There are 53 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 SmartFund (MSA)
| $0.00 |
n/a |
No Rx Coverage |
H5613 -002 -0 | This plan does NOT include Prescription Drug coverage. | |
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|
2017 SmartFund (MSA)
| $0.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2016 BasiCare with Part D (PPO)
| $29.90 |
$4,000 |
$360 | No additional gap coverage, only the Donut Hole Discount |
H9615 -008 -0 | $3.00 | $15.00 | $45.00 | $45.00 | 3,672
2016 Formulary |
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|
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2017 BasiCare with Part D (PPO)
| $0.00 |
$6,700 |
$400 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $10.00 | $47.00 | $47.00 | 3,760 2017 Formulary |
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-- This plan not offered in 2016 --
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H3328 -020 -1 | | | | | |
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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 |
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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 Medicare Advantage without Rx (HMO-POS)
| $0.00 |
$6,700 |
No Rx Coverage |
H3328 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
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|
|
2017 Fidelis Medicare Advantage without Rx (HMO-POS)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2016 Humana Gold Plus H3533-006 (HMO)
| $0.00 |
$6,700 |
$360 | Yes, some additional gap coverage. |
H3533 -006 -0 | $6.00 | $18.00 | $47.00 | $47.00 | 3,615
2016 Formulary |
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-- |
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2017 Humana Gold Plus H3533-006 (HMO)
| $0.00 |
$6,700 |
$400 | Yes, some additional gap coverage. | $8.00 | $20.00 | $47.00 | $47.00 | 3,820 2017 Formulary |
|
2016 Today's Options Premier 200 (PFFS)
| $0.00 |
n/a |
No Rx Coverage |
H2816 -007 -0 | This plan does NOT include Prescription Drug coverage. | |
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|
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2017 Today's Options Premier 300 (PFFS)
| $0.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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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 Essential (Regional PPO)
| $0.00 |
$6,700 |
No Rx Coverage |
R5342 -002 -0 | This plan does NOT include Prescription Drug coverage. | |
|
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|
|
2017 UnitedHealthcare MedicareComplete Choice Essential (Regional PPO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
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 |
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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 |
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2016 WellCare Advance (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H3361 -059 -0 | This plan does NOT include Prescription Drug coverage. | |
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2017 WellCare Advance (HMO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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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 -134 -0 | | | | | |
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2017 WellCare Essential (HMO)
| $0.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $47.00 | $47.00 | 2,914 2017 Formulary |
|
2016 WellCare Value (HMO)
| $0.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3361 -099 -0 | $3.00 | $15.00 | $47.00 | $47.00 | 2,801
2016 Formulary |
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|
|
|
2017 WellCare Value (HMO)
| $0.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $15.00 | $47.00 | $47.00 | 2,914 2017 Formulary |
|
2016 WellCare Liberty (HMO SNP)
| $24.60 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H3361 -043 -0 | $0.00 | $15.00 | $47.00 | $47.00 | 2,801
2016 Formulary |
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2017 WellCare Liberty (HMO SNP)
| $15.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $45.00 | $45.00 | 3,113 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 Access (HMO SNP)
| $21.80 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H3361 -065 -0 | $0.00 | $10.00 | $46.00 | $46.00 | 2,801
2016 Formulary |
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2017 WellCare Access (HMO SNP)
| $15.30 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $44.00 | $44.00 | 3,113 2017 Formulary |
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2016 Humana Gold Plus SNP-DE H3533-002 (HMO SNP)
| $30.90 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H3533 -002 -0 | $0.00 | $15.00 | $30.00 | $30.00 | 3,615
2016 Formulary |
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-- |
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2017 Humana Gold Plus SNP-DE H3533-002 (HMO SNP)
| $25.80 |
n/a |
$250 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,820 2017 Formulary |
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-- This plan not offered in 2016 --
|
H5521 -119 -0 | | | | | |
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2017 Aetna Medicare Elite Plan (PPO)
| $29.00 |
$6,700 |
$150 | 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 |
-- This plan not offered in 2016 --
|
H3312 -062 -0 | | | | | |
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|
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2017 Aetna Medicare Value Plan (HMO)
| $29.00 |
$6,700 |
$200 | Yes, some additional gap coverage. | $2.00 | $5.00 | $47.00 | $47.00 | 3,670 2017 Formulary |
|
2016 Humana Gold Plus H3533-013 (HMO)
| $23.10 |
$6,700 |
$360 | No additional gap coverage, only the Donut Hole Discount |
H3533 -013 -0 | $9.00 | $19.00 | $47.00 | $47.00 | 3,615
2016 Formulary |
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-- |
|
|
2017 Humana Gold Plus H3533-013 (HMO)
| $29.00 |
$6,700 |
$360 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $14.00 | $47.00 | $47.00 | 3,820 2017 Formulary |
|
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 |
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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 |
|
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 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 |
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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 CDPHP Basic RX (HMO)
| $39.50 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3388 -013 -0 | $2.00 | $15.00 | $45.00 | $45.00 | 3,035
2016 Formulary |
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2017 CDPHP Basic RX (HMO)
| $36.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $15.00 | $47.00 | $47.00 | 3,125 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 |
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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 UnitedHealthcare Nursing Home Plan (HMO SNP)
| $37.60 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H3379 -022 -0 | | | | | 3,529
2016 Formulary |
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-- |
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|
2017 UnitedHealthcare Nursing Home Plan (HMO SNP)
| $37.60 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,683 2017 Formulary |
|
2016 Today's Options Advantage Plus 450B (PPO)
| $39.70 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2775 -088 -0 | $2.00 | $7.00 | $37.00 | $37.00 | 3,020
2016 Formulary |
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|
|
2017 Today's Options Advantage Plus 550B (PPO)
| $39.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $7.00 | $37.00 | $37.00 | 3,123 2017 Formulary |
|
2016 Today's Options Premier Plus 450B (PFFS)
| $39.70 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2816 -019 -0 | $2.00 | $7.00 | $37.00 | $37.00 | 3,020
2016 Formulary |
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|
|
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2017 Today's Options Premier Plus 650B (PFFS)
| $39.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $7.00 | $37.00 | $37.00 | 3,123 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 BlueShield Senior Blue 650 Part D (HMO-POS)
| $39.70 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3384 -059 -0 | $10.00 | $15.00 | $42.00 | $42.00 | 3,607
2016 Formulary |
|
|
|
|
2017 BlueShield Senior Blue 650 Part D (HMO-POS)
| $41.00 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $15.00 | $42.00 | $42.00 | 3,773 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 |
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|
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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 |
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|
|
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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 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 |
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|
2017 VNSNY CHOICE Medicare Classic (HMO)
| $41.00 |
$6,700 |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,740 2017 Formulary |
|
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 |
|
-- This plan not offered in 2016 --
|
H3305 -020 -0 | | | | | |
|
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|
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2017 Preferred Gold without Part D (HMO-POS)
| $42.20 |
$5,500 |
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 CDPHP Choice (HMO)
| $45.00 |
$4,000 |
No Rx Coverage |
H3388 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2017 CDPHP Choice (HMO)
| $45.00 |
$4,800 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2016 Aetna Medicare Premier Plan (PPO)
| $34.00 |
$6,700 |
$250 | No additional gap coverage, only the Donut Hole Discount |
H5521 -112 -0 | $2.00 | $8.00 | $47.00 | $47.00 | 3,417
2016 Formulary |
|
|
|
|
2017 Aetna Medicare Premier Plan (PPO)
| $49.00 |
$6,700 |
$100 | Yes, some additional gap coverage. | $2.00 | $5.00 | $47.00 | $47.00 | 3,670 2017 Formulary |
|
2016 Today's Options Premier 100 (PFFS)
| $25.00 |
n/a |
No Rx Coverage |
H2816 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2017 Today's Options Premier 200 (PFFS)
| $53.00 |
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 |
2016 CDPHP Value Rx (HMO)
| $59.50 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3388 -004 -0 | $2.00 | $12.00 | $45.00 | $45.00 | 3,035
2016 Formulary |
|
|
|
|
2017 CDPHP Value Rx (HMO)
| $60.00 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $13.00 | $45.00 | $45.00 | 3,125 2017 Formulary |
|
2016 HumanaChoice H5970-008 (PPO)
| $61.00 |
$6,700 |
$360 | Yes, some additional gap coverage. |
H5970 -008 -0 | $8.00 | $18.00 | $47.00 | $47.00 | 3,615
2016 Formulary |
|
|
|
|
2017 HumanaChoice H5970-008 (PPO)
| $65.00 |
$6,700 |
$175 | Yes, some additional gap coverage. | $8.00 | $18.00 | $47.00 | $47.00 | 3,820 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 Forever Blue Medicare PPO Value (PPO)
| $75.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5526 -017 -0 | $7.00 | $15.00 | $42.00 | $42.00 | 3,607
2016 Formulary |
|
|
|
|
2017 Forever Blue Medicare PPO Value (PPO)
| $79.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $15.00 | $42.00 | $42.00 | 3,773 2017 Formulary |
|
2016 Today's Options Advantage Plus 150A (PPO)
| $89.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2775 -082 -0 | $0.00 | $5.00 | $35.00 | $35.00 | 3,020
2016 Formulary |
|
|
|
|
2017 Today's Options Advantage Plus 150A (PPO)
| $97.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $35.00 | $35.00 | 3,123 2017 Formulary |
|
-- This plan not offered in 2016 --
|
H3305 -022 -0 | | | | | |
|
|
|
|
2017 GoldValue with Part D (HMO-POS)
| $98.80 |
$6,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $15.00 | $45.00 | $45.00 | 3,760 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 Today's Options Premier Plus 150A (PFFS)
| $95.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2816 -013 -0 | $0.00 | $5.00 | $35.00 | $35.00 | 3,020
2016 Formulary |
|
|
|
|
2017 Today's Options Premier Plus 250A (PFFS)
| $106.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $35.00 | $35.00 | 3,123 2017 Formulary |
|
2016 CDPHP Choice Rx (HMO)
| $113.50 |
$4,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3388 -002 -0 | $0.00 | $11.00 | $45.00 | $45.00 | 3,035
2016 Formulary |
|
|
|
|
2017 CDPHP Choice Rx (HMO)
| $124.00 |
$4,800 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $11.00 | $42.00 | $42.00 | 3,125 2017 Formulary |
|
2016 BlueShield Senior Blue HMO 652 PartD (HMO)
| $140.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3384 -013 -0 | $5.00 | $15.00 | $42.00 | $42.00 | 3,607
2016 Formulary |
|
|
|
|
2017 BlueShield Senior Blue HMO 652 PartD (HMO)
| $139.00 |
$5,000 |
$0 | Yes, some additional gap coverage. | $5.00 | $15.00 | $42.00 | $42.00 | 3,773 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 Gold PPO with Part D (PPO)
| $151.00 |
$4,000 |
$0 | Yes, some additional gap coverage. |
H9615 -007 -0 | $0.00 | $10.00 | $35.00 | $35.00 | 3,672
2016 Formulary |
|
|
|
|
2017 Gold PPO with Part D (PPO)
| $150.70 |
$6,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $35.00 | $35.00 | 3,760 2017 Formulary |
|
-- This plan not offered in 2016 --
|
H3305 -021 -0 | | | | | |
|
|
|
|
2017 Preferred Gold with Part D (HMO-POS)
| $166.80 |
$4,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $35.00 | $35.00 | 3,760 2017 Formulary |
|
-- This plan not offered in 2016 --
|
H5526 -018 -0 | | | | | |
|
|
|
|
2017 Forever Blue Medicare PPO 770 (PPO)
| $184.00 |
$4,000 |
$0 | Yes, some additional gap coverage. | $5.00 | $15.00 | $35.00 | $35.00 | 3,773 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 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 GoldValue with Part D (HMO-POS)
| $98.70 |
$6,000 |
$0 | Yes, some additional gap coverage. |
H9859 -013 -0 | $0.00 | $10.00 | $35.00 | $35.00 | 3,672
2016 Formulary |
|
|
|
|
-- Members will be assigned to GoldValue with Part D (HMO-POS) H3305-022 --
| | | | | |
|
2016 Preferred Gold with Part D (HMO-POS)
| $166.70 |
$4,500 |
$0 | Yes, some additional gap coverage. |
H9859 -002 -0 | $0.00 | $10.00 | $35.00 | $35.00 | 3,672
2016 Formulary |
|
|
|
|
-- Members will be assigned to Preferred Gold with Part D (HMO-POS) H3305-021 --
| | | | | |
|
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 Preferred Gold without Part D (HMO-POS)
| $31.50 |
$4,500 |
No Rx Coverage |
H9859 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
-- Members will be assigned to Preferred Gold without Part D (HMO-POS) H3305-020 --
| | | | | |
|
2016 BlueShield Forever Blue Medicare PPO 750 (PPO)
| $242.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5526 -014 -0 | $5.00 | $15.00 | $42.00 | $42.00 | 3,607
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 --
|
| | | | |
|
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 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 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 --
|
| | | | |
|