Plan (HMO SNP)
| $28.30 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3379 -002 -0 | 25% | 25% | 25% | 25% | 3,604
2014 Formulary |
-- |
|
|
|
2015 UnitedHealthcare Nursing Home Plan (HMO SNP)
| $30.30 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,649 2015 Formulary |
|
-- This plan not offered in 2014 --
|
H4922 -001 -0 | | | | | |
new |
new |
new |
|
2015 LiveWell (HMO)
| $32.90 |
$6,700 |
$250 | Yes, some additional gap coverage. | $4.00 | $10.00 | $45.00 | $45.00 | 2,934 2015 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 Fidelis Dual Advantage (HMO SNP)
| $37.20 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3328 -002 -0 | $0.00 | $16.00 | $45.00 | $45.00 | 4,682
2014 Formulary |
|
|
|
|
2015 Fidelis Dual Advantage (HMO SNP)
| $33.10 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 3,712 2015 Formulary |
|
2014 Healthfirst Increased Benefits Plan (HMO)
| $30.00 |
$6,700 |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3359 -019 -0 | 25% | 25% | 25% | 25% | 2,885
2014 Formulary |
|
|
|
|
2015 Healthfirst Increased Benefits Plan (HMO)
| $34.00 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 2,885 2015 Formulary |
|
2014 VNSNY CHOICE Medicare Classic (HMO)
| $37.20 |
$6,700 |
$310 | No additional gap coverage, only the Donut Hole Discount |
H5549 -008 -0 | 25% | 25% | 25% | 25% | 4,779
2014 Formulary |
-- |
|
|
|
2015 VNSNY CHOICE Medicare Classic (HMO)
| $34.10 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,325 2015 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 Fidelis Dual Advantage Flex (HMO SNP)
| $37.20 |
n/a |
$310 | Some Generics |
H3328 -017 -0 | $0.00 | $23.00 | $45.00 | $45.00 | 4,682
2014 Formulary |
|
|
|
|
2015 Fidelis Dual Advantage Flex (HMO SNP)
| $35.40 |
$6,700 |
$320 | Yes, some additional gap coverage. | $0.00 | $0.00 | $0.00 | $0.00 | 3,712 2015 Formulary |
|
2014 Healthfirst AssuredCare (HMO SNP)
| $37.20 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3359 -035 -0 | 25% | 25% | 25% | 25% | 2,885
2014 Formulary |
|
|
|
|
2015 Healthfirst AssuredCare (HMO SNP)
| $36.00 |
$3,400 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 2,885 2015 Formulary |
|
2014 Healthfirst CompleteCare (HMO SNP)
| $37.20 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3359 -034 -0 | 0% | 0% | 0% | 0% | 2,885
2014 Formulary |
|
|
|
|
2015 Healthfirst CompleteCare (HMO SNP)
| $36.00 |
$3,400 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 2,885 2015 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 Healthfirst Life Improvement Plan (HMO SNP)
| $37.20 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3359 -021 -0 | 15% | 15% | 15% | 15% | 2,885
2014 Formulary |
|
|
|
|
2015 Healthfirst Life Improvement Plan (HMO SNP)
| $36.00 |
$3,400 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 2,885 2015 Formulary |
|
2014 AlphaCare Resilience (HMO SNP)
| $37.20 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H9122 -002 -0 | 25% | 25% | 25% | 25% | 3,193
2014 Formulary |
-- |
-- |
-- |
|
2015 AlphaCare Resilience (HMO SNP)
| $36.10 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,161 2015 Formulary |
|
2014 AlphaCare Total (HMO SNP)
| $37.20 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H9122 -003 -0 | 15% | 15% | 15% | 15% | 3,193
2014 Formulary |
-- |
-- |
-- |
|
2015 AlphaCare Total (HMO SNP)
| $36.20 |
$3,400 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,161 2015 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 VNSNY CHOICE Medicare Preferred (HMO SNP)
| $37.20 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H5549 -002 -0 | 15% | 15% | 15% | 15% | 4,779
2014 Formulary |
-- |
|
|
|
2015 VNSNY CHOICE Medicare Preferred (HMO SNP)
| $36.30 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,325 2015 Formulary |
|
2014 Access Medicare Pearl (HMO SNP)
| $37.20 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H4866 -005 -0 | 15% | 15% | 15% | 15% | 3,267
2014 Formulary |
-- |
|
|
|
2015 Access Medicare Pearl (HMO SNP)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,325 2015 Formulary |
|
2014 Access Medicare Platinum (HMO)
| $37.20 |
$5,000 |
$310 | No additional gap coverage, only the Donut Hole Discount |
H4866 -002 -0 | 25% | 25% | 25% | 25% | 3,267
2014 Formulary |
-- |
|
|
|
2015 Access Medicare Platinum (HMO)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,325 2015 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 Advantage Value One NY - Dual (HMO SNP)
| $31.10 |
n/a |
$0 | Some Generics |
H2773 -018 -0 | $0.00 | $10.00 | $30.00 | $30.00 | 2,885
2014 Formulary |
-- |
-- |
|
|
2015 Advantage Value One NY - Dual (HMO SNP)
| $36.90 |
$6,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $0.00 | $0.00 | tbd |
|
2014 Affinity Medicare Solutions (HMO SNP)
| $37.20 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H5991 -002 -0 | $0.00 | $20.00 | $45.00 | $45.00 | 2,885
2014 Formulary |
-- |
|
|
|
2015 Affinity Medicare Solutions (HMO SNP)
| $36.90 |
$3,400 |
$320 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 2,885 2015 Formulary |
|
2014 Affinity Medicare Ultimate (HMO SNP)
| $37.20 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H5991 -001 -0 | $0.00 | $20.00 | $45.00 | $45.00 | 2,885
2014 Formulary |
-- |
|
|
|
2015 Affinity Medicare Ultimate (HMO SNP)
| $36.90 |
$3,400 |
$320 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 2,885 2015 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 Amida Care Live Life Advantage (HMO SNP)
| $37.20 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H6745 -003 -0 | 25% | 25% | 25% | 25% | 5,136
2014 Formulary |
-- |
-- |
-- |
|
2015 Amida Care Live Life Advantage (HMO SNP)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | $0.00 | 25% | 25% | 25% | 5,279 2015 Formulary |
|
2014 Amida Care True Life Advantage (HMO SNP)
| $37.20 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H6745 -002 -0 | 15% | 15% | 15% | 15% | 5,136
2014 Formulary |
-- |
-- |
-- |
|
2015 Amida Care True Life Advantage (HMO SNP)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 5,279 2015 Formulary |
|
2014 ArchCare Advantage (HMO SNP)
| $37.20 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H1777 -007 -0 | 25% | 25% | | | 2,885
2014 Formulary |
-- |
-- |
|
|
2015 ArchCare Advantage (HMO SNP)
| $36.90 |
$3,400 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 2,885 2015 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2014 --
|
H4922 -002 -0 | | | | | |
new |
new |
new |
|
2015 BeWell (HMO SNP)
| $36.90 |
$3,400 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 2,934 2015 Formulary |
|
-- This plan not offered in 2014 --
|
H4922 -004 -0 | | | | | |
new |
new |
new |
|
2015 CareWell (HMO SNP)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 2,934 2015 Formulary |
|
2014 CenterLight Healthcare Direct Complete Plan (HMO SNP)
| $34.00 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H5989 -002 -0 | $4.00 | $7.25 | $45.00 | $45.00 | 3,124
2014 Formulary |
-- |
-- |
|
|
2015 CenterLight Healthcare Direct Complete Plan (HMO SNP)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $7.25 | $45.00 | $45.00 | 3,172 2015 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 Elderplan Advantage For Nursing Home Residents (HMO SNP)
| $37.20 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3347 -003 -0 | 25% | | | | 2,966
2014 Formulary |
-- |
|
|
|
2015 Elderplan Advantage For Nursing Home Residents (HMO SNP)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,088 2015 Formulary |
|
2014 Elderplan Extra Help (HMO)
| $37.20 |
$6,700 |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3347 -009 -0 | 25% | | | | 2,966
2014 Formulary |
-- |
|
|
|
2015 Elderplan Extra Help (HMO)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,088 2015 Formulary |
|
2014 Elderplan For Medicaid Beneficiaries (HMO SNP)
| $37.20 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3347 -002 -0 | 15% | | | | 2,966
2014 Formulary |
-- |
|
|
|
2015 Elderplan For Medicaid Beneficiaries (HMO SNP)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,088 2015 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 Elderplan Plus Long Term Care (HMO SNP)
| $37.20 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3347 -007 -0 | 15% | | | | 2,966
2014 Formulary |
-- |
|
|
|
2015 Elderplan Plus Long Term Care (HMO SNP)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,088 2015 Formulary |
|
2014 EmblemHealth Dual Eligible (HMO SNP)
| $34.00 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3330 -029 -0 | $2.00 | $9.00 | 25% | 25% | 3,204
2014 Formulary |
|
|
|
|
2015 EmblemHealth Dual Eligible (HMO SNP)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 3,208 2015 Formulary |
|
2014 EmblemHealth Dual Eligible (PPO SNP)
| $34.00 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H5528 -018 -0 | $2.00 | $9.00 | 25% | 25% | 3,204
2014 Formulary |
|
|
|
|
2015 EmblemHealth Dual Eligible (PPO SNP)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 3,208 2015 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2014 --
|
H3330 -035 -0 | | | | | |
|
|
|
|
2015 EmblemHealth MLTC PLUS (HMO SNP)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 3,208 2015 Formulary |
|
-- This plan not offered in 2014 --
|
H4922 -003 -0 | | | | | |
new |
new |
new |
|
2015 FeelWell (HMO SNP)
| $36.90 |
$3,400 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 2,934 2015 Formulary |
|
2014 Fidelis Medicaid Advantage Plus (HMO SNP)
| $37.20 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3328 -016 -0 | $0.00 | $29.00 | $45.00 | $45.00 | 4,682
2014 Formulary |
|
|
|
|
2015 Fidelis Medicaid Advantage Plus (HMO SNP)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 3,712 2015 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 Fidelis Medicare Advantage Flex (HMO-POS)
| $37.20 |
$6,700 |
$240 | No additional gap coverage, only the Donut Hole Discount |
H3328 -003 -0 | $0.00 | $15.00 | $35.00 | $35.00 | 4,682
2014 Formulary |
|
|
|
|
2015 Fidelis Medicare Advantage Flex (HMO-POS)
| $36.90 |
$6,700 |
$240 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $35.00 | $35.00 | 3,712 2015 Formulary |
|
2014 GuildNet Gold (HMO-POS SNP)
| $37.20 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H6864 -001 -0 | 0% | 0% | 0% | 0% | 3,204
2014 Formulary |
-- |
-- |
|
|
2015 GuildNet Gold (HMO-POS SNP)
| $36.90 |
$3,400 |
$320 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 3,208 2015 Formulary |
|
-- This plan not offered in 2014 --
|
H3337 -003 -0 | | | | | |
-- |
|
|
|
2015 Liberty Health Advantage Dual Power (HMO SNP)
| $36.90 |
$3,400 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,057 2015 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 MetroPlus Advantage Plan (HMO SNP)
| $37.20 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H0423 -001 -0 | 15% | 15% | | | 2,888
2014 Formulary |
-- |
|
|
|
2015 MetroPlus Advantage Plan (HMO SNP)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 2,885 2015 Formulary |
|
2014 Senior Whole Health of New York NHC (HMO SNP)
| $37.20 |
n/a |
$310 | Call plan for details |
H5992 -007 -0 | $0.00 | $45.00 | 25% | | 3,124
2014 Formulary |
-- |
-- |
-- |
|
2015 Senior Whole Health of New York NHC (HMO SNP)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,172 2015 Formulary |
|
2014 Touchstone Health Medicare Grand (HMO SNP)
| $37.20 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3327 -043 -0 | 0% | 0% | 0% | 0% | 3,307
2014 Formulary |
-- |
|
|
|
2015 Touchstone Health Medicare Grand (HMO SNP)
| $36.90 |
$3,400 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,064 2015 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 Touchstone Health Medicare Prestige (HMO SNP)
| $37.20 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3327 -026 -0 | 0% | 0% | 0% | 0% | 3,307
2014 Formulary |
-- |
|
|
|
2015 Touchstone Health Medicare Prestige (HMO SNP)
| $36.90 |
$3,400 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,064 2015 Formulary |
|
2014 Touchstone Health Medicare Total (HMO)
| $37.20 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3327 -002 -0 | $0.00 | $40.00 | $80.00 | $80.00 | 3,307
2014 Formulary |
-- |
|
|
|
2015 Touchstone Health Medicare Total (HMO)
| $36.90 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $7.00 | $45.00 | $45.00 | 3,064 2015 Formulary |
|
2014 UnitedHealthcare Dual Complete (HMO SNP)
| $24.10 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3387 -010 -0 | 0% | 0% | 0% | 0% | 3,604
2014 Formulary |
-- |
|
|
|
2015 UnitedHealthcare Dual Complete (HMO SNP)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,649 2015 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 VNSNY CHOICE Medicare Maximum (HMO SNP)
| $31.50 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H5549 -006 -0 | 0% | 0% | 0% | 0% | 4,779
2014 Formulary |
-- |
|
|
|
2015 VNSNY CHOICE Medicare Maximum (HMO SNP)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,325 2015 Formulary |
|
2014 VNSNY CHOICE Total (HMO SNP)
| $37.20 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H5549 -003 -0 | 0% | 0% | 0% | 0% | 4,779
2014 Formulary |
-- |
|
|
|
2015 VNSNY CHOICE Total (HMO SNP)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,325 2015 Formulary |
|
2014 WellCare Access (HMO SNP)
| $36.00 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3361 -109 -0 | $0.00 | $5.00 | $20.00 | $20.00 | 2,844
2014 Formulary |
|
|
|
|
2015 WellCare Access (HMO SNP)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 2,947 2015 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2014 --
|
H5991 -004 -0 | | | | | |
-- |
|
|
|
2015 Affinity Medicare Passport Select (HMO)
| $46.00 |
$5,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $42.00 | $42.00 | 2,885 2015 Formulary |
|
2014 Advantage Platinum Plus NY (HMO)
| $63.00 |
$3,400 |
$0 | Some Generics |
H2773 -015 -0 | $0.00 | $10.00 | $30.00 | $30.00 | 2,885
2014 Formulary |
-- |
-- |
|
|
2015 Advantage Platinum Plus NY (HMO)
| $49.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $20.00 | $20.00 | tbd |
|
2014 EmblemHealth VIP (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3330 -021 -1 | $2.00 | $10.00 | $35.00 | $35.00 | 3,204
2014 Formulary |
|
|
|
|
2015 EmblemHealth VIP (HMO)
| $49.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $40.00 | $40.00 | 3,208 2015 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 Aetna Medicare Standard Plan (PPO)
| $87.00 |
$6,700 |
$0 | Few Generics |
H5521 -040 -0 | $6.00 | $45.00 | $95.00 | $95.00 | 3,134
2014 Formulary |
|
|
|
|
2015 Aetna Medicare Standard Plan (PPO)
| $97.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $8.00 | $45.00 | $45.00 | 2,911 2015 Formulary |
|
2014 MetroPlus Platinum (HMO)
| $47.90 |
$6,700 |
$310 | No additional gap coverage, only the Donut Hole Discount |
H0423 -004 -0 | 25% | 25% | | | 2,888
2014 Formulary |
-- |
|
|
|
2015 MetroPlus Platinum (HMO)
| $101.10 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 2,885 2015 Formulary |
|
2014 MetroPlus Select Plan (HMO SNP)
| $37.20 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H0423 -003 -0 | 0% | 0% | | | 2,888
2014 Formulary |
-- |
|
|
|
2015 MetroPlus Select Plan (HMO SNP)
| $123.30 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 2,885 2015 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2014 --
|
H5991 -005 -0 | | | | | |
-- |
|
|
|
2015 Affinity Medicare Passport Elite (HMO)
| $126.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $7.00 | $40.00 | $40.00 | 2,885 2015 Formulary |
|
-- This plan not offered in 2014 --
|
H5521 -052 -0 | | | | | |
|
|
|
|
2015 Aetna Medicare Select Plus Plan (PPO)
| $139.00 |
$3,300 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $45.00 | $45.00 | 3,112 2015 Formulary |
|
-- This plan not offered in 2014 --
|
H5528 -025 -0 | | | | | |
|
|
|
|
2015 EmblemHealth Advantage (PPO)
| $199.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $40.00 | $40.00 | 3,208 2015 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 EmblemHealth VIP High Option (HMO)
| $161.50 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3330 -033 -1 | $2.00 | $10.00 | $35.00 | $35.00 | 3,204
2014 Formulary |
|
|
|
|
2015 EmblemHealth VIP High Option (HMO)
| $233.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $40.00 | $40.00 | 3,208 2015 Formulary |
|
2014 MetroPlus Medicare Partnership in Care Plan (HMO SNP)
| $134.00 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H0423 -002 -0 | 25% | 25% | | | 2,888
2014 Formulary |
-- |
|
|
|
2015 MetroPlus Medicare Partnership in Care Plan (HMO SNP)
| $244.20 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 2,885 2015 Formulary |
|
2014 Easy Choice Value (HMO)
| $0.00 |
$3,400 |
$0 | Many Generics |
H9285 -002 -0 | $0.00 | $35.00 | $79.00 | $79.00 | 2,770
2014 Formulary |
-- |
-- |
|
|
-- Members will be assigned to Easy Choice Rewards (HMO) H9285-001 --
| | | | | |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 Empire MediBlue Essential (HMO)
| $0.00 |
$6,000 |
No Rx Coverage |
H3370 -019 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
-- Members will be assigned to Empire MediBlue Essential (HMO) H3370-033 --
| | | | | |
|
2014 Empire MediBlue Plus (HMO)
| $0.00 |
$5,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3370 -001 -0 | $2.00 | $9.00 | $40.00 | $40.00 | 2,998
2014 Formulary |
|
|
|
|
-- Members will be assigned to Empire MediBlue Plus (HMO) H3370-029 --
| | | | | |
|
2014 Senior Whole Health of New York (HMO SNP)
| $37.20 |
n/a |
$310 | Call plan for details |
H5992 -006 -0 | $0.00 | $45.00 | 25% | | 3,124
2014 Formulary |
-- |
-- |
-- |
|
-- Members will be assigned to Senior Whole Health of New York NHC (HMO SNP) H5992-007 --
| | | | | |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 EmblemHealth PPO II (PPO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5528 -002 -0 | $2.00 | $10.00 | $35.00 | $35.00 | 3,204
2014 Formulary |
|
|
|
|
-- This plan not offered in 2015 --
|
| | | | |
|
2014 EmblemHealth PPO III (PPO)
| $89.00 |
$3,400 |
$0 | All Generics |
H5528 -003 -0 | $2.00 | $10.00 | $35.00 | $35.00 | 3,204
2014 Formulary |
|
|
|
|
-- This plan not offered in 2015 --
|
| | | | |
|
2014 Elderplan Medicaid Advantage (HMO SNP)
| $37.40 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3347 -008 -0 | 15% | | | | 2,966
2014 Formulary |
-- |
|
|
|
-- This plan not offered in 2015 --
|
| | | | |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 Healthfirst Maximum Plan (HMO SNP)
| $37.20 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3359 -033 -0 | 0% | 0% | 0% | 0% | 2,885
2014 Formulary |
|
|
|
|
-- This plan not offered in 2015 --
|
| | | | |
|
2014 CenterLight Direct Total Plan (HMO SNP)
| $33.90 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H5989 -008 -0 | $4.00 | $9.00 | $45.00 | $45.00 | 3,124
2014 Formulary |
-- |
-- |
|
|
-- This plan not offered in 2015 --
|
| | | | |
|
2014 GuildNet Health Advantage (HMO-POS SNP)
| $33.10 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H6864 -002 -0 | 15% | 15% | 15% | 15% | 3,204
2014 Formulary |
-- |
-- |
|
|
-- This plan not offered in 2015 --
|
| | | | |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2014 HHH Choices Gold (HMO SNP)
| $37.20 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3635 -001 -0 | 15% | | | | 2,710
2014 Formulary |
|
|
|
|
-- This plan not offered in 2015 --
|
| | | | |
|
2014 Touchstone Health Medicare Prestige Plus (HMO SNP)
| $37.20 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3327 -044 -0 | 0% | 0% | 0% | 0% | 3,307
2014 Formulary |
-- |
|
|
|
-- This plan not offered in 2015 --
|
| | | | |
|