There are 118 Medicare Advantage plans meeting your criteria.
2021 / 2022 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 |
2021 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 | 3,604
2021 Formulary |
 |
 |
 |
|
2022 AARP Medicare Advantage Mosaic Choice (PPO)
| $0.00 |
$6,900 |
$250 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | 3,654
2022 Formulary |
| |
2021 AARP Medicare Advantage Patriot (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H3307
-018
-0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 AARP Medicare Advantage Patriot (HMO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
| |
2021 AARP Medicare Advantage Prime (HMO)
| $0.00 |
$6,700 |
$295 | No additional gap coverage, only the Donut Hole Discount |
H3307
-015
-0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
2022 AARP Medicare Advantage Prime (HMO)
| $0.00 |
$7,550 |
$295 | Yes, some additional gap coverage. | $3.00 | $12.00 | $47.00 | $47.00 | 3,654
2022 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 |
2021 Aetna Medicare Eagle Plan (PPO)
| $0.00 |
$7,550 |
No Rx Coverage |
H5521
-320
-0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Aetna Medicare Eagle Plan (PPO)
| $0.00 |
$7,550 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
| |
2021 Aetna Medicare Elite Plan (PPO)
| $0.00 |
$7,550 |
$250 | Yes, some additional gap coverage. |
H5521
-120
-0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Elite Plan (PPO)
| $0.00 |
$7,550 |
$300 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,672
2022 Formulary |
| |
2021 Bright Advantage (HMO)
| $0.00 |
$6,200 |
$445 | Yes, some additional gap coverage. |
H2288
-001
-0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,364
2021 Formulary |
|
-- |
|
|
2022 Bright Advantage Classic Care Plan (HMO)
| $0.00 |
$6,200 |
$250 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,133
2022 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 |
2021 Bright Advantage Senior Savings (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H2288
-009
-0 | $0.00 | $12.00 | $47.00 | $47.00 | 3,376
2021 Formulary |
|
-- |
|
|
2022 Bright Advantage Embrace Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Some Generics | $0.00 | $12.00 | $47.00 | $47.00 | 3,133
2022 Formulary |
| |
2021 Centers Plan for Medicare Advantage Care (HMO)
| $0.00 |
$7,550 |
$395 | No additional gap coverage, only the Donut Hole Discount |
H6988
-001
-0 | $3.00 | $15.00 | $47.00 | $47.00 | 3,207
2021 Formulary |
|
-- |
|
|
2022 Centers Plan for Medicare Advantage Care (HMO)
| $0.00 |
$7,550 |
$395 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $47.00 | $47.00 | 3,133
2022 Formulary |
| |
2021 EmblemHealth VIP Essential (HMO)
| $0.00 |
$7,550 |
$295 | No additional gap coverage, only the Donut Hole Discount |
H3330
-032
-1 | $2.00 | $15.00 | $42.00 | $42.00 | 3,429
2021 Formulary |
|
-- |
|
|
2022 EmblemHealth VIP Essential (HMO)
| $0.00 |
$7,550 |
$325 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $42.00 | $42.00 | 3,453
2022 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 |
2021 EmblemHealth VIP Reserve (HMO)
| $0.00 |
$7,550 |
$295 | No additional gap coverage, only the Donut Hole Discount |
H5991
-009
-0 | $2.00 | $15.00 | $42.00 | $42.00 | 3,429
2021 Formulary |
|
-- |
|
|
2022 EmblemHealth VIP Reserve (HMO)
| $0.00 |
$7,550 |
$325 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $42.00 | $42.00 | 3,453
2022 Formulary |
| |
2021 EmblemHealth VIP Value (HMO)
| $0.00 |
$7,550 |
$295 | No additional gap coverage, only the Donut Hole Discount |
H3330
-036
-0 | $2.00 | $15.00 | $42.00 | $42.00 | 3,429
2021 Formulary |
|
-- |
|
|
2022 EmblemHealth VIP Value (HMO)
| $0.00 |
$7,550 |
$325 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $42.00 | $42.00 | 3,453
2022 Formulary |
| |
2021 Empire MediBlue HealthPlus (HMO)
| $0.00 |
$6,900 |
$350 | Yes, some additional gap coverage. |
H1732
-004
-0 | $3.00 | $15.00 | $42.00 | $42.00 | 3,639
2021 Formulary |
|
new |
new |
|
2022 Empire MediBlue HealthPlus (HMO)
| $0.00 |
$6,900 |
$350 | Yes, some additional gap coverage. | $3.00 | $15.00 | $42.00 | $42.00 | 3,626
2022 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 2021 --
|
H1732
-007
-0 | | | | | |
|
new |
new |
|
2022 Empire MediBlue HealthPlus Select (HMO)
| $0.00 |
$6,900 |
$350 | Yes, some additional gap coverage. | $0.00 | $15.00 | $35.00 | $35.00 | 3,626
2022 Formulary |
| |
2021 Empire MediBlue Select (HMO)
| $0.00 |
$7,550 |
$350 | Yes, some additional gap coverage. |
H8432
-027
-0 | $3.00 | $15.00 | $42.00 | $42.00 | 3,639
2021 Formulary |
|
 |
|
|
2022 Empire MediBlue Select (HMO)
| $0.00 |
$7,550 |
$350 | Yes, some additional gap coverage. | $3.00 | $15.00 | $42.00 | $42.00 | 3,626
2022 Formulary |
| |
2021 Empire MediBlue Core (HMO)
| $0.00 |
$7,550 |
No Rx Coverage |
H8432
-037
-1 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Empire MediBlue Service (HMO)
| $0.00 |
$7,550 |
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 |
2021 Empire MediBlue Core Select (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H8432
-036
-0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Empire MediBlue Service Select (HMO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
| |
2021 Healthfirst 65 Plus Plan (HMO)
| $0.00 |
$7,550 |
$350 | No additional gap coverage, only the Donut Hole Discount |
H3359
-001
-0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,168
2021 Formulary |
|
|
|
|
2022 Healthfirst 65 Plus Plan (HMO)
| $0.00 |
$7,550 |
$295 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,188
2022 Formulary |
| |
2021 Healthfirst Coordinated Benefits Plan (HMO)
| $0.00 |
$7,550 |
No Rx Coverage |
H3359
-027
-0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Healthfirst Coordinated Benefits Plan (HMO)
| $0.00 |
$7,550 |
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 |
2021 Healthfirst Signature (HMO)
| $0.00 |
$7,550 |
$350 | No additional gap coverage, only the Donut Hole Discount |
H5989
-011
-0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,168
2021 Formulary |
|
-- |
-- |
|
2022 Healthfirst Signature (HMO)
| $0.00 |
$7,550 |
$250 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,188
2022 Formulary |
| |
2021 Humana Gold Plus H3533-027 (HMO)
| $0.00 |
$7,550 |
$400 | No additional gap coverage, only the Donut Hole Discount |
H3533
-027
-0 | $6.00 | $16.00 | $47.00 | $47.00 | 3,172
2021 Formulary |
|
-- |
|
|
2022 Humana Gold Plus H3533-027 (HMO)
| $0.00 |
$7,550 |
$425 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $16.00 | $47.00 | $47.00 | 3,217
2022 Formulary |
| |
2021 Humana Gold Plus H3533-033 (HMO)
| $0.00 |
$7,550 |
$350 | No additional gap coverage, only the Donut Hole Discount |
H3533
-033
-0 | $2.00 | $9.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
|
-- |
|
|
2022 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 | 3,408
2022 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 |
2021 Humana Honor (PPO)
| $0.00 |
$4,500 |
No Rx Coverage |
H5970
-016
-0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Humana Honor (PPO)
| $0.00 |
$4,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
| |
2021 HumanaChoice H5970-024 (PPO)
| $0.00 |
$7,200 |
$350 | No additional gap coverage, only the Donut Hole Discount |
H5970
-024
-1 | $2.00 | $9.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
|
|
|
2022 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 | 3,408
2022 Formulary |
| |
2021 PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | All Generics,
All Brands |
H9869
-001
-0 | | | | | 3,560
2021 Formulary |
| -- |
-- |
-- |
|
2022 PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | All Generics,
All Brands | | | | | 3,510
2022 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 |
2021 UnitedHealthcare Medicare Advantage Patriot (Regional PPO)
| $0.00 |
$6,700 |
No Rx Coverage |
R5342
-002
-0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 UnitedHealthcare Medicare Advantage Patriot (Regional PPO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
| |
2021 WellCare Absolute (PPO)
| $0.00 |
$7,550 |
$150 | Yes, some additional gap coverage. |
H2775
-111
-0 | $0.00 | $12.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
|
|
|
2022 Wellcare Giveback Open (PPO)
| $0.00 |
$7,550 |
$325 | Yes, some additional gap coverage. | $1.00 | $7.00 | $37.00 | $37.00 | 3,375
2022 Formulary |
| |
-- This plan not offered in 2021 --
|
H4868
-019
-0 | | | | | |
|
-- |
|
|
2022 Wellcare No Premium (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $7.00 | $37.00 | $37.00 | 3,375
2022 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 |
2021 WellCare Today's Options Advantage Plus 550B (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H2775
-106
-0 | $0.00 | $7.00 | $37.00 | $37.00 | 3,348
2021 Formulary |
|
|
|
|
2022 Wellcare No Premium Open (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $7.00 | $37.00 | $37.00 | 3,375
2022 Formulary |
| |
2021 Empire MediBlue Plus (HMO)
| $16.00 |
$7,550 |
$350 | No additional gap coverage, only the Donut Hole Discount |
H8432
-008
-6 | $0.00 | $15.00 | $42.00 | $42.00 | 2,902
2021 Formulary |
|
|
|
|
2022 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 | 2,921
2022 Formulary |
| |
2021 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 | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO)
| $16.00 |
$7,200 |
$300 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | tbd |
| |
| Plan Name |
Monthly
Premium |
Parts A&B
MOOP |
Part D
Deduct-
ible |
Additional
Gap
Coverage |
Plan
ID |
Cost-Sharing |
Total Drugs |
Cust.
Serv. |
Plan
Exper. |
Cost
Info. |
Tier
1 |
Tier
2 |
Tier
3 |
Tier
4 |
2021 Fidelis Medicaid Advantage Plus (HMO D-SNP)
| $22.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5599
-003
-0 | $0.00 | $7.00 | $40.00 | $40.00 | 3,168
2021 Formulary |
|
|
|
|
2022 Wellcare Fidelis Dual Plus (HMO D-SNP)
| $18.30 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,375
2022 Formulary |
| |
2021 WellCare Compass (HMO)
| $12.30 |
$6,700 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H4868
-016
-0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
-- |
|
|
2022 Wellcare Assist (HMO)
| $19.40 |
$6,700 |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,375
2022 Formulary |
| |
2021 Fidelis Dual Advantage Flex (HMO D-SNP)
| $21.60 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5599
-001
-0 | $0.00 | $10.00 | 24% | 24% | 3,168
2021 Formulary |
|
|
|
|
2022 Wellcare Fidelis Dual Access (HMO D-SNP)
| $20.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,375
2022 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 |
2021 Aetna Medicare Assure Plan (HMO D-SNP)
| $25.70 |
n/a |
$190 | No additional gap coverage, only the Donut Hole Discount |
H3312
-069
-0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
 |
|
|
2022 Aetna Medicare Assure Plan (HMO D-SNP)
| $23.20 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $47.00 | $47.00 | 3,672
2022 Formulary |
| |
2021 Humana Gold Plus H3533-032 (HMO)
| $21.00 |
$6,500 |
$200 | No additional gap coverage, only the Donut Hole Discount |
H3533
-032
-1 | $2.00 | $9.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
-- |
|
|
2022 Humana Gold Plus H3533-032 (HMO)
| $24.00 |
$6,500 |
$200 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $9.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
| |
2021 Aetna Medicare Elite Plan 3 (PPO)
| $39.00 |
$7,550 |
$300 | Yes, some additional gap coverage. |
H5521
-310
-0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Elite Plan 3 (PPO)
| $25.00 |
$7,550 |
$300 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,672
2022 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 2021 --
|
H5549
-012
-0 | | | | | |
|
|
|
|
2022 VNSNY CHOICE EasyCare (HMO)
| $25.00 |
$7,550 |
$480 | No additional gap coverage, only the Donut Hole Discount | $15.00 | $20.00 | $47.00 | $47.00 | 3,133
2022 Formulary |
| |
2021 Aetna Medicare Value Plan (PPO)
| $22.00 |
$7,550 |
$250 | Yes, some additional gap coverage. |
H5521
-312
-0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Discover Value Plan (PPO)
| $26.00 |
$7,550 |
$300 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,672
2022 Formulary |
| |
2021 WellCare Access (HMO D-SNP)
| $27.10 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H4868
-014
-0 | $0.00 | $4.00 | $40.00 | $40.00 | 3,348
2021 Formulary |
|
-- |
|
|
2022 Wellcare Dual Access (HMO D-SNP)
| $27.60 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,375
2022 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 |
2021 WellCare Summit (PPO)
| $5.10 |
$6,700 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H2775
-113
-0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
|
|
|
2022 Wellcare Assist Open (PPO)
| $30.70 |
$6,700 |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $45.00 | $45.00 | 3,375
2022 Formulary |
| |
2021 AARP Medicare Advantage Plan 2 (HMO)
| $34.00 |
$6,700 |
$395 | No additional gap coverage, only the Donut Hole Discount |
H3379
-001
-0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
2022 AARP Medicare Advantage Plan 2 (HMO)
| $34.00 |
$7,550 |
$395 | Yes, some additional gap coverage. | $3.00 | $12.00 | $47.00 | $47.00 | 3,654
2022 Formulary |
| |
2021 EmblemHealth VIP Passport NYC (HMO)
| $42.30 |
$7,550 |
$295 | No additional gap coverage, only the Donut Hole Discount |
H5991
-006
-0 | $2.00 | $15.00 | $42.00 | $42.00 | 3,429
2021 Formulary |
|
-- |
|
|
2022 EmblemHealth VIP Passport NYC (HMO)
| $34.90 |
$7,550 |
$350 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $42.00 | $42.00 | 3,453
2022 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 |
2021 Empire MediBlue Extra Select (HMO)
| $42.30 |
$5,900 |
$445 | Yes, some additional gap coverage. |
H8432
-035
-0 | $0.00 | $15.00 | $47.00 | $47.00 | 3,639
2021 Formulary |
|
|
|
|
2022 Empire MediBlue Extra Select (HMO)
| $36.60 |
$6,500 |
$480 | Yes, some additional gap coverage. | $0.00 | $15.00 | $47.00 | $47.00 | 3,626
2022 Formulary |
| |
2021 Longevity Health Plan (HMO I-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H8457
-001
-0 | | | | | 3,764
2021 Formulary |
|
-- |
|
|
2022 Longevity Health Plan (HMO I-SNP)
| $36.60 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,678
2022 Formulary |
| |
2021 WellCare Imperial (PPO D-SNP)
| $12.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H2775
-112
-0 | $0.00 | $9.00 | $45.00 | $45.00 | 3,348
2021 Formulary |
|
|
|
|
2022 Wellcare Dual Access Open (PPO D-SNP)
| $37.30 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $42.00 | $42.00 | 3,375
2022 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 2021 --
|
H3387
-015
-2 | | | | | |
|
|
|
|
2022 UnitedHealthcare Dual Complete Plan 2 (HMO D-SNP)
| $37.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,654
2022 Formulary |
| |
-- This plan not offered in 2021 --
|
H3533
-034
-1 | | | | | |
|
-- |
|
|
2022 Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP)
| $38.90 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $20.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
| |
2021 Aetna Medicare Elite Plan (HMO)
| $39.00 |
$7,550 |
$300 | Yes, some additional gap coverage. |
H3312
-068
-0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Elite Plan (HMO)
| $39.00 |
$7,550 |
$300 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,672
2022 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 |
2021 Elderplan For Medicaid Beneficiaries (HMO D-SNP)
| $35.40 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3347
-002
-0 | | | | | 3,235
2021 Formulary |
|
|
|
|
2022 Elderplan For Medicaid Beneficiaries (HMO D-SNP)
| $39.90 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,257
2022 Formulary |
| |
2021 Healthfirst CompleteCare (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3359
-034
-0 | | | | | 3,233
2021 Formulary |
|
|
|
|
2022 Healthfirst CompleteCare (HMO D-SNP)
| $39.90 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,188
2022 Formulary |
| |
2021 Bright Advantage Senior Savings Assist (HMO C-SNP)
| $33.90 |
n/a |
$0 | Yes, some additional gap coverage. |
H2288
-010
-0 | $0.00 | $12.00 | $47.00 | $47.00 | 3,376
2021 Formulary |
|
-- |
|
|
2022 Bright Advantage Embrace Choice Plan (HMO C-SNP)
| $41.60 |
n/a |
$480 | Some Generics | $0.00 | $0.00 | 25% | 25% | 3,133
2022 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 |
2021 Elderplan Assist (HMO I-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3347
-015
-0 | $4.00 | $14.00 | $47.00 | $47.00 | 3,235
2021 Formulary |
|
|
|
|
2022 Elderplan Assist (HMO I-SNP)
| $42.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $14.00 | $47.00 | $47.00 | 3,257
2022 Formulary |
| |
2021 Elderplan Extra Help (HMO)
| $25.30 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3347
-009
-0 | $4.00 | $10.00 | $47.00 | $47.00 | 3,235
2021 Formulary |
|
|
|
|
2022 Elderplan Extra Help (HMO)
| $42.00 |
$7,550 |
$480 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | $47.00 | $47.00 | 3,257
2022 Formulary |
| |
2021 UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
| $32.60 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H2292
-002
-0 | | | | | 3,604
2021 Formulary |
|
-- |
|
|
2022 UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
| $42.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,654
2022 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 |
2021 AgeWell New York Advantage Plus (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H4922
-010
-0 | | | | | 3,559
2021 Formulary |
|
-- |
|
|
2022 AgeWell New York Advantage Plus (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,520
2022 Formulary |
| |
2021 AgeWell New York CareWell (HMO I-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H4922
-004
-0 | | | | | 3,559
2021 Formulary |
|
-- |
|
|
2022 AgeWell New York CareWell (HMO I-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,520
2022 Formulary |
| |
2021 AgeWell New York FeelWell (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H4922
-003
-0 | | | | | 3,559
2021 Formulary |
|
-- |
|
|
2022 AgeWell New York FeelWell (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,520
2022 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 |
2021 AgeWell New York LiveWell (HMO)
| $42.30 |
$7,550 |
$350 | Yes, some additional gap coverage. |
H4922
-011
-0 | $3.00 | $15.00 | $47.00 | $47.00 | 3,559
2021 Formulary |
|
-- |
|
|
2022 AgeWell New York LiveWell (HMO)
| $42.40 |
$7,550 |
$350 | Yes, some additional gap coverage. | $3.00 | $15.00 | $47.00 | $47.00 | 3,520
2022 Formulary |
| |
2021 ArchCare Advantage (HMO I-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H1777
-007
-0 | | | | | 3,100
2021 Formulary |
|
-- |
|
|
2022 ArchCare Advantage (HMO I-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,107
2022 Formulary |
| |
2021 Bright Advantage Special Care (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H2288
-003
-0 | | | | | 3,364
2021 Formulary |
|
-- |
|
|
2022 Bright Advantage Dual Access Plan (HMO D-SNP)
| $42.40 |
n/a |
$480 | Some Generics | $0.00 | 25% | 25% | 25% | 3,133
2022 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 |
2021 Centers Plan for Dual Coverage Care (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H6988
-002
-0 | | | | | 3,207
2021 Formulary |
|
-- |
|
|
2022 Centers Plan for Dual Coverage Care (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,133
2022 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 |
H6988
-004
-0 | | | | | 3,207
2021 Formulary |
|
-- |
|
|
2022 Centers Plan for Medicaid Advantage Plus (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,133
2022 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 |
H6988
-003
-0 | | | | | 3,207
2021 Formulary |
|
-- |
|
|
2022 Centers Plan for Nursing Home Care (HMO I-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,133
2022 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 |
2021 Elderplan Advantage For Nursing Home Residents (HMO I-SNP)
| $35.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3347
-003
-0 | | | | | 3,235
2021 Formulary |
|
|
|
|
2022 Elderplan Advantage For Nursing Home Residents (HMO I-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,257
2022 Formulary |
| |
2021 Elderplan Plus Long Term Care (HMO D-SNP)
| $31.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3347
-007
-0 | | | | | 3,235
2021 Formulary |
|
|
|
|
2022 Elderplan Plus Long Term Care (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,257
2022 Formulary |
| |
2021 EmblemHealth VIP Assist (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5991
-008
-0 | | | | | 3,429
2021 Formulary |
|
-- |
|
|
2022 EmblemHealth VIP Assist (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,453
2022 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 |
2021 EmblemHealth VIP Dual (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3330
-042
-1 | | | | | 3,429
2021 Formulary |
|
-- |
|
|
2022 EmblemHealth VIP Dual (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,453
2022 Formulary |
| |
2021 EmblemHealth VIP Dual Reserve (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5991
-010
-0 | | | | | 3,429
2021 Formulary |
|
-- |
|
|
2022 EmblemHealth VIP Dual Reserve (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,453
2022 Formulary |
| |
2021 EmblemHealth VIP Dual Select (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5991
-001
-0 | | | | | 3,429
2021 Formulary |
|
-- |
|
|
2022 EmblemHealth VIP Dual Select (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,453
2022 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 |
2021 EmblemHealth VIP Solutions (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5991
-002
-0 | | | | | 3,429
2021 Formulary |
|
-- |
|
|
2022 EmblemHealth VIP Solutions (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,453
2022 Formulary |
| |
2021 Empire MediBlue Dual Advantage (HMO D-SNP)
| $42.30 |
n/a |
$445 | Yes, some additional gap coverage. |
H8432
-007
-0 | $0.00 | $6.00 | $47.00 | $47.00 | 3,639
2021 Formulary |
|
|
|
|
2022 Empire MediBlue Dual Advantage (HMO D-SNP)
| $42.40 |
n/a |
$480 | Some Generics | $0.00 | $6.00 | $47.00 | $47.00 | 3,626
2022 Formulary |
| |
2021 Empire MediBlue Dual Advantage Select (HMO D-SNP)
| $42.30 |
n/a |
$445 | Yes, some additional gap coverage. |
H8432
-028
-0 | $0.00 | $7.00 | $47.00 | $47.00 | 3,639
2021 Formulary |
|
|
|
|
2022 Empire MediBlue Dual Advantage Select (HMO D-SNP)
| $42.40 |
n/a |
$480 | Some Generics | $0.00 | $7.00 | $47.00 | $47.00 | 3,626
2022 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 |
2021 Empire MediBlue HealthPlus Dual Connect (HMO D-SNP)
| $42.30 |
n/a |
$445 | Yes, some additional gap coverage. |
H1732
-003
-0 | $0.00 | $7.00 | $47.00 | $47.00 | 3,639
2021 Formulary |
|
new |
new |
|
2022 Empire MediBlue HealthPlus Dual Connect (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $20.00 | $47.00 | $47.00 | 3,626
2022 Formulary |
| |
2021 Empire MediBlue HealthPlus Dual Plus (HMO D-SNP)
| $42.30 |
n/a |
$445 | Yes, some additional gap coverage. |
H1732
-001
-0 | $0.00 | $6.00 | $47.00 | $47.00 | 3,639
2021 Formulary |
|
new |
new |
|
2022 Empire MediBlue HealthPlus Dual Plus (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $20.00 | $47.00 | $47.00 | 3,626
2022 Formulary |
| |
2021 Hamaspik Medicare Choice (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0034
-002
-0 | | | | | 3,655
2021 Formulary |
|
new |
new |
|
2022 Hamaspik Medicare Choice (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,240
2022 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 |
2021 Hamaspik Medicare Select (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0034
-001
-0 | | | | | 3,655
2021 Formulary |
|
new |
new |
|
2022 Hamaspik Medicare Select (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,240
2022 Formulary |
| |
-- This plan not offered in 2021 --
|
H3359
-038
-0 | | | | | |
|
|
|
|
2022 Healthfirst Connection Plan (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $47.00 | $47.00 | 3,188
2022 Formulary |
| |
2021 Healthfirst Increased Benefits Plan (HMO)
| $42.30 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3359
-019
-0 | | | | | 3,233
2021 Formulary |
|
|
|
|
2022 Healthfirst Increased Benefits Plan (HMO)
| $42.40 |
$7,550 |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,188
2022 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 |
2021 Healthfirst Life Improvement Plan (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3359
-021
-0 | | | | | 3,233
2021 Formulary |
|
|
|
|
2022 Healthfirst Life Improvement Plan (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,188
2022 Formulary |
| |
2021 Integra Harmony (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H1205
-001
-0 | | | | | 3,359
2021 Formulary |
|
-- |
-- |
|
2022 Integra Harmony (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,315
2022 Formulary |
| |
2021 Integra Synergy Medicaid Advantage Plus (MAP) (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H1205
-002
-0 | | | | | 3,359
2021 Formulary |
|
-- |
-- |
|
2022 Integra Synergy Medicaid Advantage Plus (MAP) (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,315
2022 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 |
2021 MetroPlus Advantage Plan (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0423
-001
-0 | | | | | 3,288
2021 Formulary |
|
|
|
|
2022 MetroPlus Advantage Plan (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,256
2022 Formulary |
| |
2021 MetroPlus UltraCare (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0423
-007
-0 | | | | | 3,288
2021 Formulary |
|
|
|
|
2022 MetroPlus UltraCare (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,256
2022 Formulary |
| |
2021 RiverSpring MAP (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H6776
-002
-0 | | | | | 3,387
2021 Formulary |
|
-- |
|
|
2022 RiverSpring MAP (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,553
2022 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 |
2021 RiverSpring Star (HMO I-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H6776
-001
-0 | | | | | 3,387
2021 Formulary |
|
-- |
|
|
2022 RiverSpring Star (HMO I-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,553
2022 Formulary |
| |
-- This plan not offered in 2021 --
|
H5992
-008
-0 | | | | | |
|
-- |
|
|
2022 Senior Whole Health Medicare Complete Care (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,263
2022 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 |
H5992
-007
-0 | | | | | 3,396
2021 Formulary |
|
-- |
|
|
2022 Senior Whole Health of New York NHC (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,263
2022 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 |
2021 UnitedHealthcare Assisted Living Plan (PPO I-SNP)
| $42.30 |
n/a |
$200 | No additional gap coverage, only the Donut Hole Discount |
H2292
-003
-0 | $2.00 | $12.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
-- |
|
|
2022 UnitedHealthcare Assisted Living Plan (PPO I-SNP)
| $42.40 |
n/a |
$200 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $12.00 | $47.00 | $47.00 | 3,654
2022 Formulary |
| |
-- This plan not offered in 2021 --
|
H3387
-014
-2 | | | | | |
|
|
|
|
2022 UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,654
2022 Formulary |
| |
2021 UnitedHealthcare Nursing Home Plan 2 (HMO I-SNP)
| $35.90 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3379
-002
-0 | | | | | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Nursing Home Plan 2 (HMO I-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,654
2022 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 |
2021 VillageCareMAX Medicare Health Advantage (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H2168
-001
-0 | | | | | 3,207
2021 Formulary |
|
-- |
|
|
2022 VillageCareMAX Medicare Health Advantage (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,133
2022 Formulary |
| |
-- This plan not offered in 2021 --
|
H5549
-011
-0 | | | | | |
|
|
|
|
2022 VNSNY CHOICE EasyCare Plus (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,133
2022 Formulary |
| |
2021 VNSNY CHOICE Total (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5549
-003
-0 | $7.00 | $19.00 | $47.00 | $47.00 | 3,560
2021 Formulary |
|
|
|
|
2022 VNSNY CHOICE Total (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $13.00 | $20.00 | $47.00 | $47.00 | 3,510
2022 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 |
2021 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 | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO)
| $46.00 |
$6,900 |
$250 | Yes, some additional gap coverage. | $0.00 | $14.00 | $47.00 | $47.00 | tbd |
| |
2021 AARP Medicare Advantage Plan 1 (HMO)
| $54.00 |
$6,700 |
$395 | No additional gap coverage, only the Donut Hole Discount |
H3307
-002
-0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
2022 AARP Medicare Advantage Plan 1 (HMO)
| $54.00 |
$7,550 |
$395 | Yes, some additional gap coverage. | $3.00 | $12.00 | $47.00 | $47.00 | 3,654
2022 Formulary |
| |
2021 Bright Advantage Plus (HMO)
| $59.00 |
$4,900 |
$445 | Yes, some additional gap coverage. |
H2288
-002
-0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,364
2021 Formulary |
|
-- |
|
|
2022 Bright Advantage Classic Plus Plan (HMO)
| $59.00 |
$4,900 |
$480 | Yes, some additional gap coverage. | $0.00 | $20.00 | $47.00 | $47.00 | 3,133
2022 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 |
2021 UnitedHealthcare Medicare Advantage Choice Plan 4 (Regional PPO)
| $84.00 |
$6,700 |
$150 | No additional gap coverage, only the Donut Hole Discount |
R5342
-006
-0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Medicare Advantage Choice Plan 4 (Regional PPO)
| $84.00 |
$6,700 |
$150 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | tbd |
| |
2021 EmblemHealth VIP Gold (HMO)
| $96.00 |
$7,550 |
$200 | No additional gap coverage, only the Donut Hole Discount |
H3330
-021
-1 | $2.00 | $10.00 | $40.00 | $40.00 | 3,429
2021 Formulary |
|
-- |
|
|
2022 EmblemHealth VIP Gold (HMO)
| $97.00 |
$7,550 |
$200 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $10.00 | $40.00 | $40.00 | 3,453
2022 Formulary |
| |
2021 Aetna Medicare Premier Plan (PPO)
| $99.00 |
$7,550 |
$200 | Yes, some additional gap coverage. |
H5521
-040
-0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Premier Plan (PPO)
| $99.00 |
$5,000 |
$250 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,672
2022 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 |
2021 VillageCareMAX Medicare Total Advantage (HMO D-SNP)
| $116.00 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H2168
-002
-0 | | | | | 3,207
2021 Formulary |
|
-- |
|
|
2022 VillageCareMAX Medicare Total Advantage (HMO D-SNP)
| $117.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,133
2022 Formulary |
| |
2021 WellCare Today's Options Advantage Plus 150A (PPO)
| $121.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2775
-105
-0 | $0.00 | $5.00 | $35.00 | $35.00 | 3,348
2021 Formulary |
|
|
|
|
2022 Wellcare Premium Ultra Open (PPO)
| $121.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $35.00 | $35.00 | 3,375
2022 Formulary |
| |
2021 MetroPlus Platinum Plan (HMO)
| $148.50 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0423
-004
-0 | | | | | 3,288
2021 Formulary |
|
|
|
|
2022 MetroPlus Platinum Plan (HMO)
| $149.00 |
$7,550 |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,256
2022 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 |
2021 EmblemHealth VIP Gold Plus (HMO)
| $302.00 |
$7,550 |
$200 | No additional gap coverage, only the Donut Hole Discount |
H3330
-038
-0 | $2.00 | $10.00 | $40.00 | $40.00 | 3,429
2021 Formulary |
|
-- |
|
|
2022 EmblemHealth VIP Gold Plus (HMO)
| $261.00 |
$7,550 |
$200 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $10.00 | $40.00 | $40.00 | 3,453
2022 Formulary |
| |
2021 Bright Advantage Assist (HMO)
| $42.30 |
$6,500 |
$445 | Yes, some additional gap coverage. |
H2288
-005
-0 | $0.00 | 25% | 25% | 25% | 3,364
2021 Formulary |
|
-- |
|
|
-- Members will be assigned to Bright Advantage Classic Care Plan (HMO) H2288-001 --
| | | | | |
| |
2021 Empire MediBlue HealthPlus Dual Advantage (HMO D-SNP)
| $42.30 |
n/a |
$445 | Yes, some additional gap coverage. |
H1732
-002
-0 | $0.00 | $6.00 | $47.00 | $47.00 | 3,639
2021 Formulary |
|
new |
new |
|
-- Members will be assigned to Empire MediBlue HealthPlus Dual Connect (HMO D-SNP) H1732-003 --
| | | | | |
| |
| 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 |
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 |
H3533
-031
-0 | $2.00 | $20.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
|
-- |
|
|
-- Members will be assigned to Humana Gold Plus SNP-DE (HMO D-SNP) H3533-034 --
| | | | | |
| |
2021 UnitedHealthcare Dual Complete (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3387
-010
-0 | | | | | 3,604
2021 Formulary |
|
|
|
|
-- Members will be assigned to UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP) H3387-014 --
| | | | | |
| |
2021 Fidelis Dual Advantage (HMO D-SNP)
| $22.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5599
-006
-0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,168
2021 Formulary |
|
|
|
|
-- Members will be assigned to Wellcare Fidelis Dual Access (HMO D-SNP) H5599-001 --
| | | | | |
| |
| 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 |
2021 WellCare Preferred (HMO)
| $81.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H4868
-010
-0 | $0.00 | $15.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
-- |
|
|
-- Members will be assigned to Wellcare No Premium (HMO) H4868-019 --
| | | | | |
| |
2021 WellCare Choice (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H4868
-020
-0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
-- |
|
|
-- Members will be assigned to Wellcare No Premium (HMO) H4868-019 --
| | | | | |
| |
2021 WellCare Element (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H4868
-022
-0 | $0.00 | $15.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
-- |
|
|
-- Members will be assigned to Wellcare No Premium (HMO) H4868-019 --
| | | | | |
| |
| 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 |
2021 Integra Balanced Medicaid Advantage (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H1205
-007
-0 | | | | | 3,359
2021 Formulary |
|
-- |
-- |
|
-- This plan not offered in 2022 --
|
| | | | |
| |
2021 EmblemHealth VIP Part B Saver (HMO)
| $0.00 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3330
-040
-0 | $2.00 | $15.00 | $42.00 | $42.00 | 3,429
2021 Formulary |
|
-- |
|
|
-- This plan not offered in 2022 --
|
| | | | |
| |
2021 EmblemHealth VIP Go (HMO-POS)
| $72.00 |
$7,550 |
$250 | No additional gap coverage, only the Donut Hole Discount |
H3330
-041
-1 | $2.00 | $15.00 | $42.00 | $42.00 | 3,429
2021 Formulary |
|
-- |
|
|
-- This plan not offered in 2022 --
|
| | | | |
| |
| 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 |
2021 EmblemHealth VIP Connect (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5991
-007
-0 | | | | | 3,429
2021 Formulary |
|
-- |
|
|
-- This plan not offered in 2022 --
|
| | | | |
| |
2021 Centers Plan for Medicaid Advantage (HMO D-SNP)
| $101.00 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H6988
-005
-0 | | | | | 3,207
2021 Formulary |
|
-- |
|
|
-- This plan not offered in 2022 --
|
| | | | |
| |
2021 Bright Advantage Choice (PPO)
| $0.00 |
$6,500 |
$445 | Yes, some additional gap coverage. |
H9516
-001
-0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,364
2021 Formulary |
|
|
|
|
-- This plan not offered in 2022 --
|
| | | | |
| |
| 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 |
2021 Bright Advantage Choice Plus (PPO)
| $95.00 |
$4,900 |
$445 | Yes, some additional gap coverage. |
H9516
-002
-0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,364
2021 Formulary |
|
|
|
|
-- This plan not offered in 2022 --
|
| | | | |
| |
