2010 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
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Plan Name | County | Monthly Prem. (Parts C & D) |
Deduct- ible |
(Donut Hole) Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance 30-Day Supply |
MOOP for Part A & B Benefits | |||||
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
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GoldValue Rx (HMO) in NY - H3305-015-0 Benefit Details |
Genesee | $60.00 | $0 | No Gap Coverage | Tier 1: $9.00 Tier 2: $30.00 Tier 3: $85.00 Tier 4: 33% Tier 5: 8,000% | n/a Browse Formulary | |||||
GoldValue Rx (HMO) in NY - H3305-015-0 Benefit Details |
Livingston | $60.00 | $0 | No Gap Coverage | Tier 1: $9.00 Tier 2: $30.00 Tier 3: $85.00 Tier 4: 33% Tier 5: 8,000% | n/a Browse Formulary | |||||
GoldValue Rx (HMO) in NY - H3305-015-0 Benefit Details |
Monroe | $60.00 | $0 | No Gap Coverage | Tier 1: $9.00 Tier 2: $30.00 Tier 3: $85.00 Tier 4: 33% Tier 5: 8,000% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
GoldValue Rx (HMO) in NY - H3305-015-0 Benefit Details |
Ontario | $60.00 | $0 | No Gap Coverage | Tier 1: $9.00 Tier 2: $30.00 Tier 3: $85.00 Tier 4: 33% Tier 5: 8,000% | n/a Browse Formulary | |||||
GoldValue Rx (HMO) in NY - H3305-015-0 Benefit Details |
Orleans | $60.00 | $0 | No Gap Coverage | Tier 1: $9.00 Tier 2: $30.00 Tier 3: $85.00 Tier 4: 33% Tier 5: 8,000% | n/a Browse Formulary | |||||
GoldValue Rx (HMO) in NY - H3305-015-0 Benefit Details |
Seneca | $60.00 | $0 | No Gap Coverage | Tier 1: $9.00 Tier 2: $30.00 Tier 3: $85.00 Tier 4: 33% Tier 5: 8,000% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
GoldValue Rx (HMO) in NY - H3305-015-0 Benefit Details |
Steuben | $60.00 | $0 | No Gap Coverage | Tier 1: $9.00 Tier 2: $30.00 Tier 3: $85.00 Tier 4: 33% Tier 5: 8,000% | n/a Browse Formulary | |||||
GoldValue Rx (HMO) in NY - H3305-015-0 Benefit Details |
Wayne | $60.00 | $0 | No Gap Coverage | Tier 1: $9.00 Tier 2: $30.00 Tier 3: $85.00 Tier 4: 33% Tier 5: 8,000% | n/a Browse Formulary | |||||
GoldValue Rx (HMO) in NY - H3305-015-0 Benefit Details |
Wyoming | $60.00 | $0 | No Gap Coverage | Tier 1: $9.00 Tier 2: $30.00 Tier 3: $85.00 Tier 4: 33% Tier 5: 8,000% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
GoldValue Rx (HMO) in NY - H3305-015-0 Benefit Details |
Yates | $60.00 | $0 | No Gap Coverage | Tier 1: $9.00 Tier 2: $30.00 Tier 3: $85.00 Tier 4: 33% Tier 5: 8,000% | n/a Browse Formulary | |||||
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