There are 122 Medicare Advantage plans meeting your criteria.
2016 / 2017 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 |
2016 AARP MedicareComplete Essential (HMO)
| $0.00 |
$5,200 |
No Rx Coverage |
H3307 -018 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2017 AARP MedicareComplete Essential (HMO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2016 AARP MedicareComplete Mosaic (HMO)
| $0.00 |
$4,900 |
$245 | No additional gap coverage, only the Donut Hole Discount |
H3307 -015 -0 | $3.00 | $13.00 | $43.00 | $43.00 | 3,529
2016 Formulary |
|
|
|
|
2017 AARP MedicareComplete Mosaic (HMO)
| $0.00 |
$5,700 |
$245 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $13.00 | $43.00 | $43.00 | 3,683 2017 Formulary |
|
2016 Advantage Health NYC - SNP (HMO SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H2773 -017 -0 | $0.00 | $10.00 | $25.00 | $25.00 | 3,969
2016 Formulary |
-- |
-- |
|
|
2017 Advantage Health NYC - SNP (HMO SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $35.00 | $35.00 | 4,215 2017 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 |
2016 Advantage Silver - NY City (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H2773 -020 -0 | $0.00 | $10.00 | $30.00 | $30.00 | 3,969
2016 Formulary |
-- |
-- |
|
|
2017 Advantage Silver - NY City (HMO)
| $0.00 |
$5,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $35.00 | $35.00 | 4,215 2017 Formulary |
|
2016 Aetna Better Health FIDA Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H8056 -001 -0 | $0.00 | $0.00 | $0.00 | | 3,090
2016 Formulary |
-- |
-- |
-- |
|
2017 Aetna Better Health FIDA Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | | 3,410 2017 Formulary |
|
-- This plan not offered in 2016 --
|
H5521 -120 -0 | | | | | |
|
|
|
|
2017 Aetna Medicare Elite Plan (PPO)
| $0.00 |
$6,700 |
$250 | Yes, some additional gap coverage. | $2.00 | $5.00 | $47.00 | $47.00 | 3,670 2017 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 |
2016 Affinity Medicare Passport Essentials NYC (HMO)
| $0.00 |
$6,700 |
$150 | Yes, some additional gap coverage. |
H5991 -006 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,020
2016 Formulary |
|
-- |
|
|
2017 Affinity Medicare Passport Essentials NYC (HMO)
| $0.00 |
$6,700 |
$300 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,098 2017 Formulary |
|
2016 AgeWell New York FIDA Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H6308 -001 -0 | $0.00 | $0.00 | $0.00 | | 3,068
2016 Formulary |
-- |
-- |
-- |
|
2017 AgeWell New York FIDA Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | | 3,176 2017 Formulary |
|
-- This plan not offered in 2016 --
|
H4922 -005 -1 | | | | | |
-- |
-- |
-- |
|
2017 AgeWell New York LiveWell (HMO)
| $0.00 |
$6,700 |
$370 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $20.00 | $47.00 | $47.00 | 3,176 2017 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 |
2016 Centers Plan for FIDA Care Complete (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H3018 -001 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,221
2016 Formulary |
-- |
-- |
-- |
|
2017 Centers Plan for FIDA Care Complete (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | 0% | 3,504 2017 Formulary |
|
2016 Centers Plan for Medicare Advantage Care (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H6988 -001 -0 | $2.00 | $35.00 | $85.00 | $85.00 | 3,222
2016 Formulary |
-- |
-- |
|
|
2017 Centers Plan for Medicare 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 | 3,504 2017 Formulary |
|
2016 Elderplan FIDA Total Care (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H8029 -001 -0 | $0.00 | $0.00 | $0.00 | | 3,250
2016 Formulary |
-- |
-- |
-- |
|
2017 Elderplan FIDA Total Care (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | | 3,142 2017 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 2016 --
|
H3330 -036 -0 | | | | | |
|
|
|
|
2017 EmblemHealth VIP Value (HMO)
| $0.00 |
$6,700 |
$400 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $16.00 | $42.00 | $42.00 | 3,551 2017 Formulary |
|
2016 Empire MediBlue Core (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H3370 -033 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2017 Empire MediBlue Core (HMO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2016 Empire MediBlue Plus (HMO)
| $0.00 |
$6,600 |
$245 | Yes, some additional gap coverage. |
H3370 -029 -2 | $4.00 | $10.00 | $42.00 | $42.00 | 3,266
2016 Formulary |
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|
|
|
2017 Empire MediBlue Plus (HMO)
| $0.00 |
$6,700 |
$250 | Yes, some additional gap coverage. | $3.00 | $10.00 | $41.00 | $41.00 | 3,666 2017 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 |
2016 Fidelis Fully Integrated Dual Advantage Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H1916 -001 -0 | $0.00 | $0.00 | | | 2,943
2016 Formulary |
-- |
-- |
-- |
|
2017 Fidelis Fully Integrated Dual Advantage Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | | | 3,043 2017 Formulary |
|
-- This plan not offered in 2016 --
|
H3328 -020 -1 | | | | | |
|
|
|
|
2017 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 | 5,280 2017 Formulary |
|
2016 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. | |
|
|
|
|
2017 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 |
2016 GuildNet Gold Plus FIDA Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0811 -001 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,360
2016 Formulary |
-- |
-- |
-- |
|
2017 GuildNet Gold Plus FIDA Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | 0% | 3,510 2017 Formulary |
|
2016 Healthfirst 65 Plus Plan (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3359 -001 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,020
2016 Formulary |
|
-- |
|
|
2017 Healthfirst 65 Plus Plan (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $40.00 | $40.00 | 3,098 2017 Formulary |
|
2016 Healthfirst AbsoluteCare FIDA Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5441 -001 -0 | $0.00 | $0.00 | $0.00 | | 3,030
2016 Formulary |
-- |
-- |
-- |
|
2017 Healthfirst AbsoluteCare FIDA Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | | 3,142 2017 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 |
2016 Healthfirst Coordinated Benefits Plan (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H3359 -027 -0 | This plan does NOT include Prescription Drug coverage. | |
|
-- |
|
|
2017 Healthfirst Coordinated Benefits Plan (HMO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2016 ICS Community Care Plus FIDA MMP (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H4465 -001 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,221
2016 Formulary |
-- |
-- |
-- |
|
2017 ICS Community Care Plus FIDA MMP (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | 0% | 3,504 2017 Formulary |
|
2016 Liberty Health Advantage Preferred Choice (HMO)
| $0.00 |
$5,500 |
$0 | Yes, some additional gap coverage. |
H3337 -001 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,178
2016 Formulary |
|
-- |
|
|
2017 Liberty Health Advantage Preferred Choice (HMO)
| $0.00 |
$5,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,291 2017 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 |
2016 MetroPlus FIDA (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H9115 -001 -0 | $0.00 | $0.00 | $0.00 | | 3,030
2016 Formulary |
-- |
-- |
-- |
|
2017 MetroPlus FIDA (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | | 3,142 2017 Formulary |
|
2016 North Shore-LIJ FIDA LiveWell (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H3129 -001 -0 | $0.00 | $0.00 | $0.00 | | 3,030
2016 Formulary |
-- |
-- |
-- |
|
2017 North Shore-LIJ FIDA LiveWell (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | | 3,142 2017 Formulary |
|
2016 PHP Care Complete FIDA (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H9869 -001 -0 | 0% | 0% | 0% | | 3,391
2016 Formulary |
new |
new |
new |
|
2017 PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | | 3,173 2017 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 |
2016 RiverSpring FIDA Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H6435 -001 -0 | $0.00 | $0.00 | $0.00 | | 3,494
2016 Formulary |
-- |
-- |
-- |
|
2017 RiverSpring FIDA Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | | tbd |
|
2016 SWH Whole Health FIDA (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H8851 -001 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,298
2016 Formulary |
-- |
-- |
-- |
|
2017 SWH Whole Health FIDA (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | 0% | 3,766 2017 Formulary |
|
2016 UnitedHealthcare MedicareComplete Choice Essential (Regional PPO)
| $0.00 |
$6,700 |
No Rx Coverage |
R5342 -002 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2017 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 |
2016 UnitedHealthcare MedicareComplete Choice Plan 1 (Regional PPO)
| $0.00 |
$6,700 |
$290 | No additional gap coverage, only the Donut Hole Discount |
R5342 -001 -0 | $2.00 | $12.00 | $47.00 | $47.00 | n/a |
|
|
|
|
2017 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 |
|
2016 VillageCareMAX Full Advantage FIDA (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H9345 -001 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,221
2016 Formulary |
-- |
-- |
-- |
|
2017 VillageCareMAX Full Advantage FIDA (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | 0% | 3,504 2017 Formulary |
|
2016 VNSNY CHOICE FIDA Complete (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H8490 -001 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,221
2016 Formulary |
-- |
-- |
-- |
|
2017 VNSNY CHOICE FIDA Complete (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | 0% | 3,504 2017 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 |
2016 WellCare Choice (HMO-POS)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3361 -106 -0 | $4.00 | $15.00 | $47.00 | $47.00 | 2,801
2016 Formulary |
|
|
|
|
2017 WellCare Choice (HMO-POS)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $47.00 | $47.00 | 2,914 2017 Formulary |
|
2016 WellCare Rx (HMO)
| $19.00 |
$6,700 |
$360 | No additional gap coverage, only the Donut Hole Discount |
H3361 -130 -0 | $2.00 | $7.00 | $36.00 | $36.00 | 2,801
2016 Formulary |
|
|
|
|
2017 WellCare Rx (HMO)
| $7.00 |
$6,700 |
$400 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $9.00 | $36.00 | $36.00 | 3,113 2017 Formulary |
|
2016 AARP MedicareComplete Plan 2 (HMO)
| $0.00 |
$6,700 |
$330 | No additional gap coverage, only the Donut Hole Discount |
H3379 -001 -0 | $2.00 | $12.00 | $47.00 | $47.00 | 3,529
2016 Formulary |
|
-- |
|
|
2017 AARP MedicareComplete Plan 2 (HMO)
| $19.00 |
$6,700 |
$330 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $12.00 | $47.00 | $47.00 | 3,683 2017 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 |
2016 Humana Gold Plus H3533-021 (HMO)
| $24.10 |
$6,700 |
$360 | No additional gap coverage, only the Donut Hole Discount |
H3533 -021 -0 | $9.00 | $19.00 | $47.00 | $47.00 | 3,615
2016 Formulary |
|
-- |
|
|
2017 Humana Gold Plus H3533-021 (HMO)
| $24.10 |
$6,700 |
$400 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $18.00 | $47.00 | $47.00 | 3,820 2017 Formulary |
|
2016 WellCare Access (HMO SNP)
| $34.30 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H3361 -109 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 2,801
2016 Formulary |
|
|
|
|
2017 WellCare Access (HMO SNP)
| $26.10 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,113 2017 Formulary |
|
2016 Advantage Value One NY - Dual (HMO SNP)
| $39.70 |
n/a |
$0 | Yes, some additional gap coverage. |
H2773 -018 -0 | $0.00 | $10.00 | $30.00 | $30.00 | 3,969
2016 Formulary |
-- |
-- |
|
|
2017 Advantage Value One NY - Dual (HMO SNP)
| $33.30 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $30.00 | $30.00 | 4,215 2017 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 |
2016 Fidelis Medicaid Advantage Plus (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H3328 -016 -0 | $0.00 | $16.00 | $47.00 | $47.00 | 3,966
2016 Formulary |
|
|
|
|
2017 Fidelis Medicaid Advantage Plus (HMO SNP)
| $33.70 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | $1.00 | $16.00 | $47.00 | $47.00 | 2,999 2017 Formulary |
|
2016 Fidelis Dual Advantage (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H3328 -002 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,966
2016 Formulary |
|
|
|
|
2017 Fidelis Dual Advantage (HMO SNP)
| $34.60 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 2,999 2017 Formulary |
|
2016 Humana Gold Plus SNP-DE H3533-004 (HMO SNP)
| $32.50 |
n/a |
$165 | No additional gap coverage, only the Donut Hole Discount |
H3533 -004 -0 | $0.00 | $19.00 | $47.00 | $47.00 | 3,615
2016 Formulary |
|
-- |
|
|
2017 Humana Gold Plus SNP-DE H3533-004 (HMO SNP)
| $34.60 |
n/a |
$260 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $19.00 | $47.00 | $47.00 | 3,820 2017 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 |
2016 UnitedHealthcare Nursing Home Plan (HMO SNP)
| $39.30 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H3379 -002 -0 | | | | | 3,529
2016 Formulary |
|
-- |
|
|
2017 UnitedHealthcare Nursing Home Plan (HMO SNP)
| $34.80 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,683 2017 Formulary |
|
2016 AARP MedicareComplete Plan 1 (HMO)
| $29.00 |
$5,200 |
$230 | No additional gap coverage, only the Donut Hole Discount |
H3307 -002 -0 | $2.00 | $8.00 | $45.00 | $45.00 | 3,529
2016 Formulary |
|
|
|
|
2017 AARP MedicareComplete Plan 1 (HMO)
| $35.00 |
$6,700 |
$230 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $8.00 | $45.00 | $45.00 | 3,683 2017 Formulary |
|
2016 UnitedHealthcare MedicareComplete Choice Plan 3 (Regional PPO)
| $39.00 |
$5,700 |
$150 | No additional gap coverage, only the Donut Hole Discount |
R5342 -005 -0 | $2.00 | $8.00 | $45.00 | $45.00 | n/a |
|
|
|
|
2017 UnitedHealthcare MedicareComplete Choice Plan 3 (Regional PPO)
| $36.00 |
$5,900 |
$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 |
2016 Healthfirst Increased Benefits Plan (HMO)
| $35.00 |
$6,700 |
$360 | No additional gap coverage, only the Donut Hole Discount |
H3359 -019 -0 | | | | | 3,020
2016 Formulary |
|
-- |
|
|
2017 Healthfirst Increased Benefits Plan (HMO)
| $37.00 |
$6,700 |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,098 2017 Formulary |
|
2016 Affinity Medicare Solutions (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H5991 -002 -0 | $0.00 | $11.00 | $47.00 | $47.00 | 3,020
2016 Formulary |
|
-- |
|
|
2017 Affinity Medicare Solutions (HMO SNP)
| $38.10 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $7.00 | $47.00 | $47.00 | 3,098 2017 Formulary |
|
2016 CenterLight Healthcare Direct Complete Plan (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H5989 -002 -0 | $9.50 | 25% | | | 3,678
2016 Formulary |
|
-- |
|
|
2017 CenterLight Healthcare Direct Complete Plan (HMO SNP)
| $38.10 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | $9.00 | 25% | | | 3,855 2017 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 |
2016 Aetna Medicare Value Plan (HMO)
| $0.00 |
$6,700 |
$160 | No additional gap coverage, only the Donut Hole Discount |
H3312 -060 -0 | $4.00 | $10.00 | $47.00 | $47.00 | 3,417
2016 Formulary |
|
|
|
|
2017 Aetna Medicare Value Plan (HMO)
| $39.00 |
$6,700 |
$350 | Yes, some additional gap coverage. | $2.00 | $5.00 | $47.00 | $47.00 | 3,670 2017 Formulary |
|
2016 Affinity Medicare Ultimate (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H5991 -001 -0 | $0.00 | $6.00 | $47.00 | $47.00 | 3,020
2016 Formulary |
|
-- |
|
|
2017 Affinity Medicare Ultimate (HMO SNP)
| $40.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $47.00 | $47.00 | 3,098 2017 Formulary |
|
2016 Elderplan Advantage For Nursing Home Residents (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H3347 -003 -0 | | | | | 3,250
2016 Formulary |
|
-- |
|
|
2017 Elderplan Advantage For Nursing Home Residents (HMO SNP)
| $40.90 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,098 2017 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 |
2016 Elderplan Extra Help (HMO)
| $39.70 |
$6,700 |
$360 | No additional gap coverage, only the Donut Hole Discount |
H3347 -009 -0 | | | | | 3,250
2016 Formulary |
|
-- |
|
|
2017 Elderplan Extra Help (HMO)
| $40.90 |
$6,700 |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,098 2017 Formulary |
|
2016 Elderplan For Medicaid Beneficiaries (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H3347 -002 -0 | | | | | 3,250
2016 Formulary |
|
-- |
|
|
2017 Elderplan For Medicaid Beneficiaries (HMO SNP)
| $40.90 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,098 2017 Formulary |
|
2016 Elderplan Plus Long Term Care (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H3347 -007 -0 | | | | | 3,250
2016 Formulary |
|
-- |
|
|
2017 Elderplan Plus Long Term Care (HMO SNP)
| $40.90 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,098 2017 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 2016 --
|
H3262 -001 -0 | | | | | |
new |
new |
new |
|
2017 Fresenius Total Health (HMO SNP)
| $40.90 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | $0.00 | 25% | 25% | 25% | 3,203 2017 Formulary |
|
2016 AgeWell New York BeWell (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H4922 -002 -0 | | | | | 3,068
2016 Formulary |
-- |
-- |
-- |
|
2017 AgeWell New York BeWell (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,176 2017 Formulary |
|
2016 AgeWell New York CareWell (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H4922 -004 -0 | | | | | 3,068
2016 Formulary |
-- |
-- |
-- |
|
2017 AgeWell New York CareWell (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,176 2017 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 |
2016 AgeWell New York FeelWell (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H4922 -003 -0 | | | | | 3,068
2016 Formulary |
-- |
-- |
-- |
|
2017 AgeWell New York FeelWell (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,176 2017 Formulary |
|
2016 ArchCare Advantage (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H1777 -007 -0 | | | | | 2,933
2016 Formulary |
|
-- |
|
|
2017 ArchCare Advantage (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 2,999 2017 Formulary |
|
2016 Centers Plan for Dual Coverage Care (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H6988 -002 -0 | | | | | 3,222
2016 Formulary |
-- |
-- |
|
|
2017 Centers Plan for Dual Coverage Care (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,504 2017 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 |
2016 Centers Plan for Nursing Home Care (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H6988 -003 -0 | | | | | 3,222
2016 Formulary |
-- |
-- |
|
|
2017 Centers Plan for Nursing Home Care (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,504 2017 Formulary |
|
-- This plan not offered in 2016 --
|
H3330 -037 -0 | | | | | |
|
|
|
|
2017 EmblemHealth VIP Dual (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,551 2017 Formulary |
|
2016 EmblemHealth Essential (HMO)
| $32.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3330 -032 -2 | $0.00 | $15.00 | $47.00 | $47.00 | 3,376
2016 Formulary |
|
|
|
|
2017 EmblemHealth VIP Essential (HMO)
| $41.00 |
$6,700 |
$400 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $16.00 | $42.00 | $42.00 | 3,551 2017 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 |
2016 Empire MediBlue Dual Advantage (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H3370 -028 -0 | $0.00 | $4.00 | $45.00 | $45.00 | 3,266
2016 Formulary |
|
|
|
|
2017 Empire MediBlue Dual Advantage (HMO SNP)
| $41.00 |
n/a |
$400 | Yes, some additional gap coverage. | $0.00 | $20.00 | $47.00 | $47.00 | 3,666 2017 Formulary |
|
2016 Fidelis Dual Advantage Flex (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H3328 -017 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,966
2016 Formulary |
|
|
|
|
2017 Fidelis Dual Advantage Flex (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 2,999 2017 Formulary |
|
2016 Fidelis Medicare Advantage Flex (HMO-POS)
| $39.70 |
$6,700 |
$250 | No additional gap coverage, only the Donut Hole Discount |
H3328 -003 -0 | $0.00 | $15.00 | $35.00 | $35.00 | 3,966
2016 Formulary |
|
|
|
|
2017 Fidelis Medicare Advantage Flex (HMO-POS)
| $41.00 |
$6,700 |
$250 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $35.00 | $35.00 | 5,280 2017 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 |
2016 GuildNet Gold (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H6864 -001 -0 | $1.00 | $10.00 | 25% | 25% | 3,376
2016 Formulary |
-- |
-- |
|
|
2017 GuildNet Gold (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | $1.00 | $6.00 | 25% | 25% | 3,551 2017 Formulary |
|
2016 Healthfirst AssuredCare (HMO SNP)
| $30.80 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H3359 -035 -0 | | | | | 3,020
2016 Formulary |
|
-- |
|
|
2017 Healthfirst AssuredCare (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,098 2017 Formulary |
|
2016 Healthfirst CompleteCare (HMO SNP)
| $39.00 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H3359 -034 -0 | | | | | 3,020
2016 Formulary |
|
-- |
|
|
2017 Healthfirst CompleteCare (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,098 2017 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 |
2016 Healthfirst Life Improvement Plan (HMO SNP)
| $39.00 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H3359 -021 -0 | | | | | 3,020
2016 Formulary |
|
-- |
|
|
2017 Healthfirst Life Improvement Plan (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,098 2017 Formulary |
|
2016 Liberty Health Advantage Dual Power (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H3337 -003 -0 | | | | | 3,178
2016 Formulary |
|
-- |
|
|
2017 Liberty Health Advantage Dual Power (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,291 2017 Formulary |
|
2016 MetroPlus Advantage Plan (HMO SNP)
| $38.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H0423 -001 -0 | | | | | 3,020
2016 Formulary |
|
|
|
|
2017 MetroPlus Advantage Plan (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,098 2017 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 |
2016 RiverSpring Star (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H6776 -001 -0 | | | | | 3,586
2016 Formulary |
new |
new |
new |
|
2017 RiverSpring Star (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | tbd |
|
2016 Senior Whole Health of New York NHC (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H5992 -007 -0 | | | | | 3,298
2016 Formulary |
|
-- |
|
|
2017 Senior Whole Health of New York NHC (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,766 2017 Formulary |
|
2016 UnitedHealthcare Dual Complete (HMO SNP)
| $35.90 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H3387 -010 -0 | | | | | 3,529
2016 Formulary |
|
-- |
|
|
2017 UnitedHealthcare Dual Complete (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,683 2017 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 2016 --
|
H2168 -001 -0 | | | | | |
new |
new |
new |
|
2017 VillageCareMAX Medicare Health Advantage (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,504 2017 Formulary |
|
-- This plan not offered in 2016 --
|
H2168 -002 -0 | | | | | |
new |
new |
new |
|
2017 VillageCareMAX Medicare Total Advantage (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,504 2017 Formulary |
|
2016 VNSNY CHOICE Medicare Classic (HMO)
| $39.70 |
$6,700 |
$360 | No additional gap coverage, only the Donut Hole Discount |
H5549 -008 -0 | | | | | 3,446
2016 Formulary |
|
|
|
|
2017 VNSNY CHOICE Medicare Classic (HMO)
| $41.00 |
$6,700 |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,740 2017 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 |
2016 VNSNY CHOICE Medicare Preferred (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H5549 -002 -0 | | | | | 3,446
2016 Formulary |
|
|
|
|
2017 VNSNY CHOICE Medicare Preferred (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,740 2017 Formulary |
|
2016 VNSNY CHOICE Total (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H5549 -003 -0 | | | | | 3,446
2016 Formulary |
|
|
|
|
2017 VNSNY CHOICE Total (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,740 2017 Formulary |
|
2016 Affinity Medicare Passport Select (HMO)
| $41.00 |
$5,400 |
$0 | Yes, some additional gap coverage. |
H5991 -004 -0 | $0.00 | $8.00 | $42.00 | $42.00 | 3,020
2016 Formulary |
|
-- |
|
|
2017 Affinity Medicare Passport Select (HMO)
| $45.00 |
$5,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $42.00 | $42.00 | 3,098 2017 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 2016 --
|
H3361 -135 -0 | | | | | |
|
|
|
|
2017 WellCare Preferred (HMO-POS)
| $45.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $47.00 | $47.00 | 2,914 2017 Formulary |
|
2016 AARP MedicareComplete Plan 3 (HMO)
| $69.00 |
$2,800 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3307 -024 -0 | $2.00 | $8.00 | $45.00 | $45.00 | 3,529
2016 Formulary |
|
|
|
|
2017 AARP MedicareComplete Plan 3 (HMO)
| $66.00 |
$2,800 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $8.00 | $45.00 | $45.00 | 3,683 2017 Formulary |
|
2016 UnitedHealthcare MedicareComplete Choice Plan 4 (Regional PPO)
| $69.00 |
$4,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
R5342 -006 -0 | $2.00 | $8.00 | $45.00 | $45.00 | n/a |
|
|
|
|
2017 UnitedHealthcare MedicareComplete Choice Plan 4 (Regional PPO)
| $66.00 |
$5,400 |
$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 |
2016 EmblemHealth VIP (HMO)
| $103.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3330 -021 -2 | $0.00 | $15.00 | $47.00 | $47.00 | 3,376
2016 Formulary |
|
|
|
|
2017 EmblemHealth VIP Gold (HMO)
| $98.00 |
$6,700 |
$330 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $40.00 | $40.00 | 3,551 2017 Formulary |
|
2016 Aetna Medicare Standard Plan (PPO)
| $96.00 |
$6,700 |
$150 | No additional gap coverage, only the Donut Hole Discount |
H5521 -040 -0 | $1.00 | $9.00 | $40.00 | $40.00 | 3,417
2016 Formulary |
|
|
|
|
2017 Aetna Medicare Standard Plan (PPO)
| $99.00 |
$6,700 |
$250 | Yes, some additional gap coverage. | $2.00 | $5.00 | $47.00 | $47.00 | 3,670 2017 Formulary |
|
2016 VNSNY CHOICE Medicare Maximum (HMO SNP)
| $115.80 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H5549 -006 -0 | | | | | 3,446
2016 Formulary |
|
|
|
|
2017 VNSNY CHOICE Medicare Maximum (HMO SNP)
| $109.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,740 2017 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 |
2016 MetroPlus Platinum (HMO)
| $184.30 |
$6,700 |
$360 | No additional gap coverage, only the Donut Hole Discount |
H0423 -004 -0 | | | | | 3,020
2016 Formulary |
|
|
|
|
2017 MetroPlus Platinum (HMO)
| $226.20 |
$6,700 |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,098 2017 Formulary |
|
2016 EmblemHealth VIP High Option (HMO)
| $306.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3330 -033 -2 | $0.00 | $15.00 | $47.00 | $47.00 | 3,376
2016 Formulary |
|
|
|
|
2017 EmblemHealth VIP Gold Plus (HMO)
| $295.00 |
$6,700 |
$330 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $40.00 | $40.00 | 3,551 2017 Formulary |
|
2016 AgeWell New York LiveWell (HMO)
| $0.00 |
$6,700 |
$275 | Yes, some additional gap coverage. |
H4922 -001 -0 | $5.00 | $15.00 | $45.00 | $45.00 | 3,068
2016 Formulary |
-- |
-- |
-- |
|
-- Members will be assigned to AgeWell New York LiveWell (HMO) H4922-005 --
| | | | | |
|
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 |
2016 EmblemHealth Dual Eligible (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H3330 -029 -0 | $2.00 | $9.00 | 25% | 25% | 3,376
2016 Formulary |
|
|
|
|
-- Members will be assigned to EmblemHealth VIP Dual (HMO SNP) H3330-037 --
| | | | | |
|
2016 Fidelis Medicare $0 Premium (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3328 -019 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,966
2016 Formulary |
|
|
|
|
-- Members will be assigned to Fidelis Medicare $0 Premium (HMO) H3328-020 --
| | | | | |
|
2016 Humana Gold Plus H3533-005 (HMO)
| $0.00 |
$6,700 |
$360 | Yes, some additional gap coverage. |
H3533 -005 -0 | $8.00 | $18.00 | $47.00 | $47.00 | 3,615
2016 Formulary |
|
-- |
|
|
-- Members will be assigned to Humana Gold Plus H3533-021 (HMO) H3533-021 --
| | | | | |
|
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 |
2016 Access Medicare Platinum (HMO)
| $39.70 |
$6,700 |
$360 | No additional gap coverage, only the Donut Hole Discount |
H4866 -002 -0 | | | | | 3,446
2016 Formulary |
|
|
|
|
-- This plan not offered in 2017 --
|
| | | | |
|
2016 EmblemHealth PPO I (PPO)
| $50.00 |
$6,700 |
No Rx Coverage |
H5528 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
-- This plan not offered in 2017 --
|
| | | | |
|
2016 Touchstone Health Medicare Power (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3327 -001 -0 | $3.00 | $20.00 | $47.00 | $47.00 | 3,178
2016 Formulary |
|
|
|
|
-- This plan not offered in 2017 --
|
| | | | |
|
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 |
2016 Touchstone Health Medicare Total (HMO)
| $39.70 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3327 -002 -0 | $3.00 | $15.00 | $47.00 | $47.00 | 3,178
2016 Formulary |
|
|
|
|
-- This plan not offered in 2017 --
|
| | | | |
|
2016 VNSNY CHOICE Medicare Enhanced (HMO)
| $0.00 |
$6,700 |
$360 | No additional gap coverage, only the Donut Hole Discount |
H5549 -004 -0 | $0.00 | $9.00 | $45.00 | $45.00 | 3,446
2016 Formulary |
|
|
|
|
-- This plan not offered in 2017 --
|
| | | | |
|
2016 EmblemHealth Dual Eligible (PPO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H5528 -018 -0 | $2.00 | $9.00 | 25% | 25% | 3,376
2016 Formulary |
|
|
|
|
-- This plan not offered in 2017 --
|
| | | | |
|
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 |
2016 Touchstone Health Medicare Prestige (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H3327 -026 -0 | | | | | 3,178
2016 Formulary |
|
|
|
|
-- This plan not offered in 2017 --
|
| | | | |
|
2016 Access Medicare Gold (HMO)
| $10.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H4866 -003 -0 | $4.00 | $8.00 | $35.00 | $35.00 | 3,446
2016 Formulary |
|
|
|
|
-- This plan not offered in 2017 --
|
| | | | |
|
2016 Easy Choice Rewards (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H9285 -001 -0 | $0.00 | $45.00 | $95.00 | $95.00 | 2,955
2016 Formulary |
|
|
|
|
-- This plan not offered in 2017 --
|
| | | | |
|
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 |
2016 Access Medicare Pearl (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H4866 -005 -0 | | | | | 3,446
2016 Formulary |
|
|
|
|
-- This plan not offered in 2017 --
|
| | | | |
|
2016 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 | $90.00 | $90.00 | 2,955
2016 Formulary |
|
|
|
|
-- This plan not offered in 2017 --
|
| | | | |
|
2016 Advantage Platinum Plus NY (HMO)
| $85.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H2773 -015 -0 | $0.00 | $10.00 | $20.00 | $20.00 | 3,969
2016 Formulary |
-- |
-- |
|
|
-- This plan not offered in 2017 --
|
| | | | |
|
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 |
2016 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 | $33.00 | $45.00 | $45.00 | 3,298
2016 Formulary |
|
|
|
|
-- This plan not offered in 2017 --
|
| | | | |
|
2016 AlphaCare Renew (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H9122 -001 -0 | $0.00 | $20.00 | $40.00 | $40.00 | 3,969
2016 Formulary |
|
|
|
|
-- This plan not offered in 2017 --
|
| | | | |
|
2016 AlphaCare Resilience (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H9122 -002 -0 | | | | | 3,969
2016 Formulary |
|
|
|
|
-- This plan not offered in 2017 --
|
| | | | |
|
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 |
2016 AlphaCare Total (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H9122 -003 -0 | | | | | 3,969
2016 Formulary |
|
|
|
|
-- This plan not offered in 2017 --
|
| | | | |
|
2016 Amida Care Live Life Advantage (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H6745 -003 -0 | $0.00 | $20.00 | 25% | 25% | 3,611
2016 Formulary |
|
|
|
|
-- This plan not offered in 2017 --
|
| | | | |
|
2016 Amida Care True Life Advantage (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H6745 -002 -0 | | | | | 3,611
2016 Formulary |
|
|
|
|
-- This plan not offered in 2017 --
|
| | | | |
|
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 |
2016 Touchstone Health Medicare Grand (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H3327 -043 -0 | | | | | 3,178
2016 Formulary |
|
|
|
|
-- This plan not offered in 2017 --
|
| | | | |
|
2016 Aetna Medicare Connect Plus (PPO)
| $188.00 |
$4,500 |
$0 | Yes, some additional gap coverage. |
H5521 -052 -0 | $0.00 | $7.00 | $47.00 | $47.00 | 3,417
2016 Formulary |
|
|
|
|
-- This plan not offered in 2017 --
|
| | | | |
|
2016 EmblemHealth Advantage (PPO)
| $223.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5528 -025 -0 | $0.00 | $15.00 | $47.00 | $47.00 | 3,376
2016 Formulary |
|
|
|
|
-- This plan not offered in 2017 --
|
| | | | |
|
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 |
2016 Elderplan Diabetes Care (HMO SNP)
| $0.00 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H3347 -012 -0 | $5.00 | $15.00 | $47.00 | $47.00 | 3,250
2016 Formulary |
|
-- |
|
|
-- This plan not offered in 2017 --
|
| | | | |
|
2016 WellCare Advocate Complete FIDA (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H2751 -002 -0 | $0.00 | $0.00 | $0.00 | | 3,030
2016 Formulary |
|
|
|
|
-- This plan not offered in 2017 --
|
| | | | |
|
2016 AlphaCare Signature FIDA Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H6974 -001 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,969
2016 Formulary |
|
|
|
|
-- This plan not offered in 2017 --
|
| | | | |
|
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 |
2016 Empire BlueCross BlueShield HealthPlus FIDA Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H8417 -001 -0 | $0.00 | $0.00 | $0.00 | $0.00 | n/a |
|
|
|
|
-- This plan not offered in 2017 --
|
| | | | |
|
2016 CenterLight Healthcare FIDA Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H8420 -001 -0 | $0.00 | $0.00 | | | 3,678
2016 Formulary |
|
|
|
|
-- This plan not offered in 2017 --
|
| | | | |
|
2016 Access Medicare Pearl Advantage (HMO SNP)
| $39.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H4866 -008 -0 | | | | | 3,446
2016 Formulary |
|
|
|
|
-- This plan not offered in 2017 --
|
| | | | |
|
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 |
2016 Access Medicare Platinum Advantage (HMO)
| $39.70 |
$6,700 |
$360 | No additional gap coverage, only the Donut Hole Discount |
H4866 -007 -0 | | | | | 3,446
2016 Formulary |
|
|
|
|
-- This plan not offered in 2017 --
|
| | | | |
|
2016 VNSNY CHOICE Medicare Ultra (HMO-POS)
| $96.40 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5549 -009 -0 | $0.00 | $9.00 | $45.00 | $45.00 | 3,446
2016 Formulary |
|
|
|
|
-- This plan not offered in 2017 --
|
| | | | |
|