There are 56 Medicare Advantage plans meeting your criteria.
2015 / 2016 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 |
2015 Advantage Health NY - SNP (HMO SNP)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2773 -003 -0 | $0.00 | $10.00 | $30.00 | $30.00 | n/a |
-- |
-- |
|
|
2016 Advantage Health NY - SNP (HMO SNP)
| $0.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $30.00 | $30.00 | 3,969 2016 Formulary |
|
2015 Advantage Silver - NY (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2773 -019 -0 | $4.00 | $15.00 | $30.00 | $30.00 | n/a |
-- |
-- |
|
|
2016 Advantage Silver - NY (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $15.00 | $30.00 | $30.00 | 3,969 2016 Formulary |
|
2015 Affinity Medicare Passport Essentials (HMO)
| $0.00 |
$5,800 |
$0 | Yes, some additional gap coverage. |
H5991 -003 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 2,885
2015 Formulary |
|
|
|
|
2016 Affinity Medicare Passport Essentials (HMO)
| $0.00 |
$6,700 |
$250 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,020 2016 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 |
2015 LiveWell (HMO)
| $32.90 |
$6,700 |
$250 | Yes, some additional gap coverage. |
H4922 -001 -0 | $4.00 | $10.00 | $45.00 | $45.00 | 2,934
2015 Formulary |
new |
new |
new |
|
2016 AgeWell New York LiveWell (HMO)
| $0.00 |
$6,700 |
$275 | Yes, some additional gap coverage. | $5.00 | $15.00 | $45.00 | $45.00 | 3,068 2016 Formulary |
|
2015 Elderplan Diabetes Care (HMO SNP)
| $0.00 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount |
H3347 -012 -0 | $5.00 | $40.00 | $95.00 | $95.00 | 3,088
2015 Formulary |
|
|
|
|
2016 Elderplan Diabetes Care (HMO SNP)
| $0.00 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $47.00 | $47.00 | 3,250 2016 Formulary |
|
-- This plan not offered in 2015 --
|
H3328 -019 -0 | | | | | |
|
|
|
|
2016 Fidelis Medicare $0 Premium (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,966 2016 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 |
2015 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. | |
|
|
|
|
2016 Fidelis Medicare Advantage without Rx (HMO-POS)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2015 --
|
H9869 -001 -0 | | | | | |
new |
new |
new |
|
2016 PHP Care Complete FIDA (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | | 3,391 2016 Formulary |
|
2015 UnitedHealthcare MedicareComplete Choice Essential (Regional PPO)
| $0.00 |
$6,700 |
No Rx Coverage |
R5342 -002 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2016 UnitedHealthcare MedicareComplete Choice Essential (Regional PPO)
| $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 |
2015 UnitedHealthcare MedicareComplete Choice (Regional PPO)
| $0.00 |
$6,700 |
$225 | No additional gap coverage, only the Donut Hole Discount |
R5342 -001 -0 | $2.00 | $8.00 | $45.00 | $45.00 | n/a |
|
|
|
|
2016 UnitedHealthcare MedicareComplete Choice Plan 1 (Regional PPO)
| $0.00 |
$6,700 |
$290 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $12.00 | $47.00 | $47.00 | tbd |
|
2015 VNSNY CHOICE Medicare Enhanced (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5549 -004 -0 | $0.00 | $9.00 | $45.00 | $45.00 | 3,325
2015 Formulary |
|
|
|
|
2016 VNSNY CHOICE Medicare Enhanced (HMO)
| $0.00 |
$6,700 |
$360 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $9.00 | $45.00 | $45.00 | 3,446 2016 Formulary |
|
-- This plan not offered in 2015 --
|
H3361 -065 -0 | | | | | |
|
|
|
|
2016 WellCare Access (HMO SNP)
| $21.80 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $46.00 | $46.00 | 2,801 2016 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 2015 --
|
H3533 -022 -0 | | | | | |
|
-- |
|
|
2016 Humana Gold Plus SNP-DE H3533-022 (HMO SNP)
| $29.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $30.00 | $30.00 | 3,615 2016 Formulary |
|
2015 Humana Gold Plus H3533-010 (HMO)
| $33.00 |
$6,700 |
$320 | Yes, some additional gap coverage. |
H3533 -010 -0 | $10.00 | $25.00 | $45.00 | $45.00 | 3,630
2015 Formulary |
|
-- |
|
|
2016 Humana Gold Plus H3533-010 (HMO)
| $37.00 |
$6,700 |
$360 | Yes, some additional gap coverage. | $10.00 | $20.00 | $47.00 | $47.00 | 3,615 2016 Formulary |
|
-- This plan not offered in 2015 --
|
R5342 -005 -0 | | | | | |
|
|
|
|
2016 UnitedHealthcare MedicareComplete Choice Plan 3 (Regional PPO)
| $39.00 |
$5,700 |
$150 | 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 |
2015 UnitedHealthcare Nursing Home Plan (HMO SNP)
| $30.30 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount |
H3379 -002 -0 | | | | | 3,649
2015 Formulary |
|
|
|
|
2016 UnitedHealthcare Nursing Home Plan (HMO SNP)
| $39.30 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,529 2016 Formulary |
|
2015 Advantage Value One NY - Dual (HMO SNP)
| $36.90 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H2773 -018 -0 | $0.00 | $0.00 | $0.00 | $0.00 | n/a |
-- |
-- |
|
|
2016 Advantage Value One NY - Dual (HMO SNP)
| $39.70 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $30.00 | $30.00 | 3,969 2016 Formulary |
|
2015 Affinity Medicare Solutions (HMO SNP)
| $36.90 |
$3,400 |
$320 | No additional gap coverage, only the Donut Hole Discount |
H5991 -002 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 2,885
2015 Formulary |
|
|
|
|
2016 Affinity Medicare Solutions (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $11.00 | $47.00 | $47.00 | 3,020 2016 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 |
2015 Affinity Medicare Ultimate (HMO SNP)
| $36.90 |
$3,400 |
$320 | No additional gap coverage, only the Donut Hole Discount |
H5991 -001 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 2,885
2015 Formulary |
|
|
|
|
2016 Affinity Medicare Ultimate (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $6.00 | $47.00 | $47.00 | 3,020 2016 Formulary |
|
2015 BeWell (HMO SNP)
| $36.90 |
$3,400 |
$320 | No additional gap coverage, only the Donut Hole Discount |
H4922 -002 -0 | | | | | 2,934
2015 Formulary |
new |
new |
new |
|
2016 AgeWell New York BeWell (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,068 2016 Formulary |
|
2015 CareWell (HMO SNP)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount |
H4922 -004 -0 | | | | | 2,934
2015 Formulary |
new |
new |
new |
|
2016 AgeWell New York CareWell (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,068 2016 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 |
2015 FeelWell (HMO SNP)
| $36.90 |
$3,400 |
$320 | No additional gap coverage, only the Donut Hole Discount |
H4922 -003 -0 | | | | | 2,934
2015 Formulary |
new |
new |
new |
|
2016 AgeWell New York FeelWell (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,068 2016 Formulary |
|
2015 CenterLight Healthcare Direct Complete Plan (HMO SNP)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount |
H5989 -002 -0 | $4.00 | $7.25 | $45.00 | $45.00 | 3,172
2015 Formulary |
|
-- |
|
|
2016 CenterLight Healthcare Direct Complete Plan (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount | $9.50 | 25% | | | 3,678 2016 Formulary |
|
2015 Elderplan Advantage For Nursing Home Residents (HMO SNP)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount |
H3347 -003 -0 | | | | | 3,088
2015 Formulary |
|
|
|
|
2016 Elderplan Advantage For Nursing Home Residents (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,250 2016 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 |
2015 Elderplan Extra Help (HMO)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount |
H3347 -009 -0 | | | | | 3,088
2015 Formulary |
|
|
|
|
2016 Elderplan Extra Help (HMO)
| $39.70 |
$6,700 |
$360 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,250 2016 Formulary |
|
2015 Elderplan For Medicaid Beneficiaries (HMO SNP)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount |
H3347 -002 -0 | | | | | 3,088
2015 Formulary |
|
|
|
|
2016 Elderplan For Medicaid Beneficiaries (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,250 2016 Formulary |
|
2015 EmblemHealth Dual Eligible (HMO SNP)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount |
H3330 -029 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,208
2015 Formulary |
|
|
|
|
2016 EmblemHealth Dual Eligible (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $9.00 | 25% | 25% | 3,376 2016 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 |
2015 EmblemHealth Dual Eligible (PPO SNP)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount |
H5528 -018 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,208
2015 Formulary |
|
|
|
|
2016 EmblemHealth Dual Eligible (PPO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $9.00 | 25% | 25% | 3,376 2016 Formulary |
|
2015 Fidelis Dual Advantage Flex (HMO SNP)
| $35.40 |
$6,700 |
$320 | Yes, some additional gap coverage. |
H3328 -017 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,712
2015 Formulary |
|
|
|
|
2016 Fidelis Dual Advantage Flex (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,966 2016 Formulary |
|
2015 Fidelis Medicare Advantage Flex (HMO-POS)
| $36.90 |
$6,700 |
$240 | No additional gap coverage, only the Donut Hole Discount |
H3328 -003 -0 | $0.00 | $15.00 | $35.00 | $35.00 | 3,712
2015 Formulary |
|
|
|
|
2016 Fidelis Medicare Advantage Flex (HMO-POS)
| $39.70 |
$6,700 |
$250 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $35.00 | $35.00 | 3,966 2016 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 |
2015 GuildNet Gold (HMO-POS SNP)
| $36.90 |
$3,400 |
$320 | No additional gap coverage, only the Donut Hole Discount |
H6864 -001 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,208
2015 Formulary |
-- |
|
|
|
2016 GuildNet Gold (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount | $1.00 | $10.00 | 25% | 25% | 3,376 2016 Formulary |
|
2015 VNSNY CHOICE Medicare Classic (HMO)
| $34.10 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount |
H5549 -008 -0 | | | | | 3,325
2015 Formulary |
|
|
|
|
2016 VNSNY CHOICE Medicare Classic (HMO)
| $39.70 |
$6,700 |
$360 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,446 2016 Formulary |
|
2015 VNSNY CHOICE Medicare Preferred (HMO SNP)
| $36.30 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount |
H5549 -002 -0 | | | | | 3,325
2015 Formulary |
|
|
|
|
2016 VNSNY CHOICE Medicare Preferred (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,446 2016 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 |
2015 VNSNY CHOICE Total (HMO SNP)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount |
H5549 -003 -0 | | | | | 3,325
2015 Formulary |
|
|
|
|
2016 VNSNY CHOICE Total (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,446 2016 Formulary |
|
2015 Affinity Medicare Passport Select (HMO)
| $46.00 |
$5,000 |
$0 | Yes, some additional gap coverage. |
H5991 -004 -0 | $0.00 | $8.00 | $42.00 | $42.00 | 2,885
2015 Formulary |
|
|
|
|
2016 Affinity Medicare Passport Select (HMO)
| $41.00 |
$5,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $42.00 | $42.00 | 3,020 2016 Formulary |
|
-- This plan not offered in 2015 --
|
R5342 -006 -0 | | | | | |
|
|
|
|
2016 UnitedHealthcare MedicareComplete Choice Plan 4 (Regional PPO)
| $69.00 |
$4,900 |
$0 | 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 |
2015 Empire MediBlue Plus (HMO)
| $80.00 |
$5,200 |
$315 | No additional gap coverage, only the Donut Hole Discount |
H3370 -032 -0 | $5.00 | $23.00 | $40.00 | $40.00 | 3,016
2015 Formulary |
|
|
|
|
2016 Empire MediBlue Plus (HMO)
| $81.00 |
$6,700 |
$260 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | $42.00 | $42.00 | 3,266 2016 Formulary |
|
2015 Advantage Platinum Plus NY (HMO)
| $49.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H2773 -015 -0 | $0.00 | $10.00 | $20.00 | $20.00 | n/a |
-- |
-- |
|
|
2016 Advantage Platinum Plus NY (HMO)
| $85.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $20.00 | $20.00 | 3,969 2016 Formulary |
|
-- This plan not offered in 2015 --
|
H3347 -013 -0 | | | | | |
|
|
|
|
2016 Elderplan Healthy Balance (HMO-POS)
| $85.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $12.00 | $47.00 | $47.00 | 3,250 2016 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 |
2015 EmblemHealth PPO I (PPO)
| $87.00 |
$6,700 |
No Rx Coverage |
H5528 -009 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2016 EmblemHealth PPO I (PPO)
| $88.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2015 --
|
H5549 -009 -0 | | | | | |
|
|
|
|
2016 VNSNY CHOICE Medicare Ultra (HMO-POS)
| $96.40 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $9.00 | $45.00 | $45.00 | 3,446 2016 Formulary |
|
2015 VNSNY CHOICE Medicare Maximum (HMO SNP)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount |
H5549 -006 -0 | | | | | 3,325
2015 Formulary |
|
|
|
|
2016 VNSNY CHOICE Medicare Maximum (HMO SNP)
| $115.80 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,446 2016 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 |
2015 EmblemHealth Essential (HMO)
| $122.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3330 -032 -3 | $0.00 | $10.00 | $40.00 | $40.00 | 3,208
2015 Formulary |
|
|
|
|
2016 EmblemHealth Essential (HMO)
| $141.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $47.00 | $47.00 | 3,376 2016 Formulary |
|
2015 EmblemHealth Advantage (PPO)
| $199.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5528 -026 -0 | $0.00 | $10.00 | $40.00 | $40.00 | 3,208
2015 Formulary |
|
|
|
|
2016 EmblemHealth Advantage (PPO)
| $202.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $47.00 | $47.00 | 3,376 2016 Formulary |
|
2015 EmblemHealth VIP (HMO)
| $173.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3330 -021 -3 | $0.00 | $10.00 | $40.00 | $40.00 | 3,208
2015 Formulary |
|
|
|
|
2016 EmblemHealth VIP (HMO)
| $229.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $47.00 | $47.00 | 3,376 2016 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 |
2015 EmblemHealth VIP High Option (HMO)
| $328.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3330 -033 -3 | $0.00 | $10.00 | $40.00 | $40.00 | 3,208
2015 Formulary |
|
|
|
|
2016 EmblemHealth VIP High Option (HMO)
| $388.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $47.00 | $47.00 | 3,376 2016 Formulary |
|
2015 Affinity Medicare Passport Elite (HMO)
| $126.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H5991 -005 -0 | $0.00 | $7.00 | $40.00 | $40.00 | 2,885
2015 Formulary |
|
|
|
|
-- Members will be assigned to Affinity Medicare Passport Select (HMO) H5991-004 --
| | | | | |
|
2015 ActiveSaver MSA (MSA)
| $0.00 |
n/a |
No Rx Coverage |
H9788 -004 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
-- This plan not offered in 2016 --
|
| | | | |
|
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 |
2015 WellCare Access (HMO SNP)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount |
H3361 -109 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 2,947
2015 Formulary |
|
|
|
|
-- This plan not offered in 2016 --
|
| | | | |
|
2015 Fidelis Long Term Care Advantage (HMO SNP)
| $3.00 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount |
H3328 -018 -0 | | | | | 3,712
2015 Formulary |
|
|
|
|
-- This plan not offered in 2016 --
|
| | | | |
|
2015 WellCare Choice (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3361 -132 -0 | $1.00 | $14.00 | $43.00 | $43.00 | 2,946
2015 Formulary |
|
|
|
|
-- This plan not offered in 2016 --
|
| | | | |
|
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 |
2015 Elderplan Plus Long Term Care (HMO SNP)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount |
H3347 -007 -0 | | | | | 3,088
2015 Formulary |
|
|
|
|
-- This plan not offered in 2016 --
|
| | | | |
|
2015 Empire MediBlue Freedom I (PPO)
| $71.00 |
$4,500 |
$304 | No additional gap coverage, only the Donut Hole Discount |
H3342 -019 -0 | $5.00 | $22.00 | $40.00 | $40.00 | 3,016
2015 Formulary |
|
|
|
|
-- This plan not offered in 2016 --
|
| | | | |
|
2015 Elderplan Classic: Zero Premium (HMO)
| $0.00 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount |
H3347 -005 -0 | $5.00 | $40.00 | $95.00 | $95.00 | 3,088
2015 Formulary |
|
|
|
|
-- This plan not offered in 2016 --
|
| | | | |
|
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 |
2015 Humana Gold Plus H3533-019 (HMO)
| $163.00 |
$3,400 |
$320 | Yes, some additional gap coverage. |
H3533 -019 -0 | $8.00 | $18.00 | $45.00 | $45.00 | 3,630
2015 Formulary |
|
-- |
|
|
-- This plan not offered in 2016 --
|
| | | | |
|
2015 EmblemHealth MLTC PLUS (HMO SNP)
| $36.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount |
H3330 -035 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,208
2015 Formulary |
|
|
|
|
-- This plan not offered in 2016 --
|
| | | | |
|