There are 105 Medicare Advantage plans meeting your criteria.
2018 / 2019 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 |
2018 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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2019 AARP MedicareComplete Essential (HMO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2018 Aetna Medicare Elite Plan (PPO)
| $0.00 |
$6,700 |
$250 | Yes, some additional gap coverage. |
H5521 -120 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 5,223
2018 Formulary |
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2019 Aetna Medicare Elite Plan (PPO)
| $0.00 |
$6,700 |
$245 | Yes, some additional gap coverage. | $2.00 | $5.00 | $47.00 | $47.00 | 3,744 2019 Formulary |
|
2018 Aetna Medicare Select Plan (HMO)
| $28.00 |
$6,700 |
$200 | Yes, some additional gap coverage. |
H3312 -002 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 5,223
2018 Formulary |
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2019 Aetna Medicare Value Plan (HMO)
| $0.00 |
$6,700 |
$195 | Yes, some additional gap coverage. | $2.00 | $5.00 | $47.00 | $47.00 | 3,744 2019 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 |
2018 Affinity Medicare Passport Essentials NYC (HMO)
| $0.00 |
$5,700 |
$250 | Yes, some additional gap coverage. |
H5991 -006 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,114
2018 Formulary |
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2019 Affinity Medicare Passport Essentials NYC (HMO)
| $0.00 |
$5,700 |
$295 | Yes, some additional gap coverage. | $1.00 | $12.00 | $47.00 | $47.00 | 3,250 2019 Formulary |
|
2018 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% | 3,535
2018 Formulary |
-- |
-- |
-- |
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2019 Centers Plan for FIDA Care Complete (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | 0% | 3,154 2019 Formulary |
|
2018 Centers Plan for Medicare Advantage Care (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H6988 -001 -0 | $3.00 | $35.00 | $85.00 | $85.00 | 3,535
2018 Formulary |
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-- |
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2019 Centers Plan for Medicare Advantage Care (HMO)
| $0.00 |
$6,700 |
$395 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $47.00 | $100.00 | $100.00 | 3,154 2019 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 |
2018 Elderplan FIDA Total Care (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H8029 -001 -0 | 0% | 0% | 0% | | 3,153
2018 Formulary |
-- |
-- |
-- |
|
2019 Elderplan FIDA Total Care (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | | 3,163 2019 Formulary |
|
2018 EmblemHealth VIP Essential (HMO)
| $0.00 |
$6,700 |
$250 | No additional gap coverage, only the Donut Hole Discount |
H3330 -032 -1 | $0.00 | $16.00 | $42.00 | $42.00 | 3,518
2018 Formulary |
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2019 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 | 3,377 2019 Formulary |
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-- This plan not offered in 2018 --
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H3330 -040 -0 | | | | | |
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2019 EmblemHealth VIP Part B Saver (HMO)
| $0.00 |
$6,700 |
$415 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $18.00 | $45.00 | $45.00 | 3,377 2019 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 |
2018 Empire MediBlue Core (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H8432 -012 -0 | This plan does NOT include Prescription Drug coverage. | |
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2019 Empire MediBlue Core (HMO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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2018 Empire MediBlue Plus (HMO)
| $0.00 |
$6,600 |
$350 | Yes, some additional gap coverage. |
H8432 -008 -5 | $3.00 | $15.00 | $42.00 | $42.00 | 3,752
2018 Formulary |
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2019 Empire MediBlue Plus (HMO)
| $0.00 |
$6,700 |
$350 | Yes, some additional gap coverage. | $3.00 | $15.00 | $42.00 | $42.00 | 3,606 2019 Formulary |
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-- This plan not offered in 2018 --
|
H8432 -027 -0 | | | | | |
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2019 Empire MediBlue Select (HMO)
| $0.00 |
$6,400 |
$350 | Yes, some additional gap coverage. | $3.00 | $15.00 | $42.00 | $42.00 | 3,606 2019 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 |
2018 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 | 3,112
2018 Formulary |
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2019 Healthfirst 65 Plus Plan (HMO)
| $0.00 |
$6,700 |
$350 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,078 2019 Formulary |
|
2018 Healthfirst AbsoluteCare FIDA Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5441 -001 -0 | 0% | 0% | 0% | | 3,153
2018 Formulary |
-- |
-- |
-- |
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2019 Healthfirst AbsoluteCare FIDA Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | | 3,163 2019 Formulary |
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2018 Healthfirst Coordinated Benefits Plan (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H3359 -027 -0 | This plan does NOT include Prescription Drug coverage. | |
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2019 Healthfirst Coordinated Benefits Plan (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 |
2018 Humana Gold Plus H3533-027 (HMO)
| $0.00 |
$6,700 |
$400 | No additional gap coverage, only the Donut Hole Discount |
H3533 -027 -0 | $6.00 | $16.00 | $47.00 | $47.00 | 3,192
2018 Formulary |
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2019 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 | 3,098 2019 Formulary |
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-- This plan not offered in 2018 --
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H5970 -016 -0 | | | | | |
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2019 HumanaChoice H5970-016 (PPO)
| $0.00 |
$4,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2018 --
|
H5970 -021 -0 | | | | | |
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2019 HumanaChoice H5970-021 (PPO)
| $0.00 |
$6,700 |
$350 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $9.00 | $47.00 | $47.00 | 3,368 2019 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 |
2018 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% | | 3,358
2018 Formulary |
-- |
-- |
-- |
|
2019 PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | | 3,337 2019 Formulary |
|
2018 RiverSpring FIDA Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H6435 -001 -0 | 0% | 0% | 0% | | 3,881
2018 Formulary |
-- |
-- |
-- |
|
2019 RiverSpring FIDA Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | | 3,575 2019 Formulary |
|
2018 SWH Whole Health FIDA (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H8851 -001 -0 | 0% | 0% | 0% | 0% | 3,863
2018 Formulary |
-- |
-- |
-- |
|
2019 SWH Whole Health FIDA (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | 0% | 3,319 2019 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 |
2018 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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2019 UnitedHealthcare MedicareComplete Choice Essential (Regional PPO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2018 VNSNY CHOICE FIDA Complete (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H8490 -001 -0 | 0% | 0% | 0% | 0% | 3,535
2018 Formulary |
-- |
-- |
-- |
|
2019 VNSNY CHOICE FIDA Complete (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | 0% | 3,154 2019 Formulary |
|
-- This plan not offered in 2018 --
|
H4868 -012 -1 | | | | | |
new |
new |
new |
|
2019 WellCare Choice (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $15.00 | $47.00 | $47.00 | 3,254 2019 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 2018 --
|
H4868 -006 -4 | | | | | |
new |
new |
new |
|
2019 WellCare Rx (HMO)
| $14.70 |
$6,700 |
$415 | Yes, some additional gap coverage. | $0.00 | $20.00 | $47.00 | $47.00 | 3,254 2019 Formulary |
|
2018 UnitedHealthcare MedicareComplete Choice Plan 1 (Regional PPO)
| $17.00 |
$6,700 |
$350 | No additional gap coverage, only the Donut Hole Discount |
R5342 -001 -0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,779
2018 Formulary |
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2019 UnitedHealthcare MedicareComplete Choice Plan 1 (Regional PPO)
| $16.00 |
$6,700 |
$350 | No additional gap coverage, only the Donut Hole Discount | | | | | tbd |
|
-- This plan not offered in 2018 --
|
H4922 -011 -0 | | | | | |
|
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|
|
2019 AgeWell New York LiveWell (HMO)
| $19.00 |
$6,700 |
$275 | Yes, some additional gap coverage. | $3.00 | $12.00 | $47.00 | $47.00 | 3,383 2019 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 |
2018 Humana Gold Plus H3533-021 (HMO)
| $26.00 |
$6,500 |
$200 | No additional gap coverage, only the Donut Hole Discount |
H3533 -021 -0 | $2.00 | $9.00 | $47.00 | $47.00 | 3,666
2018 Formulary |
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2019 Humana Gold Plus H3533-021 (HMO)
| $21.00 |
$6,500 |
$200 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $9.00 | $47.00 | $47.00 | 3,368 2019 Formulary |
|
2018 AARP MedicareComplete Plan 2 (HMO)
| $27.00 |
$6,700 |
$330 | No additional gap coverage, only the Donut Hole Discount |
H3379 -001 -0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,779
2018 Formulary |
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2019 AARP MedicareComplete Plan 2 (HMO)
| $26.00 |
$6,700 |
$415 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $47.00 | $47.00 | 3,516 2019 Formulary |
|
2018 UnitedHealthcare Dual Complete (HMO SNP)
| $25.30 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H3387 -010 -0 | | | | | 3,779
2018 Formulary |
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2019 UnitedHealthcare Dual Complete (HMO SNP)
| $28.50 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 3,516 2019 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 |
2018 Fidelis Medicaid Advantage Plus (HMO SNP)
| $28.40 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H3328 -016 -0 | $1.00 | $20.00 | $47.00 | $47.00 | 3,005
2018 Formulary |
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2019 Fidelis Medicaid Advantage Plus (HMO SNP)
| $29.20 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $14.50 | 23% | 23% | 2,961 2019 Formulary |
|
-- This plan not offered in 2018 --
|
H4868 -005 -4 | | | | | |
new |
new |
new |
|
2019 WellCare Access (HMO SNP)
| $33.60 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $1.00 | $44.00 | $44.00 | 3,254 2019 Formulary |
|
2018 UnitedHealthcare Nursing Home Plan (HMO SNP)
| $33.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H3379 -002 -0 | | | | | 3,779
2018 Formulary |
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2019 UnitedHealthcare Nursing Home Plan 2 (HMO SNP)
| $35.40 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,516 2019 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 |
2018 Humana Gold Plus SNP-DE H3533-004 (HMO SNP)
| $34.30 |
n/a |
$320 | No additional gap coverage, only the Donut Hole Discount |
H3533 -004 -0 | $0.00 | $19.00 | $47.00 | $47.00 | 3,666
2018 Formulary |
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2019 Humana Gold Plus SNP-DE H3533-004 (HMO SNP)
| $35.70 |
n/a |
$385 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $16.00 | $47.00 | $47.00 | 3,368 2019 Formulary |
|
2018 Fidelis Dual Advantage Flex (HMO SNP)
| $38.40 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H3328 -017 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,005
2018 Formulary |
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|
|
|
2019 Fidelis Dual Advantage Flex (HMO SNP)
| $36.10 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 2,961 2019 Formulary |
|
-- This plan not offered in 2018 --
|
H2292 -002 -0 | | | | | |
new |
new |
new |
|
2019 UnitedHealthcare Nursing Home Plan 1 (PPO SNP)
| $36.30 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,516 2019 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 |
2018 Fidelis Dual Advantage (HMO SNP)
| $38.80 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H3328 -002 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,005
2018 Formulary |
|
|
|
|
2019 Fidelis Dual Advantage (HMO SNP)
| $38.90 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 2,961 2019 Formulary |
|
2018 MetroPlus Advantage Plan (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H0423 -001 -0 | | | | | 3,112
2018 Formulary |
|
|
|
|
2019 MetroPlus Advantage Plan (HMO SNP)
| $39.00 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | 15% | | | | 3,152 2019 Formulary |
|
2018 Affinity Medicare Solutions (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H5991 -002 -0 | $0.00 | $2.00 | $47.00 | $47.00 | 3,114
2018 Formulary |
|
|
|
|
2019 Affinity Medicare Solutions (HMO SNP)
| $39.30 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $7.00 | $47.00 | $47.00 | 3,250 2019 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 |
2018 Affinity Medicare Ultimate (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H5991 -001 -0 | $0.00 | $3.00 | $45.00 | $45.00 | 3,114
2018 Formulary |
|
|
|
|
2019 Affinity Medicare Ultimate (HMO SNP)
| $39.30 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $6.00 | $45.00 | $45.00 | 3,250 2019 Formulary |
|
-- This plan not offered in 2018 --
|
H4922 -010 -0 | | | | | |
|
|
|
|
2019 AgeWell New York Advantage Plus (HMO SNP)
| $39.30 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 3,383 2019 Formulary |
|
2018 AgeWell New York CareWell (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H4922 -004 -0 | | | | | 3,496
2018 Formulary |
|
|
|
|
2019 AgeWell New York CareWell (HMO SNP)
| $39.30 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,383 2019 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 |
2018 AgeWell New York FeelWell (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H4922 -003 -0 | | | | | 3,496
2018 Formulary |
|
|
|
|
2019 AgeWell New York FeelWell (HMO SNP)
| $39.30 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 3,383 2019 Formulary |
|
2018 ArchCare Advantage (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H1777 -007 -0 | | | | | 3,005
2018 Formulary |
|
-- |
|
|
2019 ArchCare Advantage (HMO SNP)
| $39.30 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | 25% | | | | 3,012 2019 Formulary |
|
2018 CenterLight Healthcare Direct Complete Plan (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H5989 -002 -0 | $10.25 | 25% | | | 3,884
2018 Formulary |
-- |
-- |
|
|
2019 CenterLight Healthcare Direct Complete Plan (HMO SNP)
| $39.30 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | $5.75 | 25% | | | 3,685 2019 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 |
2018 Centers Plan for Dual Coverage Care (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H6988 -002 -0 | | | | | 3,535
2018 Formulary |
|
-- |
|
|
2019 Centers Plan for Dual Coverage Care (HMO SNP)
| $39.30 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | 15% | | | | 3,154 2019 Formulary |
|
2018 Centers Plan for Nursing Home Care (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H6988 -003 -0 | | | | | 3,535
2018 Formulary |
|
-- |
|
|
2019 Centers Plan for Nursing Home Care (HMO SNP)
| $39.30 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | 25% | | | | 3,154 2019 Formulary |
|
2018 Elderplan Advantage For Nursing Home Residents (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H3347 -003 -0 | | | | | 3,112
2018 Formulary |
|
|
|
|
2019 Elderplan Advantage For Nursing Home Residents (HMO SNP)
| $39.30 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | 25% | | | | 3,151 2019 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 |
2018 Elderplan Extra Help (HMO)
| $39.00 |
$6,700 |
$405 | No additional gap coverage, only the Donut Hole Discount |
H3347 -009 -0 | | | | | 3,112
2018 Formulary |
|
|
|
|
2019 Elderplan Extra Help (HMO)
| $39.30 |
$6,700 |
$415 | No additional gap coverage, only the Donut Hole Discount | 25% | | | | 3,151 2019 Formulary |
|
2018 Elderplan For Medicaid Beneficiaries (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H3347 -002 -0 | | | | | 3,112
2018 Formulary |
|
|
|
|
2019 Elderplan For Medicaid Beneficiaries (HMO SNP)
| $39.30 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | 15% | | | | 3,151 2019 Formulary |
|
2018 Elderplan Plus Long Term Care (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H3347 -007 -0 | | | | | 3,112
2018 Formulary |
|
|
|
|
2019 Elderplan Plus Long Term Care (HMO SNP)
| $39.30 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | 15% | | | | 3,151 2019 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 2018 --
|
H3330 -042 -1 | | | | | |
|
|
|
|
2019 EmblemHealth VIP Dual (HMO SNP)
| $39.30 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 3,377 2019 Formulary |
|
2018 Empire MediBlue Dual Advantage (HMO SNP)
| $39.00 |
n/a |
$405 | Yes, some additional gap coverage. |
H8432 -007 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,752
2018 Formulary |
|
|
|
|
2019 Empire MediBlue Dual Advantage (HMO SNP)
| $39.30 |
n/a |
$415 | Yes, some additional gap coverage. | $0.00 | $14.00 | $47.00 | $47.00 | 3,606 2019 Formulary |
|
-- This plan not offered in 2018 --
|
H8432 -028 -0 | | | | | |
|
|
|
|
2019 Empire MediBlue Dual Advantage Select (HMO SNP)
| $39.30 |
n/a |
$415 | Yes, some additional gap coverage. | $0.00 | $14.00 | $47.00 | $47.00 | 3,606 2019 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 2018 --
|
H1722 -001 -0 | | | | | |
new |
new |
new |
|
2019 Health Pointe Direct Complete Plan (HMO SNP)
| $39.30 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | $4.70 | 25% | | | 3,685 2019 Formulary |
|
2018 Healthfirst CompleteCare (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H3359 -034 -0 | | | | | 3,112
2018 Formulary |
|
|
|
|
2019 Healthfirst CompleteCare (HMO SNP)
| $39.30 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | $0.00 | | | | 3,151 2019 Formulary |
|
2018 Healthfirst Increased Benefits Plan (HMO)
| $29.70 |
$6,700 |
$405 | No additional gap coverage, only the Donut Hole Discount |
H3359 -019 -0 | | | | | 3,112
2018 Formulary |
|
|
|
|
2019 Healthfirst Increased Benefits Plan (HMO)
| $39.30 |
$6,700 |
$415 | No additional gap coverage, only the Donut Hole Discount | 25% | | | | 3,151 2019 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 |
2018 Healthfirst Life Improvement Plan (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H3359 -021 -0 | | | | | 3,112
2018 Formulary |
|
|
|
|
2019 Healthfirst Life Improvement Plan (HMO SNP)
| $39.30 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | $0.00 | | | | 3,151 2019 Formulary |
|
-- This plan not offered in 2018 --
|
H1205 -001 -0 | | | | | |
new |
new |
new |
|
2019 Integra Harmony Plan (HMO SNP)
| $39.30 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | 15% | | | | 3,133 2019 Formulary |
|
-- This plan not offered in 2018 --
|
H1205 -002 -0 | | | | | |
new |
new |
new |
|
2019 Integra Synergy Plan (HMO SNP)
| $39.30 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | $0.00 | | | | 3,133 2019 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 2018 --
|
H8457 -001 -0 | | | | | |
new |
new |
new |
|
2019 Longevity Health Plan (HMO SNP)
| $39.30 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | 25% | | | | 3,690 2019 Formulary |
|
2018 RiverSpring MAP (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H6776 -002 -0 | | | | | 3,881
2018 Formulary |
-- |
-- |
|
|
2019 RiverSpring MAP (HMO SNP)
| $39.30 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | 15% | | | | 3,575 2019 Formulary |
|
2018 RiverSpring Star (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H6776 -001 -0 | | | | | 3,881
2018 Formulary |
-- |
-- |
|
|
2019 RiverSpring Star (HMO SNP)
| $39.30 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | 25% | | | | 3,575 2019 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 |
2018 Senior Whole Health of New York NHC (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H5992 -007 -0 | | | | | 3,863
2018 Formulary |
-- |
-- |
-- |
|
2019 Senior Whole Health of New York NHC (HMO SNP)
| $39.30 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | 15% | | | | 3,319 2019 Formulary |
|
2018 VillageCareMAX Medicare Health Advantage (HMO-POS SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H2168 -001 -0 | | | | | 3,535
2018 Formulary |
-- |
-- |
|
|
2019 VillageCareMAX Medicare Health Advantage (HMO SNP)
| $39.30 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | 15% | | | | 3,154 2019 Formulary |
|
2018 VNSNY CHOICE Total (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H5549 -003 -0 | | | | | 3,817
2018 Formulary |
|
|
|
|
2019 VNSNY CHOICE Total (HMO SNP)
| $39.30 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | 25% | 25% | 3,562 2019 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 |
2018 AARP MedicareComplete Plan 1 (HMO)
| $47.00 |
$6,700 |
$295 | No additional gap coverage, only the Donut Hole Discount |
H3307 -002 -0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,779
2018 Formulary |
|
|
|
|
2019 AARP MedicareComplete Plan 1 (HMO)
| $46.00 |
$6,700 |
$395 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $47.00 | $47.00 | 3,516 2019 Formulary |
|
2018 UnitedHealthcare MedicareComplete Choice Plan 3 (Regional PPO)
| $47.00 |
$6,700 |
$225 | No additional gap coverage, only the Donut Hole Discount |
R5342 -005 -0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,779
2018 Formulary |
|
|
|
|
2019 UnitedHealthcare MedicareComplete Choice Plan 3 (Regional PPO)
| $46.00 |
$6,700 |
$275 | No additional gap coverage, only the Donut Hole Discount | | | | | tbd |
|
-- This plan not offered in 2018 --
|
H4868 -010 -0 | | | | | |
new |
new |
new |
|
2019 WellCare Preferred (HMO)
| $53.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $15.00 | $47.00 | $47.00 | 3,254 2019 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 2018 --
|
H3330 -039 -1 | | | | | |
|
|
|
|
2019 EmblemHealth VIP Rx Saver (HMO)
| $55.00 |
$6,700 |
$395 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $16.00 | $42.00 | $42.00 | 3,377 2019 Formulary |
|
2018 VillageCareMAX Medicare Total Advantage (HMO-POS SNP)
| $215.50 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H2168 -002 -0 | | | | | 3,535
2018 Formulary |
-- |
-- |
|
|
2019 VillageCareMAX Medicare Total Advantage (HMO SNP)
| $60.00 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | $0.00 | | | | 3,154 2019 Formulary |
|
2018 Aetna Medicare Premier Plan (PPO)
| $96.00 |
$6,700 |
$200 | Yes, some additional gap coverage. |
H5521 -121 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 5,223
2018 Formulary |
|
|
|
|
2019 Aetna Medicare Premier Plan (PPO)
| $67.00 |
$6,700 |
$195 | Yes, some additional gap coverage. | $2.00 | $5.00 | $47.00 | $47.00 | 3,744 2019 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 |
2018 Humana Gold Plus H3533-023 (HMO)
| $67.00 |
$3,300 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3533 -023 -0 | $0.00 | $9.00 | $47.00 | $47.00 | 3,666
2018 Formulary |
|
|
|
|
2019 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 | 3,368 2019 Formulary |
|
-- This plan not offered in 2018 --
|
H3330 -041 -1 | | | | | |
|
|
|
|
2019 EmblemHealth VIP Go (HMO-POS)
| $68.00 |
$6,700 |
$250 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $16.00 | $42.00 | $42.00 | 3,377 2019 Formulary |
|
2018 UnitedHealthcare MedicareComplete Choice Plan 4 (Regional PPO)
| $77.00 |
$5,400 |
$100 | No additional gap coverage, only the Donut Hole Discount |
R5342 -006 -0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,779
2018 Formulary |
|
|
|
|
2019 UnitedHealthcare MedicareComplete Choice Plan 4 (Regional PPO)
| $76.00 |
$6,700 |
$150 | No additional gap coverage, only the Donut Hole Discount | | | | | 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 |
-- This plan not offered in 2018 --
|
H4922 -008 -0 | | | | | |
|
|
|
|
2019 AgeWell New York PlanWell (HMO)
| $86.00 |
$6,700 |
$250 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,383 2019 Formulary |
|
2018 EmblemHealth VIP Gold (HMO)
| $78.00 |
$6,700 |
$200 | No additional gap coverage, only the Donut Hole Discount |
H3330 -021 -1 | $0.00 | $10.00 | $40.00 | $40.00 | 3,518
2018 Formulary |
|
|
|
|
2019 EmblemHealth VIP Gold (HMO)
| $88.50 |
$6,700 |
$200 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $40.00 | $40.00 | 3,377 2019 Formulary |
|
-- This plan not offered in 2018 --
|
H5970 -022 -0 | | | | | |
|
|
|
|
2019 HumanaChoice H5970-022 (PPO)
| $95.00 |
$3,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $9.00 | $47.00 | $47.00 | 3,368 2019 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 |
2018 Centers Plan for Medicaid Advantage Plus (HMO SNP)
| $99.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H6988 -004 -0 | | | | | 3,535
2018 Formulary |
|
-- |
|
|
2019 Centers Plan for Medicaid Advantage Plus (HMO SNP)
| $135.00 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | $0.00 | | | | 3,154 2019 Formulary |
|
-- This plan not offered in 2018 --
|
H5970 -023 -0 | | | | | |
|
|
|
|
2019 HumanaChoice H5970-023 (PPO)
| $199.00 |
$3,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $12.00 | $47.00 | $47.00 | 3,098 2019 Formulary |
|
2018 MetroPlus Platinum (HMO)
| $254.20 |
$6,700 |
$405 | No additional gap coverage, only the Donut Hole Discount |
H0423 -004 -0 | | | | | 3,112
2018 Formulary |
|
|
|
|
2019 MetroPlus Platinum (HMO)
| $253.50 |
$6,700 |
$415 | No additional gap coverage, only the Donut Hole Discount | 25% | | | | 3,152 2019 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 |
2018 EmblemHealth VIP Gold Plus (HMO)
| $297.00 |
$6,700 |
$200 | No additional gap coverage, only the Donut Hole Discount |
H3330 -038 -0 | $0.00 | $10.00 | $40.00 | $40.00 | 3,518
2018 Formulary |
|
|
|
|
2019 EmblemHealth VIP Gold Plus (HMO)
| $298.00 |
$6,700 |
$200 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $40.00 | $40.00 | 3,377 2019 Formulary |
|
2018 AgeWell New York LiveWell (HMO)
| $0.00 |
$6,700 |
$225 | Yes, some additional gap coverage. |
H4922 -005 -1 | $5.00 | $15.00 | $47.00 | $47.00 | 3,496
2018 Formulary |
|
|
|
|
-- Members will be assigned to AgeWell New York LiveWell (HMO) H4922-011 --
| | | | | |
|
2018 EmblemHealth VIP Dual (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H3330 -037 -0 | | | | | 3,518
2018 Formulary |
|
|
|
|
-- Members will be assigned to EmblemHealth VIP Dual (HMO SNP) H3330-042 --
| | | | | |
|
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 |
2018 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 | 4,081
2018 Formulary |
|
|
|
|
-- Members will be assigned to Fidelis Medicare $0 Premium (HMO) H3328-021 --
| | | | | |
|
2018 WellCare Access (HMO SNP)
| $36.90 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H3361 -109 -0 | $0.00 | $3.00 | $47.00 | $47.00 | 3,119
2018 Formulary |
|
|
|
|
-- Members will be assigned to WellCare Access (HMO SNP) H4868-005 --
| | | | | |
|
2018 WellCare Choice (HMO-POS)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3361 -137 -1 | $0.00 | $15.00 | $47.00 | $47.00 | 2,973
2018 Formulary |
|
|
|
|
-- Members will be assigned to WellCare Choice (HMO) H4868-012 --
| | | | | |
|
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 |
2018 WellCare Preferred (HMO-POS)
| $53.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3361 -135 -0 | $0.00 | $15.00 | $47.00 | $47.00 | 2,973
2018 Formulary |
|
|
|
|
-- Members will be assigned to WellCare Preferred (HMO) H4868-010 --
| | | | | |
|
2018 WellCare Rx (HMO)
| $14.50 |
$5,000 |
$405 | No additional gap coverage, only the Donut Hole Discount |
H3361 -130 -0 | $2.00 | $17.00 | $47.00 | $47.00 | 2,973
2018 Formulary |
|
|
|
|
-- Members will be assigned to WellCare Rx (HMO) H4868-006 --
| | | | | |
|
2018 Fidelis Medicare Advantage Flex (HMO-POS)
| $38.00 |
$6,700 |
$125 | No additional gap coverage, only the Donut Hole Discount |
H3328 -003 -0 | $0.00 | $15.00 | $35.00 | $35.00 | 4,081
2018 Formulary |
|
|
|
|
-- This plan not offered in 2019 --
|
| | | | |
|
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 |
2018 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. | |
|
|
|
|
-- This plan not offered in 2019 --
|
| | | | |
|
2018 AARP MedicareComplete Mosaic (HMO)
| $0.00 |
$6,200 |
$295 | No additional gap coverage, only the Donut Hole Discount |
H3307 -015 -0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,779
2018 Formulary |
|
|
|
|
-- This plan not offered in 2019 --
|
| | | | |
|
2018 GuildNet Gold (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H6864 -001 -0 | $2.00 | $7.00 | 25% | 25% | 3,518
2018 Formulary |
|
|
|
|
-- This plan not offered in 2019 --
|
| | | | |
|
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 |
2018 VNSNY CHOICE Medicare Preferred (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H5549 -002 -0 | $4.00 | $10.00 | 25% | 25% | 3,817
2018 Formulary |
|
|
|
|
-- This plan not offered in 2019 --
|
| | | | |
|
2018 VNSNY CHOICE Medicare Maximum (HMO SNP)
| $119.60 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H5549 -006 -0 | $5.00 | $10.00 | 25% | 25% | 3,817
2018 Formulary |
|
|
|
|
-- This plan not offered in 2019 --
|
| | | | |
|
2018 Healthfirst AssuredCare (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H3359 -035 -0 | | | | | 3,112
2018 Formulary |
|
|
|
|
-- This plan not offered in 2019 --
|
| | | | |
|
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 |
2018 VNSNY CHOICE Medicare Classic (HMO)
| $39.00 |
$6,700 |
$405 | No additional gap coverage, only the Donut Hole Discount |
H5549 -008 -0 | | | | | 3,817
2018 Formulary |
|
|
|
|
-- This plan not offered in 2019 --
|
| | | | |
|
2018 AgeWell New York BeWell (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H4922 -002 -0 | | | | | 3,496
2018 Formulary |
|
|
|
|
-- This plan not offered in 2019 --
|
| | | | |
|
2018 GuildNet Gold Plus FIDA Plan POS (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0811 -001 -0 | 0% | 0% | 0% | 0% | 3,505
2018 Formulary |
|
|
|
|
-- This plan not offered in 2019 --
|
| | | | |
|
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 |
2018 AgeWell New York FIDA Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H6308 -001 -0 | 0% | 0% | 0% | | 3,496
2018 Formulary |
|
|
|
|
-- This plan not offered in 2019 --
|
| | | | |
|
2018 MetroPlus FIDA (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H9115 -001 -0 | 0% | 0% | 0% | | 3,153
2018 Formulary |
|
|
|
|
-- This plan not offered in 2019 --
|
| | | | |
|
2018 VillageCareMAX Full Advantage FIDA (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H9345 -001 -0 | 0% | 0% | 0% | 0% | 3,535
2018 Formulary |
|
|
|
|
-- This plan not offered in 2019 --
|
| | | | |
|
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 |
2018 AARP MedicareComplete Plan 3 (HMO)
| $83.00 |
$4,500 |
$100 | No additional gap coverage, only the Donut Hole Discount |
H3307 -024 -0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,779
2018 Formulary |
|
|
|
|
-- This plan not offered in 2019 --
|
| | | | |
|
2018 Fresenius Total Health (HMO SNP)
| $39.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H3262 -001 -0 | $0.00 | 25% | 25% | 25% | 3,367
2018 Formulary |
|
|
|
|
-- This plan not offered in 2019 --
|
| | | | |
|
2018 AgeWell New York StayWell (HMO)
| $39.00 |
$6,700 |
$405 | No additional gap coverage, only the Donut Hole Discount |
H4922 -006 -0 | | | | | 3,496
2018 Formulary |
|
|
|
|
-- This plan not offered in 2019 --
|
| | | | |
|