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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CDPHP Classic Rx (PPO) in NY - H5042-001-0 Benefit Details |
Albany | $79.60 | $0 | Many Generics | Tier 1 Formulary Preferred Generics: $2.00 Tier 2 Formulary Non-Preferred Generics: $4.00 Tier 3 Formulary Preferred Brand: $35.00 Tier 4 Formulary Non-Preferred Brand: $70.00 Tier 5 Formulary Specialty: 30% | n/a Browse Formulary | |||||
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CDPHP Classic Rx (PPO) in NY - H5042-001-0 Benefit Details |
Broome | $79.60 | $0 | Many Generics | Tier 1 Formulary Preferred Generics: $2.00 Tier 2 Formulary Non-Preferred Generics: $4.00 Tier 3 Formulary Preferred Brand: $35.00 Tier 4 Formulary Non-Preferred Brand: $70.00 Tier 5 Formulary Specialty: 30% | n/a Browse Formulary | |||||
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CDPHP Classic Rx (PPO) in NY - H5042-001-0 Benefit Details |
Chenango | $79.60 | $0 | Many Generics | Tier 1 Formulary Preferred Generics: $2.00 Tier 2 Formulary Non-Preferred Generics: $4.00 Tier 3 Formulary Preferred Brand: $35.00 Tier 4 Formulary Non-Preferred Brand: $70.00 Tier 5 Formulary Specialty: 30% | n/a Browse Formulary | |||||
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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 | |||||||||
CDPHP Classic Rx (PPO) in NY - H5042-001-0 Benefit Details |
Columbia | $79.60 | $0 | Many Generics | Tier 1 Formulary Preferred Generics: $2.00 Tier 2 Formulary Non-Preferred Generics: $4.00 Tier 3 Formulary Preferred Brand: $35.00 Tier 4 Formulary Non-Preferred Brand: $70.00 Tier 5 Formulary Specialty: 30% | n/a Browse Formulary | |||||
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CDPHP Classic Rx (PPO) in NY - H5042-001-0 Benefit Details |
Delaware | $79.60 | $0 | Many Generics | Tier 1 Formulary Preferred Generics: $2.00 Tier 2 Formulary Non-Preferred Generics: $4.00 Tier 3 Formulary Preferred Brand: $35.00 Tier 4 Formulary Non-Preferred Brand: $70.00 Tier 5 Formulary Specialty: 30% | n/a Browse Formulary | |||||
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CDPHP Classic Rx (PPO) in NY - H5042-001-0 Benefit Details |
Dutchess | $79.60 | $0 | Many Generics | Tier 1 Formulary Preferred Generics: $2.00 Tier 2 Formulary Non-Preferred Generics: $4.00 Tier 3 Formulary Preferred Brand: $35.00 Tier 4 Formulary Non-Preferred Brand: $70.00 Tier 5 Formulary Specialty: 30% | n/a Browse Formulary | |||||
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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 | |||||||||
CDPHP Classic Rx (PPO) in NY - H5042-001-0 Benefit Details |
Essex | $79.60 | $0 | Many Generics | Tier 1 Formulary Preferred Generics: $2.00 Tier 2 Formulary Non-Preferred Generics: $4.00 Tier 3 Formulary Preferred Brand: $35.00 Tier 4 Formulary Non-Preferred Brand: $70.00 Tier 5 Formulary Specialty: 30% | n/a Browse Formulary | |||||
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CDPHP Classic Rx (PPO) in NY - H5042-001-0 Benefit Details |
Fulton | $79.60 | $0 | Many Generics | Tier 1 Formulary Preferred Generics: $2.00 Tier 2 Formulary Non-Preferred Generics: $4.00 Tier 3 Formulary Preferred Brand: $35.00 Tier 4 Formulary Non-Preferred Brand: $70.00 Tier 5 Formulary Specialty: 30% | n/a Browse Formulary | |||||
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CDPHP Classic Rx (PPO) in NY - H5042-001-0 Benefit Details |
Greene | $79.60 | $0 | Many Generics | Tier 1 Formulary Preferred Generics: $2.00 Tier 2 Formulary Non-Preferred Generics: $4.00 Tier 3 Formulary Preferred Brand: $35.00 Tier 4 Formulary Non-Preferred Brand: $70.00 Tier 5 Formulary Specialty: 30% | n/a Browse Formulary | |||||
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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 | |||||||||
CDPHP Classic Rx (PPO) in NY - H5042-001-0 Benefit Details |
Hamilton | $79.60 | $0 | Many Generics | Tier 1 Formulary Preferred Generics: $2.00 Tier 2 Formulary Non-Preferred Generics: $4.00 Tier 3 Formulary Preferred Brand: $35.00 Tier 4 Formulary Non-Preferred Brand: $70.00 Tier 5 Formulary Specialty: 30% | n/a Browse Formulary | |||||
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CDPHP Classic Rx (PPO) in NY - H5042-001-0 Benefit Details |
Herkimer | $79.60 | $0 | Many Generics | Tier 1 Formulary Preferred Generics: $2.00 Tier 2 Formulary Non-Preferred Generics: $4.00 Tier 3 Formulary Preferred Brand: $35.00 Tier 4 Formulary Non-Preferred Brand: $70.00 Tier 5 Formulary Specialty: 30% | n/a Browse Formulary | |||||
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CDPHP Classic Rx (PPO) in NY - H5042-001-0 Benefit Details |
Madison | $79.60 | $0 | Many Generics | Tier 1 Formulary Preferred Generics: $2.00 Tier 2 Formulary Non-Preferred Generics: $4.00 Tier 3 Formulary Preferred Brand: $35.00 Tier 4 Formulary Non-Preferred Brand: $70.00 Tier 5 Formulary Specialty: 30% | n/a Browse Formulary | |||||
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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 | |||||||||
CDPHP Classic Rx (PPO) in NY - H5042-001-0 Benefit Details |
Montgomery | $79.60 | $0 | Many Generics | Tier 1 Formulary Preferred Generics: $2.00 Tier 2 Formulary Non-Preferred Generics: $4.00 Tier 3 Formulary Preferred Brand: $35.00 Tier 4 Formulary Non-Preferred Brand: $70.00 Tier 5 Formulary Specialty: 30% | n/a Browse Formulary | |||||
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CDPHP Classic Rx (PPO) in NY - H5042-001-0 Benefit Details |
Oneida | $79.60 | $0 | Many Generics | Tier 1 Formulary Preferred Generics: $2.00 Tier 2 Formulary Non-Preferred Generics: $4.00 Tier 3 Formulary Preferred Brand: $35.00 Tier 4 Formulary Non-Preferred Brand: $70.00 Tier 5 Formulary Specialty: 30% | n/a Browse Formulary | |||||
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CDPHP Classic Rx (PPO) in NY - H5042-001-0 Benefit Details |
Otsego | $79.60 | $0 | Many Generics | Tier 1 Formulary Preferred Generics: $2.00 Tier 2 Formulary Non-Preferred Generics: $4.00 Tier 3 Formulary Preferred Brand: $35.00 Tier 4 Formulary Non-Preferred Brand: $70.00 Tier 5 Formulary Specialty: 30% | n/a Browse Formulary | |||||
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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 | |||||||||
CDPHP Classic Rx (PPO) in NY - H5042-001-0 Benefit Details |
Rensselaer | $79.60 | $0 | Many Generics | Tier 1 Formulary Preferred Generics: $2.00 Tier 2 Formulary Non-Preferred Generics: $4.00 Tier 3 Formulary Preferred Brand: $35.00 Tier 4 Formulary Non-Preferred Brand: $70.00 Tier 5 Formulary Specialty: 30% | n/a Browse Formulary | |||||
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CDPHP Classic Rx (PPO) in NY - H5042-001-0 Benefit Details |
Saratoga | $79.60 | $0 | Many Generics | Tier 1 Formulary Preferred Generics: $2.00 Tier 2 Formulary Non-Preferred Generics: $4.00 Tier 3 Formulary Preferred Brand: $35.00 Tier 4 Formulary Non-Preferred Brand: $70.00 Tier 5 Formulary Specialty: 30% | n/a Browse Formulary | |||||
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CDPHP Classic Rx (PPO) in NY - H5042-001-0 Benefit Details |
Schenectady | $79.60 | $0 | Many Generics | Tier 1 Formulary Preferred Generics: $2.00 Tier 2 Formulary Non-Preferred Generics: $4.00 Tier 3 Formulary Preferred Brand: $35.00 Tier 4 Formulary Non-Preferred Brand: $70.00 Tier 5 Formulary Specialty: 30% | n/a Browse Formulary | |||||
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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 | |||||||||
CDPHP Classic Rx (PPO) in NY - H5042-001-0 Benefit Details |
Schoharie | $79.60 | $0 | Many Generics | Tier 1 Formulary Preferred Generics: $2.00 Tier 2 Formulary Non-Preferred Generics: $4.00 Tier 3 Formulary Preferred Brand: $35.00 Tier 4 Formulary Non-Preferred Brand: $70.00 Tier 5 Formulary Specialty: 30% | n/a Browse Formulary | |||||
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CDPHP Classic Rx (PPO) in NY - H5042-001-0 Benefit Details |
Tioga | $79.60 | $0 | Many Generics | Tier 1 Formulary Preferred Generics: $2.00 Tier 2 Formulary Non-Preferred Generics: $4.00 Tier 3 Formulary Preferred Brand: $35.00 Tier 4 Formulary Non-Preferred Brand: $70.00 Tier 5 Formulary Specialty: 30% | n/a Browse Formulary | |||||
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CDPHP Classic Rx (PPO) in NY - H5042-001-0 Benefit Details |
Ulster | $79.60 | $0 | Many Generics | Tier 1 Formulary Preferred Generics: $2.00 Tier 2 Formulary Non-Preferred Generics: $4.00 Tier 3 Formulary Preferred Brand: $35.00 Tier 4 Formulary Non-Preferred Brand: $70.00 Tier 5 Formulary Specialty: 30% | n/a Browse Formulary | |||||
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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 | |||||||||
CDPHP Classic Rx (PPO) in NY - H5042-001-0 Benefit Details |
Warren | $79.60 | $0 | Many Generics | Tier 1 Formulary Preferred Generics: $2.00 Tier 2 Formulary Non-Preferred Generics: $4.00 Tier 3 Formulary Preferred Brand: $35.00 Tier 4 Formulary Non-Preferred Brand: $70.00 Tier 5 Formulary Specialty: 30% | n/a Browse Formulary | |||||
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CDPHP Classic Rx (PPO) in NY - H5042-001-0 Benefit Details |
Washington | $79.60 | $0 | Many Generics | Tier 1 Formulary Preferred Generics: $2.00 Tier 2 Formulary Non-Preferred Generics: $4.00 Tier 3 Formulary Preferred Brand: $35.00 Tier 4 Formulary Non-Preferred Brand: $70.00 Tier 5 Formulary Specialty: 30% | n/a Browse Formulary | |||||
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