There are 99 Medicare Advantage plans meeting your criteria.
2017 / 2018 Medicare Advantage Plan Information
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Plan Name |
Monthly Premium |
Part A&B Maximum Out-Of Pocket |
Part D Deduct- ible |
(Donut Hole) Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Formulary Drugs |
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2017 AARP MedicareComplete Essential (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H3307 -018 -0 | This plan does NOT include Prescription Drug coverage. | |
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|
|
|
2018 AARP MedicareComplete Essential (HMO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2017 AARP MedicareComplete Mosaic (HMO)
| $0.00 |
$5,700 |
$245 | No additional gap coverage, only the Donut Hole Discount |
H3307 -015 -0 | $3.00 | $13.00 | $43.00 | $43.00 | 3,683
2017 Formulary |
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2018 AARP MedicareComplete Mosaic (HMO)
| $0.00 |
$6,200 |
$295 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $47.00 | $47.00 | 3,779 2018 Formulary |
|
2017 Aetna Medicare Elite Plan (PPO)
| $0.00 |
$6,700 |
$250 | Yes, some additional gap coverage. |
H5521 -120 -0 | $2.00 | $5.00 | $47.00 | $47.00 | 3,670
2017 Formulary |
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2018 Aetna Medicare Elite Plan (PPO)
| $0.00 |
$6,700 |
$250 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 5,223 2018 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 2017 --
|
H3312 -063 -0 | | | | | |
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|
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2018 Aetna Medicare Select Plan (HMO)
| $0.00 |
$6,700 |
$200 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 5,223 2018 Formulary |
|
2017 Affinity Medicare Passport Essentials NYC (HMO)
| $0.00 |
$6,700 |
$300 | Yes, some additional gap coverage. |
H5991 -006 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,098
2017 Formulary |
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2018 Affinity Medicare Passport Essentials NYC (HMO)
| $0.00 |
$5,700 |
$250 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,114 2018 Formulary |
|
2017 AgeWell New York FIDA Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H6308 -001 -0 | 0% | 0% | 0% | | 3,176
2017 Formulary |
-- |
-- |
-- |
|
2018 AgeWell New York FIDA Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | | 3,496 2018 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 |
2017 AgeWell New York LiveWell (HMO)
| $0.00 |
$6,700 |
$370 | No additional gap coverage, only the Donut Hole Discount |
H4922 -005 -1 | $5.00 | $20.00 | $47.00 | $47.00 | 3,176
2017 Formulary |
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2018 AgeWell New York LiveWell (HMO)
| $0.00 |
$6,700 |
$225 | Yes, some additional gap coverage. | $5.00 | $15.00 | $47.00 | $47.00 | 3,496 2018 Formulary |
|
2017 Centers Plan for FIDA Care Complete (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H3018 -001 -0 | 0% | 0% | 0% | 0% | 3,504
2017 Formulary |
-- |
-- |
-- |
|
2018 Centers Plan for FIDA Care Complete (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | 0% | 3,535 2018 Formulary |
|
2017 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 | 3,504
2017 Formulary |
-- |
-- |
|
|
2018 Centers Plan for Medicare Advantage Care (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $35.00 | $85.00 | $85.00 | 3,535 2018 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 |
2017 Elderplan FIDA Total Care (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H8029 -001 -0 | 0% | 0% | 0% | | 3,142
2017 Formulary |
-- |
-- |
-- |
|
2018 Elderplan FIDA Total Care (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | | 3,153 2018 Formulary |
|
2017 EmblemHealth VIP Essential (HMO)
| $-9.00 |
n/a |
$400 | n/a |
H3330 -032 -1 | $0.00 | $16.00 | $42.00 | $42.00 | 3,551
2017 Formulary |
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2018 EmblemHealth VIP Essential (HMO)
| $0.00 |
$6,700 |
$250 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $16.00 | $42.00 | $42.00 | 3,518 2018 Formulary |
|
2017 EmblemHealth VIP Value (HMO)
| $0.00 |
$6,700 |
$400 | No additional gap coverage, only the Donut Hole Discount |
H3330 -036 -0 | $0.00 | $16.00 | $42.00 | $42.00 | 3,551
2017 Formulary |
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2018 EmblemHealth VIP Value (HMO)
| $0.00 |
$6,700 |
$250 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $16.00 | $42.00 | $42.00 | 3,518 2018 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 2017 --
|
H8432 -013 -0 | | | | | |
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2018 Empire MediBlue Plus (HMO)
| $0.00 |
$6,700 |
$350 | Yes, some additional gap coverage. | $4.00 | $15.00 | $42.00 | $42.00 | 3,752 2018 Formulary |
|
2017 Fidelis Medicare $0 Premium (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3328 -020 -1 | $0.00 | $20.00 | $47.00 | $47.00 | 5,280
2017 Formulary |
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2018 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 | 4,081 2018 Formulary |
|
2017 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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2018 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 |
2017 GuildNet Gold Plus FIDA Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0811 -001 -0 | 0% | 0% | 0% | 0% | 3,510
2017 Formulary |
-- |
-- |
-- |
|
2018 GuildNet Gold Plus FIDA Plan POS (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | 0% | 3,505 2018 Formulary |
|
2017 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 | $40.00 | $40.00 | 3,098
2017 Formulary |
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2018 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 | 3,112 2018 Formulary |
|
2017 Healthfirst AbsoluteCare FIDA Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5441 -001 -0 | 0% | 0% | 0% | | 3,142
2017 Formulary |
-- |
-- |
-- |
|
2018 Healthfirst AbsoluteCare FIDA Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | | 3,153 2018 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 |
2017 Healthfirst Coordinated Benefits Plan (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H3359 -027 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2018 Healthfirst Coordinated Benefits Plan (HMO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2017 --
|
H3533 -027 -0 | | | | | |
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2018 Humana Gold Plus H3533-027 (HMO)
| $0.00 |
$6,700 |
$400 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $16.00 | $47.00 | $47.00 | 3,192 2018 Formulary |
|
2017 MetroPlus FIDA (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H9115 -001 -0 | 0% | 0% | 0% | | 3,142
2017 Formulary |
-- |
-- |
-- |
|
2018 MetroPlus FIDA (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | | 3,153 2018 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 |
2017 PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H9869 -001 -0 | 0% | 0% | 0% | | 3,173
2017 Formulary |
new |
new |
new |
|
2018 PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | | 3,358 2018 Formulary |
|
2017 RiverSpring FIDA Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H6435 -001 -0 | 0% | 0% | 0% | | n/a |
-- |
-- |
-- |
|
2018 RiverSpring FIDA Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | | 3,881 2018 Formulary |
|
2017 SWH Whole Health FIDA (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H8851 -001 -0 | 0% | 0% | 0% | 0% | 3,766
2017 Formulary |
-- |
-- |
-- |
|
2018 SWH Whole Health FIDA (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | 0% | 3,863 2018 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 |
2017 UnitedHealthcare MedicareComplete Choice Essential (Regional PPO)
| $0.00 |
$6,700 |
No Rx Coverage |
R5342 -002 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2018 UnitedHealthcare MedicareComplete Choice Essential (Regional PPO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2017 VillageCareMAX Full Advantage FIDA (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H9345 -001 -0 | 0% | 0% | 0% | 0% | 3,504
2017 Formulary |
-- |
-- |
-- |
|
2018 VillageCareMAX Full Advantage FIDA (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | 0% | 3,535 2018 Formulary |
|
2017 VNSNY CHOICE FIDA Complete (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H8490 -001 -0 | 0% | 0% | 0% | 0% | 3,504
2017 Formulary |
-- |
-- |
-- |
|
2018 VNSNY CHOICE FIDA Complete (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | 0% | 3,535 2018 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 2017 --
|
H3361 -137 -2 | | | | | |
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|
|
2018 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 | 2,973 2018 Formulary |
|
-- This plan not offered in 2017 --
|
H0088 -001 -0 | | | | | |
new |
new |
new |
|
2018 WellCare Premier (PPO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $47.00 | $47.00 | 2,973 2018 Formulary |
|
2017 WellCare Rx (HMO)
| $7.00 |
$6,700 |
$400 | No additional gap coverage, only the Donut Hole Discount |
H3361 -130 -0 | $2.00 | $9.00 | $36.00 | $36.00 | 3,113
2017 Formulary |
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|
|
2018 WellCare Rx (HMO)
| $14.50 |
$5,000 |
$405 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $17.00 | $47.00 | $47.00 | 2,973 2018 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 |
2017 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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|
|
2018 UnitedHealthcare MedicareComplete Choice Plan 1 (Regional PPO)
| $17.00 |
$6,700 |
$350 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $47.00 | $47.00 | 3,779 2018 Formulary |
|
2017 UnitedHealthcare Dual Complete (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H3387 -010 -0 | | | | | 3,683
2017 Formulary |
|
|
|
|
2018 UnitedHealthcare Dual Complete (HMO SNP)
| $25.30 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,779 2018 Formulary |
|
2017 Humana Gold Plus H3533-021 (HMO)
| $24.10 |
$6,700 |
$400 | No additional gap coverage, only the Donut Hole Discount |
H3533 -021 -0 | $8.00 | $18.00 | $47.00 | $47.00 | 3,820
2017 Formulary |
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|
|
|
2018 Humana Gold Plus H3533-021 (HMO)
| $26.00 |
$6,500 |
$200 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $9.00 | $47.00 | $47.00 | 3,666 2018 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 |
2017 AARP MedicareComplete Plan 2 (HMO)
| $19.00 |
$6,700 |
$330 | No additional gap coverage, only the Donut Hole Discount |
H3379 -001 -0 | $2.00 | $12.00 | $47.00 | $47.00 | 3,683
2017 Formulary |
|
|
|
|
2018 AARP MedicareComplete Plan 2 (HMO)
| $27.00 |
$6,700 |
$330 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $47.00 | $47.00 | 3,779 2018 Formulary |
|
2017 Fidelis Medicaid Advantage Plus (HMO SNP)
| $33.70 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H3328 -016 -0 | $1.00 | $16.00 | $47.00 | $47.00 | 2,999
2017 Formulary |
|
|
|
|
2018 Fidelis Medicaid Advantage Plus (HMO SNP)
| $28.40 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | $1.00 | $20.00 | $47.00 | $47.00 | 3,005 2018 Formulary |
|
2017 Healthfirst Increased Benefits Plan (HMO)
| $37.00 |
$6,700 |
$400 | No additional gap coverage, only the Donut Hole Discount |
H3359 -019 -0 | | | | | 3,098
2017 Formulary |
|
|
|
|
2018 Healthfirst Increased Benefits Plan (HMO)
| $29.70 |
$6,700 |
$405 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,112 2018 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 |
2017 UnitedHealthcare Nursing Home Plan (HMO SNP)
| $34.80 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H3379 -002 -0 | | | | | 3,683
2017 Formulary |
|
|
|
|
2018 UnitedHealthcare Nursing Home Plan (HMO SNP)
| $33.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,779 2018 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 |
H3533 -004 -0 | $0.00 | $19.00 | $47.00 | $47.00 | 3,820
2017 Formulary |
|
|
|
|
2018 Humana Gold Plus SNP-DE H3533-004 (HMO SNP)
| $34.30 |
n/a |
$320 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $19.00 | $47.00 | $47.00 | 3,666 2018 Formulary |
|
2017 WellCare Access (HMO SNP)
| $26.10 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H3361 -109 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,113
2017 Formulary |
|
|
|
|
2018 WellCare Access (HMO SNP)
| $36.90 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $3.00 | $47.00 | $47.00 | 3,119 2018 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 |
2017 Healthfirst Mount Sinai Select (HMO)
| $49.90 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3359 -036 -0 | $0.00 | $40.00 | $90.00 | $90.00 | 3,098
2017 Formulary |
|
|
|
|
2018 Healthfirst Mount Sinai Select (HMO)
| $37.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $40.00 | $40.00 | 3,112 2018 Formulary |
|
2017 Fidelis Medicare Advantage Flex (HMO-POS)
| $41.00 |
$6,700 |
$250 | No additional gap coverage, only the Donut Hole Discount |
H3328 -003 -0 | $0.00 | $15.00 | $35.00 | $35.00 | 5,280
2017 Formulary |
|
|
|
|
2018 Fidelis Medicare Advantage Flex (HMO-POS)
| $38.00 |
$6,700 |
$125 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $35.00 | $35.00 | 4,081 2018 Formulary |
|
2017 Fidelis Dual Advantage Flex (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H3328 -017 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 2,999
2017 Formulary |
|
|
|
|
2018 Fidelis Dual Advantage Flex (HMO SNP)
| $38.40 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,005 2018 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 |
2017 Fidelis Dual Advantage (HMO SNP)
| $34.60 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H3328 -002 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 2,999
2017 Formulary |
|
|
|
|
2018 Fidelis Dual Advantage (HMO SNP)
| $38.80 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,005 2018 Formulary |
|
2017 Affinity Medicare Solutions (HMO SNP)
| $38.10 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H5991 -002 -0 | $0.00 | $7.00 | $47.00 | $47.00 | 3,098
2017 Formulary |
|
|
|
|
2018 Affinity Medicare Solutions (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $2.00 | $47.00 | $47.00 | 3,114 2018 Formulary |
|
2017 Affinity Medicare Ultimate (HMO SNP)
| $40.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H5991 -001 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,098
2017 Formulary |
|
|
|
|
2018 Affinity Medicare Ultimate (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $3.00 | $45.00 | $45.00 | 3,114 2018 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 |
2017 AgeWell New York BeWell (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H4922 -002 -0 | | | | | 3,176
2017 Formulary |
|
|
|
|
2018 AgeWell New York BeWell (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,496 2018 Formulary |
|
2017 AgeWell New York CareWell (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H4922 -004 -0 | | | | | 3,176
2017 Formulary |
|
|
|
|
2018 AgeWell New York CareWell (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,496 2018 Formulary |
|
2017 AgeWell New York FeelWell (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H4922 -003 -0 | | | | | 3,176
2017 Formulary |
|
|
|
|
2018 AgeWell New York FeelWell (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,496 2018 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 2017 --
|
H4922 -006 -0 | | | | | |
|
|
|
|
2018 AgeWell New York StayWell (HMO)
| $39.00 |
$6,700 |
$405 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,496 2018 Formulary |
|
2017 ArchCare Advantage (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H1777 -007 -0 | | | | | 2,999
2017 Formulary |
|
-- |
|
|
2018 ArchCare Advantage (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,005 2018 Formulary |
|
2017 CenterLight Healthcare Direct Complete Plan (HMO SNP)
| $38.10 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H5989 -002 -0 | $9.00 | 25% | | | 3,855
2017 Formulary |
|
-- |
|
|
2018 CenterLight Healthcare Direct Complete Plan (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | $10.25 | 25% | | | 3,884 2018 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 |
2017 Centers Plan for Dual Coverage Care (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H6988 -002 -0 | | | | | 3,504
2017 Formulary |
-- |
-- |
|
|
2018 Centers Plan for Dual Coverage Care (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,535 2018 Formulary |
|
2017 Centers Plan for Nursing Home Care (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H6988 -003 -0 | | | | | 3,504
2017 Formulary |
-- |
-- |
|
|
2018 Centers Plan for Nursing Home Care (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,535 2018 Formulary |
|
2017 Elderplan Advantage For Nursing Home Residents (HMO SNP)
| $40.90 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H3347 -003 -0 | | | | | 3,098
2017 Formulary |
|
|
|
|
2018 Elderplan Advantage For Nursing Home Residents (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,112 2018 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 |
2017 Elderplan Extra Help (HMO)
| $40.90 |
$6,700 |
$400 | No additional gap coverage, only the Donut Hole Discount |
H3347 -009 -0 | | | | | 3,098
2017 Formulary |
|
|
|
|
2018 Elderplan Extra Help (HMO)
| $39.00 |
$6,700 |
$405 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,112 2018 Formulary |
|
2017 Elderplan For Medicaid Beneficiaries (HMO SNP)
| $40.90 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H3347 -002 -0 | | | | | 3,098
2017 Formulary |
|
|
|
|
2018 Elderplan For Medicaid Beneficiaries (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,112 2018 Formulary |
|
2017 Elderplan Plus Long Term Care (HMO SNP)
| $40.90 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H3347 -007 -0 | | | | | 3,098
2017 Formulary |
|
|
|
|
2018 Elderplan Plus Long Term Care (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,112 2018 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 |
2017 EmblemHealth VIP Dual (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H3330 -037 -0 | | | | | 3,551
2017 Formulary |
|
|
|
|
2018 EmblemHealth VIP Dual (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,518 2018 Formulary |
|
-- This plan not offered in 2017 --
|
H8432 -007 -0 | | | | | |
|
|
|
|
2018 Empire MediBlue Dual Advantage (HMO SNP)
| $39.00 |
n/a |
$405 | Yes, some additional gap coverage. | $0.00 | $20.00 | $47.00 | $47.00 | 3,752 2018 Formulary |
|
2017 Fresenius Total Health (HMO SNP)
| $40.90 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H3262 -001 -0 | $0.00 | 25% | 25% | 25% | 3,203
2017 Formulary |
new |
new |
new |
|
2018 Fresenius Total Health (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | $0.00 | 25% | 25% | 25% | 3,367 2018 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 |
2017 GuildNet Gold (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H6864 -001 -0 | $1.00 | $6.00 | 25% | 25% | 3,551
2017 Formulary |
-- |
-- |
|
|
2018 GuildNet Gold (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $7.00 | 25% | 25% | 3,518 2018 Formulary |
|
2017 Healthfirst AssuredCare (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H3359 -035 -0 | | | | | 3,098
2017 Formulary |
|
|
|
|
2018 Healthfirst AssuredCare (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,112 2018 Formulary |
|
2017 Healthfirst CompleteCare (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H3359 -034 -0 | | | | | 3,098
2017 Formulary |
|
|
|
|
2018 Healthfirst CompleteCare (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,112 2018 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 |
2017 Healthfirst Life Improvement Plan (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H3359 -021 -0 | | | | | 3,098
2017 Formulary |
|
|
|
|
2018 Healthfirst Life Improvement Plan (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,112 2018 Formulary |
|
2017 MetroPlus Advantage Plan (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H0423 -001 -0 | | | | | 3,098
2017 Formulary |
|
|
|
|
2018 MetroPlus Advantage Plan (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,112 2018 Formulary |
|
-- This plan not offered in 2017 --
|
H6776 -002 -0 | | | | | |
-- |
-- |
-- |
|
2018 RiverSpring MAP (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,881 2018 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 |
2017 RiverSpring Star (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H6776 -001 -0 | | | | | n/a |
-- |
-- |
-- |
|
2018 RiverSpring Star (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,881 2018 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 |
H5992 -007 -0 | | | | | 3,766
2017 Formulary |
-- |
-- |
|
|
2018 Senior Whole Health of New York NHC (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,863 2018 Formulary |
|
2017 VillageCareMAX Medicare Health Advantage (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H2168 -001 -0 | | | | | 3,504
2017 Formulary |
new |
new |
new |
|
2018 VillageCareMAX Medicare Health Advantage (HMO-POS SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,535 2018 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 |
2017 VNSNY CHOICE Medicare Classic (HMO)
| $41.00 |
$6,700 |
$400 | No additional gap coverage, only the Donut Hole Discount |
H5549 -008 -0 | | | | | 3,740
2017 Formulary |
|
|
|
|
2018 VNSNY CHOICE Medicare Classic (HMO)
| $39.00 |
$6,700 |
$405 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,817 2018 Formulary |
|
2017 VNSNY CHOICE Medicare Preferred (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H5549 -002 -0 | | | | | 3,740
2017 Formulary |
|
|
|
|
2018 VNSNY CHOICE Medicare Preferred (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | 25% | 25% | 3,817 2018 Formulary |
|
2017 VNSNY CHOICE Total (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H5549 -003 -0 | | | | | 3,740
2017 Formulary |
|
|
|
|
2018 VNSNY CHOICE Total (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,817 2018 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 |
2017 AARP MedicareComplete Plan 1 (HMO)
| $35.00 |
$6,700 |
$230 | No additional gap coverage, only the Donut Hole Discount |
H3307 -002 -0 | $2.00 | $8.00 | $45.00 | $45.00 | 3,683
2017 Formulary |
|
|
|
|
2018 AARP MedicareComplete Plan 1 (HMO)
| $47.00 |
$6,700 |
$295 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $47.00 | $47.00 | 3,779 2018 Formulary |
|
2017 UnitedHealthcare MedicareComplete Choice Plan 3 (Regional PPO)
| $36.00 |
$5,900 |
$150 | No additional gap coverage, only the Donut Hole Discount |
R5342 -005 -0 | $2.00 | $8.00 | $45.00 | $45.00 | n/a |
|
|
|
|
2018 UnitedHealthcare MedicareComplete Choice Plan 3 (Regional PPO)
| $47.00 |
$6,700 |
$225 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $47.00 | $47.00 | 3,779 2018 Formulary |
|
2017 WellCare Preferred (HMO-POS)
| $45.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3361 -135 -0 | $0.00 | $15.00 | $47.00 | $47.00 | 2,914
2017 Formulary |
|
|
|
|
2018 WellCare Preferred (HMO-POS)
| $53.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $47.00 | $47.00 | 2,973 2018 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 2017 --
|
H3533 -023 -0 | | | | | |
|
|
|
|
2018 Humana Gold Plus H3533-023 (HMO)
| $67.00 |
$3,300 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $9.00 | $47.00 | $47.00 | 3,666 2018 Formulary |
|
2017 UnitedHealthcare MedicareComplete Choice Plan 4 (Regional PPO)
| $66.00 |
$5,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
R5342 -006 -0 | $2.00 | $8.00 | $45.00 | $45.00 | n/a |
|
|
|
|
2018 UnitedHealthcare MedicareComplete Choice Plan 4 (Regional PPO)
| $77.00 |
$5,400 |
$100 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $47.00 | $47.00 | 3,779 2018 Formulary |
|
2017 EmblemHealth VIP Gold (HMO)
| $-9.00 |
n/a |
$330 | n/a |
H3330 -021 -1 | $0.00 | $10.00 | $40.00 | $40.00 | 3,551
2017 Formulary |
|
|
|
|
2018 EmblemHealth VIP Gold (HMO)
| $78.00 |
$6,700 |
$200 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $40.00 | $40.00 | 3,518 2018 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 |
2017 AARP MedicareComplete Plan 3 (HMO)
| $66.00 |
$2,800 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3307 -024 -0 | $2.00 | $8.00 | $45.00 | $45.00 | 3,683
2017 Formulary |
|
|
|
|
2018 AARP MedicareComplete Plan 3 (HMO)
| $83.00 |
$4,500 |
$100 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $47.00 | $47.00 | 3,779 2018 Formulary |
|
2017 Aetna Medicare Standard Plan (PPO)
| $99.00 |
$6,700 |
$250 | Yes, some additional gap coverage. |
H5521 -040 -0 | $2.00 | $5.00 | $47.00 | $47.00 | 3,670
2017 Formulary |
|
|
|
|
2018 Aetna Medicare Standard Plan (PPO)
| $96.00 |
$6,700 |
$150 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 5,223 2018 Formulary |
|
-- This plan not offered in 2017 --
|
H6988 -004 -0 | | | | | |
-- |
-- |
|
|
2018 Centers Plan for Medicaid Advantage Plus (HMO SNP)
| $99.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,535 2018 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 |
2017 VNSNY CHOICE Medicare Maximum (HMO SNP)
| $109.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H5549 -006 -0 | | | | | 3,740
2017 Formulary |
|
|
|
|
2018 VNSNY CHOICE Medicare Maximum (HMO SNP)
| $119.60 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $10.00 | 25% | 25% | 3,817 2018 Formulary |
|
2017 VillageCareMAX Medicare Total Advantage (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H2168 -002 -0 | | | | | 3,504
2017 Formulary |
new |
new |
new |
|
2018 VillageCareMAX Medicare Total Advantage (HMO-POS SNP)
| $215.50 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,535 2018 Formulary |
|
2017 MetroPlus Platinum (HMO)
| $226.20 |
$6,700 |
$400 | No additional gap coverage, only the Donut Hole Discount |
H0423 -004 -0 | | | | | 3,098
2017 Formulary |
|
|
|
|
2018 MetroPlus Platinum (HMO)
| $254.20 |
$6,700 |
$405 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,112 2018 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 2017 --
|
H3330 -038 -0 | | | | | |
|
|
|
|
2018 EmblemHealth VIP Gold Plus (HMO)
| $297.00 |
$6,700 |
$200 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $40.00 | $40.00 | 3,518 2018 Formulary |
|
2017 EmblemHealth VIP Gold Plus (HMO)
| $295.00 |
$6,700 |
$330 | No additional gap coverage, only the Donut Hole Discount |
H3330 -033 -2 | $0.00 | $10.00 | $40.00 | $40.00 | 3,551
2017 Formulary |
|
|
|
|
-- Members will be assigned to EmblemHealth VIP Gold Plus (HMO) H3330-038 --
| | | | | |
|
2017 Empire MediBlue Dual Advantage (HMO SNP)
| $41.00 |
n/a |
$400 | Yes, some additional gap coverage. |
H3370 -028 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,666
2017 Formulary |
|
|
|
|
-- Members will be assigned to Empire MediBlue Dual Advantage (HMO SNP) H8432-007 --
| | | | | |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2017 Empire MediBlue Plus (HMO)
| $0.00 |
$6,700 |
$230 | Yes, some additional gap coverage. |
H3370 -035 -0 | $4.00 | $10.00 | $42.00 | $42.00 | 3,666
2017 Formulary |
|
|
|
|
-- Members will be assigned to Empire MediBlue Plus (HMO) H8432-013 --
| | | | | |
|
2017 WellCare Choice (HMO-POS)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3361 -106 -0 | $0.00 | $15.00 | $47.00 | $47.00 | 2,914
2017 Formulary |
|
|
|
|
-- Members will be assigned to WellCare Choice (HMO-POS) H3361-137 --
| | | | | |
|
2017 Liberty Health Advantage Preferred Choice (HMO)
| $0.00 |
$5,500 |
$0 | Yes, some additional gap coverage. |
H3337 -001 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,291
2017 Formulary |
|
|
|
|
-- This plan not offered in 2018 --
|
| | | | |
|
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 |
2017 Liberty Health Advantage Dual Power (HMO SNP)
| $41.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount |
H3337 -003 -0 | | | | | 3,291
2017 Formulary |
|
|
|
|
-- This plan not offered in 2018 --
|
| | | | |
|
2017 Aetna Medicare Value Plan (HMO)
| $39.00 |
$6,700 |
$350 | Yes, some additional gap coverage. |
H3312 -060 -0 | $2.00 | $5.00 | $47.00 | $47.00 | 3,670
2017 Formulary |
|
|
|
|
-- This plan not offered in 2018 --
|
| | | | |
|
2017 Affinity Medicare Passport Select (HMO)
| $45.00 |
$5,900 |
$0 | Yes, some additional gap coverage. |
H5991 -004 -0 | $0.00 | $8.00 | $42.00 | $42.00 | 3,098
2017 Formulary |
|
|
|
|
-- This plan not offered in 2018 --
|
| | | | |
|
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 |
2017 Fidelis Fully Integrated Dual Advantage Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H1916 -001 -0 | 0% | 0% | | | 3,043
2017 Formulary |
|
|
|
|
-- This plan not offered in 2018 --
|
| | | | |
|
2017 North Shore-LIJ FIDA LiveWell (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H3129 -001 -0 | 0% | 0% | 0% | | 3,142
2017 Formulary |
|
|
|
|
-- This plan not offered in 2018 --
|
| | | | |
|
2017 ICS Community Care Plus FIDA MMP (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H4465 -001 -0 | 0% | 0% | 0% | 0% | 3,504
2017 Formulary |
|
|
|
|
-- This plan not offered in 2018 --
|
| | | | |
|
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 |
2017 Aetna Better Health FIDA Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H8056 -001 -0 | 0% | 0% | 0% | | 3,410
2017 Formulary |
|
|
|
|
-- This plan not offered in 2018 --
|
| | | | |
|
2017 EmblemHealth VIP Essential (HMO)
| $41.00 |
$6,700 |
$400 | No additional gap coverage, only the Donut Hole Discount |
H3330 -032 -2 | $0.00 | $16.00 | $42.00 | $42.00 | 3,551
2017 Formulary |
|
|
|
|
-- This plan not offered in 2018 --
|
| | | | |
|
2017 EmblemHealth VIP Gold (HMO)
| $98.00 |
$6,700 |
$330 | No additional gap coverage, only the Donut Hole Discount |
H3330 -021 -2 | $0.00 | $10.00 | $40.00 | $40.00 | 3,551
2017 Formulary |
|
|
|
|
-- This plan not offered in 2018 --
|
| | | | |
|