There are 53 Medicare Advantage plans meeting your criteria.
2014 / 2015 Medicare Advantage Plan Information
Click here to jump to the Chart Legend |
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 BlueSaver MSA (MSA)
| $0.00 |
n/a |
No Rx Coverage |
H9788 -002 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2015 BlueSaver MSA (MSA)
| $0.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
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. | |
|
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 H3533-006 (HMO)
| $0.00 |
$5,500 |
$0 | Few Generics, Few Brands |
H3533 -006 -0 | $0.00 | $18.00 | $45.00 | $45.00 | 3,711
2014 Formulary |
-- |
-- |
|
|
2015 Humana Gold Plus H3533-006 (HMO)
| $0.00 |
$6,700 |
$320 | Yes, some additional gap coverage. | $6.00 | $18.00 | $45.00 | $45.00 | 3,630 2015 Formulary |
|
2014 Today's Options Premier 400 (PFFS)
| $0.00 |
$4,400 |
No Rx Coverage |
H2816 -007 -0 | This plan does NOT include Prescription Drug coverage. | |
-- |
|
|
|
2015 Today's Options Premier 200 (PFFS)
| $0.00 |
$4,400 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
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 |
|
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 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 |
|
2014 WellCare Value (HMO-POS)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3361 -099 -0 | $3.00 | $10.00 | $44.00 | $44.00 | 2,844
2014 Formulary |
|
|
|
|
2015 WellCare Value (HMO)
| $0.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $14.00 | $44.00 | $44.00 | 2,946 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 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 |
|
-- This plan not offered in 2014 --
|
H3533 -013 -0 | | | | | |
-- |
-- |
|
|
2015 Humana Gold Plus H3533-013 (HMO)
| $22.40 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $14.00 | $45.00 | $45.00 | 3,630 2015 Formulary |
|
2014 Today's Options Premier 100 (PFFS)
| $40.00 |
n/a |
No Rx Coverage |
H2816 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
-- |
|
|
|
2015 Today's Options Premier 100 (PFFS)
| $25.00 |
n/a |
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 UnitedHealthcare Nursing Home Plan (HMO SNP)
| $35.20 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3379 -022 -0 | 25% | 25% | 25% | 25% | 3,604
2014 Formulary |
-- |
|
|
|
2015 UnitedHealthcare Nursing Home Plan (HMO SNP)
| $27.10 |
$3,500 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,649 2015 Formulary |
|
2014 WellCare Access (HMO SNP)
| $23.40 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3361 -065 -0 | $0.00 | $2.00 | $15.00 | $15.00 | 2,844
2014 Formulary |
|
|
|
|
2015 WellCare Access (HMO SNP)
| $28.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 2,947 2015 Formulary |
|
-- This plan not offered in 2014 --
|
H3388 -013 -0 | | | | | |
-- |
|
|
|
2015 CDPHP Basic RX (HMO)
| $29.50 |
$6,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $45.00 | $45.00 | 2,899 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 Today's Options Advantage Plus 850B (PPO)
| $36.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2775 -088 -0 | $5.00 | $12.00 | $45.00 | $45.00 | 2,885
2014 Formulary |
-- |
|
|
|
2015 Today's Options Advantage Plus 350B (PPO)
| $34.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $12.00 | $45.00 | $45.00 | 2,885 2015 Formulary |
|
2014 Today's Options Premier Plus 850B (PFFS)
| $37.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2816 -019 -0 | $5.00 | $12.00 | $45.00 | $45.00 | 2,885
2014 Formulary |
-- |
|
|
|
2015 Today's Options Premier Plus 350B (PFFS)
| $34.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $12.00 | $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 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 |
|
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 |
|
-- This plan not offered in 2014 --
|
H3533 -002 -0 | | | | | |
-- |
-- |
|
|
2015 Humana Gold Plus SNP-DE H3533-002 (HMO SNP)
| $36.00 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 3,630 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 |
|
-- This plan not offered in 2014 --
|
H3361 -043 -0 | | | | | |
|
|
|
|
2015 WellCare Liberty (HMO SNP)
| $36.30 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 2,947 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 |
|
-- This plan not offered in 2014 --
|
H5526 -017 -0 | | | | | |
|
|
|
|
2015 Forever Blue Medicare PPO Value (PPO)
| $36.90 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $20.00 | $45.00 | $45.00 | 3,337 2015 Formulary |
|
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 |
|
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 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 CDPHP Choice (HMO)
| $24.00 |
$2,500 |
No Rx Coverage |
H3388 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
-- |
|
|
|
2015 CDPHP Choice (HMO)
| $40.00 |
$4,000 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2014 CDPHP Value Rx (HMO)
| $32.00 |
$3,300 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3388 -004 -0 | $0.00 | $9.00 | $45.00 | $45.00 | 2,922
2014 Formulary |
-- |
|
|
|
2015 CDPHP Value Rx (HMO)
| $45.50 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $12.00 | $45.00 | $45.00 | 2,899 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 Preferred Gold without Part D (HMO-POS)
| $18.40 |
$4,500 |
No Rx Coverage |
H9859 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
-- |
|
|
|
2015 MVP Preferred Gold without Part D (HMO-POS)
| $47.40 |
$4,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2014 BasiCare with Part D (PPO)
| $27.00 |
$4,000 |
$310 | No additional gap coverage, only the Donut Hole Discount |
H9615 -008 -0 | 25% | 25% | 25% | 25% | 3,577
2014 Formulary |
|
|
|
|
2015 BasiCare with Part D (PPO)
| $49.70 |
$4,000 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,666 2015 Formulary |
|
2014 HumanaChoice H5970-008 (PPO)
| $48.00 |
$6,700 |
$0 | Few Generics, Few Brands |
H5970 -008 -0 | $6.00 | $15.00 | $45.00 | $45.00 | 3,711
2014 Formulary |
-- |
|
|
|
2015 HumanaChoice H5970-008 (PPO)
| $55.00 |
$6,700 |
$320 | Yes, some additional gap coverage. | $8.00 | $18.00 | $45.00 | $45.00 | 3,630 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 BlueShield Senior Blue 650 Part D (HMO-POS)
| $39.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3384 -059 -0 | $3.00 | $12.00 | $45.00 | $45.00 | 3,280
2014 Formulary |
|
|
|
|
2015 BlueShield Senior Blue 650 Part D (HMO-POS)
| $63.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $25.00 | $45.00 | $45.00 | 3,337 2015 Formulary |
|
-- This plan not offered in 2014 --
|
H3342 -019 -0 | | | | | |
|
|
|
|
2015 Empire MediBlue Freedom I (PPO)
| $71.00 |
$4,500 |
$304 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $22.00 | $40.00 | $40.00 | 3,016 2015 Formulary |
|
2014 Today's Options Premier Plus 350A (PFFS)
| $92.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2816 -013 -0 | $2.00 | $7.00 | $40.00 | $40.00 | 2,885
2014 Formulary |
-- |
|
|
|
2015 Today's Options Premier Plus 150A (PFFS)
| $85.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $7.00 | $40.00 | $40.00 | 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 Today's Options Advantage Plus 350A (PPO)
| $90.00 |
$3,250 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2775 -082 -0 | $2.00 | $7.00 | $40.00 | $40.00 | 2,885
2014 Formulary |
-- |
|
|
|
2015 Today's Options Advantage Plus 150A (PPO)
| $89.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $7.00 | $40.00 | $40.00 | 2,885 2015 Formulary |
|
2014 CDPHP Choice Rx (HMO)
| $81.00 |
$2,500 |
$0 | Some Generics, Few Brands |
H3388 -002 -0 | $0.00 | $8.00 | $40.00 | $40.00 | 2,922
2014 Formulary |
-- |
|
|
|
2015 CDPHP Choice Rx (HMO)
| $95.50 |
$4,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $11.00 | $45.00 | $45.00 | 2,899 2015 Formulary |
|
2014 GoldValue with Part D (HMO-POS)
| $59.50 |
$6,000 |
$0 | Few Generics |
H9859 -013 -0 | $10.00 | $35.00 | $90.00 | $90.00 | 3,577
2014 Formulary |
-- |
|
|
|
2015 MVP GoldValue with Part D (HMO-POS)
| $103.60 |
$6,000 |
$0 | Yes, some additional gap coverage. | $3.00 | $15.00 | $45.00 | $45.00 | 3,666 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 BlueShield Senior Blue HMO 652 PartD (HMO)
| $99.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3384 -013 -0 | $3.00 | $12.00 | $45.00 | $45.00 | 3,280
2014 Formulary |
|
|
|
|
2015 BlueShield Senior Blue HMO 652 PartD (HMO)
| $119.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $45.00 | $45.00 | 3,337 2015 Formulary |
|
2014 GoldAnywhere with Part D - Option 2 (PPO)
| $64.00 |
$4,000 |
$0 | Few Generics |
H9615 -007 -0 | $10.00 | $35.00 | $90.00 | $90.00 | 3,577
2014 Formulary |
|
|
|
|
2015 Gold PPO with Part D (PPO)
| $122.60 |
$4,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $35.00 | $35.00 | 3,666 2015 Formulary |
|
2014 CDPHP Core Rx (PPO)
| $126.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5042 -005 -0 | $0.00 | $12.00 | $45.00 | $45.00 | 2,922
2014 Formulary |
-- |
|
|
|
2015 CDPHP Core Rx (PPO)
| $134.50 |
$4,250 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $12.00 | $45.00 | $45.00 | 2,899 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 CDPHP Classic (PPO)
| $110.00 |
$3,400 |
No Rx Coverage |
H5042 -004 -0 | This plan does NOT include Prescription Drug coverage. | |
-- |
|
|
|
2015 CDPHP Classic (PPO)
| $138.00 |
$4,000 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2014 HumanaChoice H5970-010 (PPO)
| $133.00 |
$6,700 |
$0 | Few Generics, Few Brands |
H5970 -010 -0 | $6.00 | $15.00 | $45.00 | $45.00 | 3,711
2014 Formulary |
-- |
|
|
|
2015 HumanaChoice H5970-010 (PPO)
| $157.00 |
$6,700 |
$320 | Yes, some additional gap coverage. | $6.00 | $15.00 | $45.00 | $45.00 | 3,630 2015 Formulary |
|
2014 Preferred Gold with Part D (HMO-POS)
| $117.00 |
$4,500 |
$0 | Few Generics |
H9859 -002 -0 | $10.00 | $35.00 | $90.00 | $90.00 | 3,577
2014 Formulary |
-- |
|
|
|
2015 MVP Preferred Gold with Part D (HMO-POS)
| $167.40 |
$4,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $35.00 | $35.00 | 3,666 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 BlueShield Forever Blue Medicare PPO 750 (PPO)
| $144.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5526 -014 -0 | $5.00 | $12.00 | $45.00 | $45.00 | 3,280
2014 Formulary |
|
|
|
|
2015 BlueShield Forever Blue Medicare PPO 750 (PPO)
| $187.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $45.00 | $45.00 | 3,337 2015 Formulary |
|
2014 CDPHP Classic Rx (PPO)
| $182.00 |
$3,400 |
$0 | Some Generics, Few Brands |
H5042 -001 -0 | $0.00 | $10.00 | $40.00 | $40.00 | 2,922
2014 Formulary |
-- |
|
|
|
2015 CDPHP Classic Rx (PPO)
| $194.50 |
$4,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $40.00 | $40.00 | 2,899 2015 Formulary |
|
2014 CDPHP Prime Rx (PPO)
| $256.00 |
$3,400 |
$0 | Some Generics, Few Brands |
H5042 -007 -0 | $0.00 | $8.00 | $40.00 | $40.00 | 2,922
2014 Formulary |
-- |
|
|
|
2015 CDPHP Prime Rx (PPO)
| $276.50 |
$3,750 |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $40.00 | $40.00 | 2,899 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 Empire MediBlue Freedom I (PPO)
| $50.00 |
$4,500 |
$125 | No additional gap coverage, only the Donut Hole Discount |
H3342 -012 -0 | $3.00 | $11.00 | $40.00 | $40.00 | 2,998
2014 Formulary |
|
|
|
|
-- Members will be assigned to Empire MediBlue Freedom I (PPO) H3342-019 --
| | | | | |
|
2014 Humana Gold Plus HMO-SNP-DE H3533-008 (HMO SNP)
| $13.80 |
n/a |
$110 | No additional gap coverage, only the Donut Hole Discount |
H3533 -008 -0 | $0.00 | $13.00 | $45.00 | $45.00 | 3,711
2014 Formulary |
-- |
-- |
|
|
-- Members will be assigned to Humana Gold Plus SNP-DE H3533-002 (HMO SNP) H3533-002 --
| | | | | |
|
2014 WellCare Liberty (HMO SNP)
| $32.40 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3361 -098 -0 | $0.00 | $2.00 | $15.00 | $15.00 | 2,844
2014 Formulary |
|
|
|
|
-- Members will be assigned to WellCare Liberty (HMO SNP) H3361-043 --
| | | | | |
|
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 GoldAnywhere with Part D - Option 1 (PPO)
| $238.00 |
$2,000 |
$0 | Few Generics |
H9615 -002 -0 | $8.00 | $35.00 | $90.00 | $90.00 | 3,577
2014 Formulary |
|
|
|
|
-- This plan not offered in 2015 --
|
| | | | |
|
2014 Today's Options Advantage 800 (PPO)
| $0.00 |
$6,700 |
No Rx Coverage |
H2775 -094 -0 | This plan does NOT include Prescription Drug coverage. | |
-- |
|
|
|
-- This plan not offered in 2015 --
|
| | | | |
|