There are 127 Medicare Advantage plans meeting your criteria.
2020 / 2021 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 |
2020 AARP Medicare Advantage Mosaic Choice (PPO)
| $0.00 |
$6,700 |
$250 | No additional gap coverage, only the Donut Hole Discount |
H3418
-001
-0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,601
2020 Formulary |
| new |
new |
new |
|
2021 AARP Medicare Advantage Mosaic Choice (PPO)
| $0.00 |
$6,700 |
$250 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
| |
2020 AARP Medicare Advantage Essential (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H3307
-018
-0 | This plan does NOT include Prescription Drug coverage. | |
 |
 |
 |
|
2021 AARP Medicare Advantage Patriot (HMO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
| |
2020 AARP Medicare Advantage Mosaic (HMO)
| $0.00 |
$6,700 |
$250 | No additional gap coverage, only the Donut Hole Discount |
H3307
-015
-0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,601
2020 Formulary |
|
|
|
|
2021 AARP Medicare Advantage Prime (HMO)
| $0.00 |
$6,700 |
$295 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $47.00 | $47.00 | 3,604
2021 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 2020 --
|
H5521
-320
-0 | | | | | |
|
 |
|
|
2021 Aetna Medicare Eagle Plan (PPO)
| $0.00 |
$7,550 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
| |
2020 Aetna Medicare Elite Plan (PPO)
| $0.00 |
$6,700 |
$300 | Yes, some additional gap coverage. |
H5521
-120
-0 | $2.00 | $5.00 | $47.00 | $47.00 | 3,763
2020 Formulary |
|
|
|
|
2021 Aetna Medicare Elite Plan (PPO)
| $0.00 |
$7,550 |
$250 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
| |
2020 Bright Advantage (HMO)
| $0.00 |
$6,200 |
$95 | Yes, some additional gap coverage. |
H2288
-001
-0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,320
2020 Formulary |
| new |
new |
|
|
2021 Bright Advantage (HMO)
| $0.00 |
$6,200 |
$445 | Yes, some additional gap coverage. | $0.00 | $20.00 | $47.00 | $47.00 | 3,364
2021 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 |
2020 Bright Advantage Flex (PPO)
| $0.00 |
$6,500 |
$195 | Yes, some additional gap coverage. |
H9516
-001
-0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,320
2020 Formulary |
| new |
new |
new |
|
2021 Bright Advantage Choice (PPO)
| $0.00 |
$6,500 |
$445 | Yes, some additional gap coverage. | $0.00 | $20.00 | $47.00 | $47.00 | 3,364
2021 Formulary |
| |
-- This plan not offered in 2020 --
|
H2288
-009
-0 | | | | | |
| new |
new |
|
|
2021 Bright Advantage Senior Savings (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | 3,376
2021 Formulary |
| |
2020 Centers Plan for Medicare Advantage Care (HMO)
| $0.00 |
$6,700 |
$395 | No additional gap coverage, only the Donut Hole Discount |
H6988
-001
-0 | $3.00 | $15.00 | $47.00 | $47.00 | 3,181
2020 Formulary |
|
-- |
|
|
2021 Centers Plan for Medicare Advantage Care (HMO)
| $0.00 |
$7,550 |
$395 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $15.00 | $47.00 | $47.00 | 3,207
2021 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 |
2020 EmblemHealth VIP Essential (HMO)
| $0.00 |
$6,700 |
$295 | No additional gap coverage, only the Donut Hole Discount |
H3330
-032
-1 | $0.00 | $18.00 | $45.00 | $45.00 | 3,401
2020 Formulary |
|
|
|
|
2021 EmblemHealth VIP Essential (HMO)
| $0.00 |
$7,550 |
$295 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $42.00 | $42.00 | 3,429
2021 Formulary |
| |
2020 EmblemHealth VIP Part B Saver (HMO)
| $0.00 |
$6,700 |
$435 | No additional gap coverage, only the Donut Hole Discount |
H3330
-040
-0 | $0.00 | $18.00 | $45.00 | $45.00 | 3,401
2020 Formulary |
|
|
|
|
2021 EmblemHealth VIP Part B Saver (HMO)
| $0.00 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $42.00 | $42.00 | 3,429
2021 Formulary |
| |
-- This plan not offered in 2020 --
|
H5991
-009
-0 | | | | | |
|
-- |
|
|
2021 EmblemHealth VIP Reserve (HMO)
| $0.00 |
$7,550 |
$295 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $42.00 | $42.00 | 3,429
2021 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 |
2020 EmblemHealth VIP Value (HMO)
| $0.00 |
$6,700 |
$295 | No additional gap coverage, only the Donut Hole Discount |
H3330
-036
-0 | $0.00 | $18.00 | $45.00 | $45.00 | 3,401
2020 Formulary |
|
|
|
|
2021 EmblemHealth VIP Value (HMO)
| $0.00 |
$7,550 |
$295 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $42.00 | $42.00 | 3,429
2021 Formulary |
| |
-- This plan not offered in 2020 --
|
H8432
-037
-1 | | | | | |
|
|
|
|
2021 Empire MediBlue Core (HMO)
| $0.00 |
$7,550 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
| |
2020 Empire MediBlue Core Select (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H8432
-036
-0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2021 Empire MediBlue Core Select (HMO)
| $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 |
-- This plan not offered in 2020 --
|
H1732
-004
-0 | | | | | |
| new |
new |
new |
|
2021 Empire MediBlue HealthPlus (HMO)
| $0.00 |
$6,900 |
$350 | Yes, some additional gap coverage. | $3.00 | $15.00 | $42.00 | $42.00 | 3,639
2021 Formulary |
| |
2020 Empire MediBlue Select (HMO)
| $0.00 |
$6,400 |
$350 | Yes, some additional gap coverage. |
H8432
-027
-0 | $3.00 | $15.00 | $42.00 | $42.00 | 3,780
2020 Formulary |
|
|
|
|
2021 Empire MediBlue Select (HMO)
| $0.00 |
$7,550 |
$350 | Yes, some additional gap coverage. | $3.00 | $15.00 | $42.00 | $42.00 | 3,639
2021 Formulary |
| |
2020 Healthfirst 65 Plus Plan (HMO)
| $0.00 |
$6,700 |
$350 | No additional gap coverage, only the Donut Hole Discount |
H3359
-001
-0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,098
2020 Formulary |
|
|
|
|
2021 Healthfirst 65 Plus Plan (HMO)
| $0.00 |
$7,550 |
$350 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,168
2021 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 |
2020 Healthfirst Coordinated Benefits Plan (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H3359
-027
-0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2021 Healthfirst Coordinated Benefits Plan (HMO)
| $0.00 |
$7,550 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
| |
-- This plan not offered in 2020 --
|
H5989
-011
-0 | | | | | |
| -- |
-- |
-- |
|
2021 Healthfirst Signature (HMO)
| $0.00 |
$7,550 |
$350 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,168
2021 Formulary |
| |
2020 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 | 3,117
2020 Formulary |
|
|
|
|
2021 Humana Gold Plus H3533-027 (HMO)
| $0.00 |
$7,550 |
$400 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $16.00 | $47.00 | $47.00 | 3,172
2021 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 2020 --
|
H3533
-033
-0 | | | | | |
|
|
|
|
2021 Humana Gold Plus H3533-033 (HMO)
| $0.00 |
$7,550 |
$350 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $9.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
| |
2020 HumanaChoice H5970-016 (PPO)
| $0.00 |
$4,500 |
No Rx Coverage |
H5970
-016
-0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2021 Humana Honor (PPO)
| $0.00 |
$4,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
| |
-- This plan not offered in 2020 --
|
H5970
-024
-1 | | | | | |
|
|
|
|
2021 HumanaChoice H5970-024 (PPO)
| $0.00 |
$7,200 |
$350 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $9.00 | $47.00 | $47.00 | 3,386
2021 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 |
2020 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% | | 3,427
2020 Formulary |
| -- |
-- |
-- |
|
2021 PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | All Generics,
All Brands | | | | | 3,560
2021 Formulary |
| |
2020 UnitedHealthcare Medicare Advantage Essential (Regional PPO)
| $0.00 |
$6,700 |
No Rx Coverage |
R5342
-002
-0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2021 UnitedHealthcare Medicare Advantage Patriot (Regional PPO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
| |
-- This plan not offered in 2020 --
|
H2775
-111
-0 | | | | | |
|
|
|
|
2021 WellCare Absolute (PPO)
| $0.00 |
$7,550 |
$150 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | 3,348
2021 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 2020 --
|
H4868
-020
-0 | | | | | |
|
new |
|
|
2021 WellCare Choice (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
| |
2020 WellCare Element (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H4868
-022
-0 | $0.00 | $15.00 | $47.00 | $47.00 | 3,274
2020 Formulary |
|
new |
|
|
2021 WellCare Element (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $15.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
| |
2020 WellCare Today's Options Advantage Plus 550B (PPO)
| $10.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2775
-106
-0 | $2.00 | $7.00 | $37.00 | $37.00 | 3,102
2020 Formulary |
|
|
|
|
2021 WellCare Today's Options Advantage Plus 550B (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $7.00 | $37.00 | $37.00 | 3,348
2021 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 2020 --
|
H2775
-113
-0 | | | | | |
|
|
|
|
2021 WellCare Summit (PPO)
| $5.10 |
$6,700 |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
| |
2020 WellCare Rx (HMO)
| $13.00 |
$6,700 |
$435 | No additional gap coverage, only the Donut Hole Discount |
H4868
-016
-0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,274
2020 Formulary |
|
new |
|
|
2021 WellCare Compass (HMO)
| $12.30 |
$6,700 |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
| |
-- This plan not offered in 2020 --
|
H2775
-112
-0 | | | | | |
|
|
|
|
2021 WellCare Imperial (PPO D-SNP)
| $12.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $9.00 | $45.00 | $45.00 | 3,348
2021 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 |
2020 Empire MediBlue Plus (HMO)
| $0.00 |
$6,700 |
$350 | No additional gap coverage, only the Donut Hole Discount |
H8432
-008
-6 | $0.00 | $15.00 | $42.00 | $42.00 | 2,847
2020 Formulary |
|
|
|
|
2021 Empire MediBlue Plus (HMO)
| $16.00 |
$7,550 |
$350 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $42.00 | $42.00 | 2,902
2021 Formulary |
| |
2020 UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO)
| $16.00 |
$6,700 |
$300 | No additional gap coverage, only the Donut Hole Discount |
R5342
-001
-0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,601
2020 Formulary |
|
|
|
|
2021 UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO)
| $16.00 |
$6,700 |
$300 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
| |
-- This plan not offered in 2020 --
|
H3533
-032
-1 | | | | | |
|
|
|
|
2021 Humana Gold Plus H3533-032 (HMO)
| $21.00 |
$6,500 |
$200 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $9.00 | $47.00 | $47.00 | 3,386
2021 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 2020 --
|
H5599
-001
-0 | | | | | |
| new |
new |
new |
|
2021 Fidelis Dual Advantage Flex (HMO D-SNP)
| $21.60 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | 24% | 24% | 3,168
2021 Formulary |
| |
-- This plan not offered in 2020 --
|
H5521
-312
-0 | | | | | |
|
|
|
|
2021 Aetna Medicare Value Plan (PPO)
| $22.00 |
$7,550 |
$250 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
| |
-- This plan not offered in 2020 --
|
H5599
-003
-0 | | | | | |
| new |
new |
new |
|
2021 Fidelis Medicaid Advantage Plus (HMO D-SNP)
| $22.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $7.00 | $40.00 | $40.00 | 3,168
2021 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 2020 --
|
H5599
-006
-0 | | | | | |
| new |
new |
new |
|
2021 Fidelis Dual Advantage (HMO D-SNP)
| $22.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,168
2021 Formulary |
| |
2020 Elderplan Extra Help (HMO)
| $23.80 |
$6,700 |
$435 | No additional gap coverage, only the Donut Hole Discount |
H3347
-009
-0 | $4.00 | $20.00 | $47.00 | $47.00 | 3,175
2020 Formulary |
|
|
|
|
2021 Elderplan Extra Help (HMO)
| $25.30 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | $47.00 | $47.00 | 3,235
2021 Formulary |
| |
-- This plan not offered in 2020 --
|
H3312
-069
-0 | | | | | |
|
 |
|
|
2021 Aetna Medicare Assure Plan (HMO D-SNP)
| $25.70 |
n/a |
$190 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $47.00 | $47.00 | 3,659
2021 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 |
2020 WellCare Access (HMO D-SNP)
| $27.40 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H4868
-014
-0 | $0.00 | $7.00 | $47.00 | $47.00 | 3,274
2020 Formulary |
|
new |
|
|
2021 WellCare Access (HMO D-SNP)
| $27.10 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $4.00 | $40.00 | $40.00 | 3,348
2021 Formulary |
| |
2020 Elderplan Plus Long Term Care (HMO D-SNP)
| $35.00 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H3347
-007
-0 | 15% | | | | 3,174
2020 Formulary |
|
|
|
|
2021 Elderplan Plus Long Term Care (HMO D-SNP)
| $31.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,235
2021 Formulary |
| |
2020 UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
| $34.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H2292
-002
-0 | 25% | 25% | 25% | 25% | 3,601
2020 Formulary |
|
new |
|
|
2021 UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
| $32.60 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,604
2021 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 2020 --
|
H2288
-010
-0 | | | | | |
| new |
new |
|
|
2021 Bright Advantage Senior Savings Assist (HMO C-SNP)
| $33.90 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | 3,376
2021 Formulary |
| |
2020 AARP Medicare Advantage Plan 2 (HMO)
| $29.00 |
$6,700 |
$415 | No additional gap coverage, only the Donut Hole Discount |
H3379
-001
-0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,601
2020 Formulary |
|
|
|
|
2021 AARP Medicare Advantage Plan 2 (HMO)
| $34.00 |
$6,700 |
$395 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
| |
2020 Elderplan For Medicaid Beneficiaries (HMO D-SNP)
| $31.70 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H3347
-002
-0 | 15% | | | | 3,174
2020 Formulary |
|
|
|
|
2021 Elderplan For Medicaid Beneficiaries (HMO D-SNP)
| $35.40 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,235
2021 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 |
2020 Elderplan Advantage For Nursing Home Residents (HMO I-SNP)
| $36.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H3347
-003
-0 | 25% | | | | 3,174
2020 Formulary |
|
|
|
|
2021 Elderplan Advantage For Nursing Home Residents (HMO I-SNP)
| $35.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,235
2021 Formulary |
| |
2020 UnitedHealthcare Nursing Home Plan 2 (HMO I-SNP)
| $34.90 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H3379
-002
-0 | 25% | 25% | 25% | 25% | 3,601
2020 Formulary |
|
|
|
|
2021 UnitedHealthcare Nursing Home Plan 2 (HMO I-SNP)
| $35.90 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,604
2021 Formulary |
| |
2020 Aetna Medicare Elite Plan (HMO)
| $34.00 |
$6,700 |
$300 | Yes, some additional gap coverage. |
H3312
-068
-0 | $2.00 | $5.00 | $47.00 | $47.00 | 3,763
2020 Formulary |
|
|
|
|
2021 Aetna Medicare Elite Plan (HMO)
| $39.00 |
$7,550 |
$300 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,659
2021 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 2020 --
|
H5521
-310
-0 | | | | | |
|
|
|
|
2021 Aetna Medicare Elite Plan 3 (PPO)
| $39.00 |
$7,550 |
$300 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
| |
-- This plan not offered in 2020 --
|
H3533
-031
-0 | | | | | |
|
|
|
|
2021 Humana Gold Plus SNP-DE H3533-031 (HMO D-SNP)
| $40.30 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $20.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
| |
2020 AgeWell New York Advantage Plus (HMO D-SNP)
| $36.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H4922
-010
-0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,426
2020 Formulary |
|
-- |
|
|
2021 AgeWell New York Advantage Plus (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,559
2021 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 |
2020 AgeWell New York CareWell (HMO I-SNP)
| $36.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H4922
-004
-0 | 25% | 25% | 25% | 25% | 3,426
2020 Formulary |
|
-- |
|
|
2021 AgeWell New York CareWell (HMO I-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,559
2021 Formulary |
| |
2020 AgeWell New York FeelWell (HMO D-SNP)
| $36.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H4922
-003
-0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,426
2020 Formulary |
|
-- |
|
|
2021 AgeWell New York FeelWell (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,559
2021 Formulary |
| |
2020 AgeWell New York LiveWell (HMO)
| $36.60 |
$6,700 |
$290 | Yes, some additional gap coverage. |
H4922
-011
-0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,426
2020 Formulary |
|
-- |
|
|
2021 AgeWell New York LiveWell (HMO)
| $42.30 |
$7,550 |
$350 | Yes, some additional gap coverage. | $3.00 | $15.00 | $47.00 | $47.00 | 3,559
2021 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 |
2020 ArchCare Advantage (HMO I-SNP)
| $36.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H1777
-007
-0 | 25% | | | | 3,034
2020 Formulary |
|
-- |
|
|
2021 ArchCare Advantage (HMO I-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,100
2021 Formulary |
| |
2020 Bright Advantage Assist (HMO)
| $36.60 |
$6,500 |
$435 | Yes, some additional gap coverage. |
H2288
-005
-0 | $0.00 | 25% | 25% | 25% | 3,320
2020 Formulary |
| new |
new |
|
|
2021 Bright Advantage Assist (HMO)
| $42.30 |
$6,500 |
$445 | Yes, some additional gap coverage. | $0.00 | 25% | 25% | 25% | 3,364
2021 Formulary |
| |
-- This plan not offered in 2020 --
|
H2288
-003
-0 | | | | | |
| new |
new |
|
|
2021 Bright Advantage Special Care (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,364
2021 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 |
2020 Centers Plan for Dual Coverage Care (HMO D-SNP)
| $36.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H6988
-002
-0 | 15% | | | | 3,181
2020 Formulary |
|
-- |
|
|
2021 Centers Plan for Dual Coverage Care (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,207
2021 Formulary |
| |
2020 Centers Plan for Nursing Home Care (HMO I-SNP)
| $36.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H6988
-003
-0 | 25% | | | | 3,181
2020 Formulary |
|
-- |
|
|
2021 Centers Plan for Nursing Home Care (HMO I-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,207
2021 Formulary |
| |
2020 Elderplan Assist (HMO I-SNP)
| $36.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H3347
-015
-0 | $3.00 | $19.00 | $47.00 | $47.00 | 3,175
2020 Formulary |
|
|
|
|
2021 Elderplan Assist (HMO I-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $14.00 | $47.00 | $47.00 | 3,235
2021 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 |
2020 EmblemHealth VIP Assist (HMO D-SNP)
| $36.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H5991
-008
-0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,401
2020 Formulary |
|
-- |
|
|
2021 EmblemHealth VIP Assist (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,429
2021 Formulary |
| |
2020 EmblemHealth VIP Connect (HMO D-SNP)
| $36.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H5991
-007
-0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,401
2020 Formulary |
|
-- |
|
|
2021 EmblemHealth VIP Connect (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,429
2021 Formulary |
| |
2020 EmblemHealth VIP Dual (HMO D-SNP)
| $36.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H3330
-042
-1 | $0.00 | $0.00 | $0.00 | $0.00 | 3,401
2020 Formulary |
|
|
|
|
2021 EmblemHealth VIP Dual (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,429
2021 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 2020 --
|
H5991
-010
-0 | | | | | |
|
-- |
|
|
2021 EmblemHealth VIP Dual Reserve (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,429
2021 Formulary |
| |
2020 EmblemHealth VIP Dual Select (HMO D-SNP)
| $36.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H5991
-001
-0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,401
2020 Formulary |
|
-- |
|
|
2021 EmblemHealth VIP Dual Select (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,429
2021 Formulary |
| |
2020 EmblemHealth VIP Passport NYC (HMO)
| $32.00 |
$6,700 |
$295 | No additional gap coverage, only the Donut Hole Discount |
H5991
-006
-0 | $0.00 | $18.00 | $45.00 | $45.00 | 3,401
2020 Formulary |
|
-- |
|
|
2021 EmblemHealth VIP Passport NYC (HMO)
| $42.30 |
$7,550 |
$295 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $42.00 | $42.00 | 3,429
2021 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 |
2020 EmblemHealth VIP Solutions (HMO D-SNP)
| $36.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H5991
-002
-0 | 15% | 15% | 15% | 15% | 3,401
2020 Formulary |
|
-- |
|
|
2021 EmblemHealth VIP Solutions (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,429
2021 Formulary |
| |
2020 Empire MediBlue Dual Advantage (HMO D-SNP)
| $36.60 |
n/a |
$435 | Yes, some additional gap coverage. |
H8432
-007
-0 | $0.00 | $6.00 | $47.00 | $47.00 | 3,780
2020 Formulary |
|
|
|
|
2021 Empire MediBlue Dual Advantage (HMO D-SNP)
| $42.30 |
n/a |
$445 | Yes, some additional gap coverage. | $0.00 | $6.00 | $47.00 | $47.00 | 3,639
2021 Formulary |
| |
2020 Empire MediBlue Dual Advantage Select (HMO D-SNP)
| $36.60 |
n/a |
$435 | Yes, some additional gap coverage. |
H8432
-028
-0 | $0.00 | $7.00 | $47.00 | $47.00 | 3,780
2020 Formulary |
|
|
|
|
2021 Empire MediBlue Dual Advantage Select (HMO D-SNP)
| $42.30 |
n/a |
$445 | Yes, some additional gap coverage. | $0.00 | $7.00 | $47.00 | $47.00 | 3,639
2021 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 |
2020 Empire MediBlue Extra (HMO)
| $21.70 |
$5,900 |
$435 | Yes, some additional gap coverage. |
H8432
-035
-0 | $0.00 | $15.00 | $47.00 | $47.00 | 3,780
2020 Formulary |
|
|
|
|
2021 Empire MediBlue Extra Select (HMO)
| $42.30 |
$5,900 |
$445 | Yes, some additional gap coverage. | $0.00 | $15.00 | $47.00 | $47.00 | 3,639
2021 Formulary |
| |
-- This plan not offered in 2020 --
|
H1732
-002
-0 | | | | | |
| new |
new |
new |
|
2021 Empire MediBlue HealthPlus Dual Advantage (HMO D-SNP)
| $42.30 |
n/a |
$445 | Yes, some additional gap coverage. | $0.00 | $6.00 | $47.00 | $47.00 | 3,639
2021 Formulary |
| |
-- This plan not offered in 2020 --
|
H1732
-003
-0 | | | | | |
| new |
new |
new |
|
2021 Empire MediBlue HealthPlus Dual Connect (HMO D-SNP)
| $42.30 |
n/a |
$445 | Yes, some additional gap coverage. | $0.00 | $7.00 | $47.00 | $47.00 | 3,639
2021 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 2020 --
|
H1732
-001
-0 | | | | | |
| new |
new |
new |
|
2021 Empire MediBlue HealthPlus Dual Plus (HMO D-SNP)
| $42.30 |
n/a |
$445 | Yes, some additional gap coverage. | $0.00 | $6.00 | $47.00 | $47.00 | 3,639
2021 Formulary |
| |
-- This plan not offered in 2020 --
|
H0034
-002
-0 | | | | | |
| new |
new |
new |
|
2021 Hamaspik Medicare Choice (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,655
2021 Formulary |
| |
2020 Hamaspik Medicare Select (HMO D-SNP)
| $36.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H0034
-001
-0 | 15% | | | | 3,807
2020 Formulary |
| new |
new |
new |
|
2021 Hamaspik Medicare Select (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,655
2021 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 |
2020 Healthfirst CompleteCare (HMO D-SNP)
| $36.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H3359
-034
-0 | $0.00 | | | | 3,172
2020 Formulary |
|
|
|
|
2021 Healthfirst CompleteCare (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,233
2021 Formulary |
| |
2020 Healthfirst Increased Benefits Plan (HMO)
| $36.60 |
$6,700 |
$435 | No additional gap coverage, only the Donut Hole Discount |
H3359
-019
-0 | 25% | | | | 3,172
2020 Formulary |
|
|
|
|
2021 Healthfirst Increased Benefits Plan (HMO)
| $42.30 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,233
2021 Formulary |
| |
2020 Healthfirst Life Improvement Plan (HMO D-SNP)
| $36.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H3359
-021
-0 | $0.00 | | | | 3,172
2020 Formulary |
|
|
|
|
2021 Healthfirst Life Improvement Plan (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,233
2021 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 2020 --
|
H1205
-007
-0 | | | | | |
| new |
new |
new |
|
2021 Integra Balanced Medicaid Advantage (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,359
2021 Formulary |
| |
2020 Integra Harmony (HMO D-SNP)
| $36.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H1205
-001
-0 | 15% | | | | 3,305
2020 Formulary |
| new |
new |
new |
|
2021 Integra Harmony (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,359
2021 Formulary |
| |
2020 Integra Synergy Medicaid Advantage Plus (MAP) (HMO D-SNP)
| $36.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H1205
-002
-0 | $0.00 | | | | 3,305
2020 Formulary |
| new |
new |
new |
|
2021 Integra Synergy Medicaid Advantage Plus (MAP) (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,359
2021 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 |
2020 Longevity Health Plan (HMO I-SNP)
| $36.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H8457
-001
-0 | 25% | | | | 3,717
2020 Formulary |
| new |
new |
|
|
2021 Longevity Health Plan (HMO I-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,764
2021 Formulary |
| |
2020 MetroPlus Advantage Plan (HMO D-SNP)
| $36.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H0423
-001
-0 | 15% | | | | 3,174
2020 Formulary |
|
|
|
|
2021 MetroPlus Advantage Plan (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,288
2021 Formulary |
| |
-- This plan not offered in 2020 --
|
H0423
-007
-0 | | | | | |
|
|
|
|
2021 MetroPlus UltraCare (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,288
2021 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 |
2020 RiverSpring MAP (HMO D-SNP)
| $36.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H6776
-002
-0 | 15% | | | | 3,268
2020 Formulary |
| -- |
-- |
-- |
|
2021 RiverSpring MAP (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,387
2021 Formulary |
| |
2020 RiverSpring Star (HMO I-SNP)
| $36.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H6776
-001
-0 | 25% | | | | 3,268
2020 Formulary |
| -- |
-- |
-- |
|
2021 RiverSpring Star (HMO I-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,387
2021 Formulary |
| |
2020 Senior Whole Health of New York NHC (HMO D-SNP)
| $36.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H5992
-007
-0 | 15% | | | | 3,392
2020 Formulary |
| -- |
-- |
-- |
|
2021 Senior Whole Health of New York NHC (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,396
2021 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 |
2020 UnitedHealthcare Assisted Living Plan (PPO I-SNP)
| $20.30 |
n/a |
$200 | No additional gap coverage, only the Donut Hole Discount |
H2292
-003
-0 | $2.00 | $12.00 | $47.00 | $47.00 | 3,601
2020 Formulary |
|
new |
|
|
2021 UnitedHealthcare Assisted Living Plan (PPO I-SNP)
| $42.30 |
n/a |
$200 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $12.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
| |
2020 UnitedHealthcare Dual Complete (HMO D-SNP)
| $29.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H3387
-010
-0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,601
2020 Formulary |
|
|
|
|
2021 UnitedHealthcare Dual Complete (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,604
2021 Formulary |
| |
2020 VillageCareMAX Medicare Health Advantage (HMO D-SNP)
| $36.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H2168
-001
-0 | 15% | | | | 3,181
2020 Formulary |
|
-- |
|
|
2021 VillageCareMAX Medicare Health Advantage (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,207
2021 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 |
2020 VNSNY CHOICE Total (HMO D-SNP)
| $36.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H5549
-003
-0 | $7.00 | $19.00 | $47.00 | $47.00 | 3,562
2020 Formulary |
|
|
|
|
2021 VNSNY CHOICE Total (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $19.00 | $47.00 | $47.00 | 3,560
2021 Formulary |
| |
2020 UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO)
| $46.00 |
$6,700 |
$275 | No additional gap coverage, only the Donut Hole Discount |
R5342
-005
-0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,601
2020 Formulary |
|
|
|
|
2021 UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO)
| $46.00 |
$6,700 |
$275 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
| |
2020 AARP Medicare Advantage Plan 1 (HMO)
| $49.00 |
$6,700 |
$395 | No additional gap coverage, only the Donut Hole Discount |
H3307
-002
-0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,601
2020 Formulary |
|
|
|
|
2021 AARP Medicare Advantage Plan 1 (HMO)
| $54.00 |
$6,700 |
$395 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $47.00 | $47.00 | 3,604
2021 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 |
2020 Bright Advantage Plus (HMO)
| $55.00 |
$4,900 |
$0 | Yes, some additional gap coverage. |
H2288
-002
-0 | $0.00 | $8.00 | $47.00 | $47.00 | 3,320
2020 Formulary |
| new |
new |
|
|
2021 Bright Advantage Plus (HMO)
| $59.00 |
$4,900 |
$445 | Yes, some additional gap coverage. | $0.00 | $20.00 | $47.00 | $47.00 | 3,364
2021 Formulary |
| |
2020 EmblemHealth VIP Go (HMO-POS)
| $71.00 |
$6,700 |
$250 | No additional gap coverage, only the Donut Hole Discount |
H3330
-041
-1 | $0.00 | $18.00 | $45.00 | $45.00 | 3,401
2020 Formulary |
|
|
|
|
2021 EmblemHealth VIP Go (HMO-POS)
| $72.00 |
$7,550 |
$250 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $42.00 | $42.00 | 3,429
2021 Formulary |
| |
2020 WellCare Preferred (HMO)
| $81.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H4868
-010
-0 | $0.00 | $15.00 | $47.00 | $47.00 | 3,274
2020 Formulary |
|
new |
|
|
2021 WellCare Preferred (HMO)
| $81.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $15.00 | $47.00 | $47.00 | 3,348
2021 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 |
2020 UnitedHealthcare Medicare Advantage Choice Plan 4 (Regional PPO)
| $79.00 |
$6,700 |
$150 | No additional gap coverage, only the Donut Hole Discount |
R5342
-006
-0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,601
2020 Formulary |
|
|
|
|
2021 UnitedHealthcare Medicare Advantage Choice Plan 4 (Regional PPO)
| $84.00 |
$6,700 |
$150 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
| |
2020 Bright Advantage Flex Plus (PPO)
| $95.00 |
$4,900 |
$0 | Yes, some additional gap coverage. |
H9516
-002
-0 | $0.00 | $8.00 | $47.00 | $47.00 | 3,320
2020 Formulary |
| new |
new |
new |
|
2021 Bright Advantage Choice Plus (PPO)
| $95.00 |
$4,900 |
$445 | Yes, some additional gap coverage. | $0.00 | $20.00 | $47.00 | $47.00 | 3,364
2021 Formulary |
| |
2020 EmblemHealth VIP Gold (HMO)
| $95.00 |
$6,700 |
$200 | No additional gap coverage, only the Donut Hole Discount |
H3330
-021
-1 | $0.00 | $10.00 | $40.00 | $40.00 | 3,401
2020 Formulary |
|
|
|
|
2021 EmblemHealth VIP Gold (HMO)
| $96.00 |
$7,550 |
$200 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $10.00 | $40.00 | $40.00 | 3,429
2021 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 |
2020 Aetna Medicare Premier Plan (PPO)
| $83.00 |
$6,700 |
$250 | Yes, some additional gap coverage. |
H5521
-040
-0 | $3.00 | $7.00 | $47.00 | $47.00 | 3,763
2020 Formulary |
|
|
|
|
2021 Aetna Medicare Premier Plan (PPO)
| $99.00 |
$7,550 |
$200 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
| |
-- This plan not offered in 2020 --
|
H6988
-005
-0 | | | | | |
|
-- |
|
|
2021 Centers Plan for Medicaid Advantage (HMO D-SNP)
| $101.00 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,207
2021 Formulary |
| |
2020 Centers Plan for Medicaid Advantage Plus (HMO D-SNP)
| $76.00 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H6988
-004
-0 | $0.00 | | | | 3,181
2020 Formulary |
|
-- |
|
|
2021 Centers Plan for Medicaid Advantage Plus (HMO D-SNP)
| $101.00 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,207
2021 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 |
2020 VillageCareMAX Medicare Total Advantage (HMO D-SNP)
| $101.00 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H2168
-002
-0 | $0.00 | | | | 3,181
2020 Formulary |
|
-- |
|
|
2021 VillageCareMAX Medicare Total Advantage (HMO D-SNP)
| $116.00 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,207
2021 Formulary |
| |
2020 WellCare Today's Options Advantage Plus 150A (PPO)
| $136.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2775
-105
-0 | $0.00 | $5.00 | $35.00 | $35.00 | 3,102
2020 Formulary |
|
|
|
|
2021 WellCare Today's Options Advantage Plus 150A (PPO)
| $121.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $35.00 | $35.00 | 3,348
2021 Formulary |
| |
2020 MetroPlus Platinum Plan (HMO)
| $141.00 |
$6,700 |
$435 | No additional gap coverage, only the Donut Hole Discount |
H0423
-004
-0 | 25% | | | | 3,174
2020 Formulary |
|
|
|
|
2021 MetroPlus Platinum Plan (HMO)
| $148.50 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,288
2021 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 |
2020 EmblemHealth VIP Gold Plus (HMO)
| $301.00 |
$6,700 |
$200 | No additional gap coverage, only the Donut Hole Discount |
H3330
-038
-0 | $0.00 | $10.00 | $40.00 | $40.00 | 3,401
2020 Formulary |
|
|
|
|
2021 EmblemHealth VIP Gold Plus (HMO)
| $302.00 |
$7,550 |
$200 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $10.00 | $40.00 | $40.00 | 3,429
2021 Formulary |
| |
2020 Bright Advantage Choice (HMO)
| $0.00 |
$6,700 |
$295 | Yes, some additional gap coverage. |
H2288
-008
-0 | $5.00 | $20.00 | $47.00 | $47.00 | 3,320
2020 Formulary |
| new |
new |
|
|
-- Members will be assigned to Bright Advantage (HMO) H2288-001-0 --
| | | | | |
| |
2020 Empire MediBlue Core (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H8432
-012
-0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
-- Members will be assigned to Empire MediBlue Core (HMO) H8432-037-1 --
| | | | | |
| |
| 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 |
2020 Humana Gold Plus H3533-021 (HMO)
| $20.00 |
$6,500 |
$200 | No additional gap coverage, only the Donut Hole Discount |
H3533
-021
-0 | $2.00 | $9.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
-- Members will be assigned to Humana Gold Plus H3533-032 (HMO) H3533-032-1 --
| | | | | |
| |
2020 Humana Gold Plus SNP-DE H3533-029 (HMO D-SNP)
| $33.60 |
n/a |
$390 | No additional gap coverage, only the Donut Hole Discount |
H3533
-029
-1 | $0.00 | $20.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
-- Members will be assigned to Humana Gold Plus SNP-DE H3533-031 (HMO D-SNP) H3533-031-0 --
| | | | | |
| |
2020 HumanaChoice H5970-021 (PPO)
| $0.00 |
$6,700 |
$350 | No additional gap coverage, only the Donut Hole Discount |
H5970
-021
-0 | $2.00 | $9.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
-- Members will be assigned to HumanaChoice H5970-024 (PPO) H5970-024-1 --
| | | | | |
| |
| 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 |
2020 WellCare Choice (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H4868
-021
-0 | $0.00 | $15.00 | $47.00 | $47.00 | 3,274
2020 Formulary |
|
new |
|
|
-- Members will be assigned to WellCare Choice (HMO) H4868-020-0 --
| | | | | |
| |
2020 Health Pointe Direct Complete Plan (HMO I-SNP)
| $36.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H1722
-001
-0 | 25% | | | | 3,721
2020 Formulary |
| new |
new |
new |
|
-- This plan not offered in 2021 --
|
| | | | |
| |
2020 ArchCare Community Choice (HMO D-SNP)
| $36.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H1777
-014
-0 | $0.00 | | | | 3,034
2020 Formulary |
|
-- |
|
|
-- This plan not offered in 2021 --
|
| | | | |
| |
| 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 |
2020 Advantage Health NYC - SNP (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H2773
-017
-0 | $0.00 | $10.00 | $35.00 | $35.00 | n/a |
| -- |
-- |
|
|
-- This plan not offered in 2021 --
|
| | | | |
| |
2020 Advantage Value One NY - Dual (HMO D-SNP)
| $25.00 |
n/a |
$385 | Yes, some additional gap coverage. |
H2773
-018
-0 | $0.00 | $20.00 | $47.00 | $47.00 | n/a |
| -- |
-- |
|
|
-- This plan not offered in 2021 --
|
| | | | |
| |
2020 Advantage Silver - NY City (HMO)
| $0.00 |
$5,990 |
$0 | Yes, some additional gap coverage. |
H2773
-020
-0 | $0.00 | $10.00 | $35.00 | $35.00 | n/a |
| -- |
-- |
|
|
-- This plan not offered in 2021 --
|
| | | | |
| |
| 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 |
2020 Fidelis Dual Advantage (HMO D-SNP)
| $31.80 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3328
-002
-0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,098
2020 Formulary |
|
|
|
|
-- This plan not offered in 2021 --
|
| | | | |
| |
2020 Fidelis Dual Advantage Flex (HMO D-SNP)
| $27.10 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3328
-017
-0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,098
2020 Formulary |
|
|
|
|
-- This plan not offered in 2021 --
|
| | | | |
| |
2020 Fidelis Medicaid Advantage Plus (HMO D-SNP)
| $17.40 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H3328
-023
-1 | $0.00 | $15.00 | 23% | 23% | 3,098
2020 Formulary |
|
|
|
|
-- This plan not offered in 2021 --
|
| | | | |
| |
| 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 |
2020 Humana Gold Plus H3533-023 (HMO)
| $48.00 |
$5,400 |
$200 | No additional gap coverage, only the Donut Hole Discount |
H3533
-023
-0 | $0.00 | $9.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
-- This plan not offered in 2021 --
|
| | | | |
| |
2020 HumanaChoice H5970-022 (PPO)
| $98.00 |
$4,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5970
-022
-0 | $0.00 | $9.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
-- This plan not offered in 2021 --
|
| | | | |
| |
2020 HumanaChoice H5970-023 (PPO)
| $207.00 |
$3,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5970
-023
-0 | $5.00 | $12.00 | $47.00 | $47.00 | 3,117
2020 Formulary |
|
|
|
|
-- This plan not offered in 2021 --
|
| | | | |
| |
| 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 |
2020 CenterLight Healthcare Direct Complete Plan (HMO I-SNP)
| $36.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H5989
-002
-0 | $5.25 | 25% | | | 3,727
2020 Formulary |
| -- |
-- |
-- |
|
-- This plan not offered in 2021 --
|
| | | | |
| |
