2013 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) Additional 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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GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Albany | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Broome | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Cayuga | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Chenango | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Cortland | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Erie | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Essex | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Fulton | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Genesee | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Herkimer | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Livingston | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Madison | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Monroe | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Montgomery | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Niagara | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Oneida | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Onondaga | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Ontario | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Orleans | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Oswego | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Otsego | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Rensselaer | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Saratoga | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Schenectady | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Schoharie | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Seneca | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Steuben | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Tioga | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Tompkins | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Warren | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Washington | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Wayne | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Wyoming | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
GoldAnywhere Rx Option 2 (PPO) in NY - H9615-007-0 Benefit Details |
Yates | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
GoldAnywhere Rx Option 2 (PPO) in VT - H9615-007-0 Benefit Details |
Addison | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
GoldAnywhere Rx Option 2 (PPO) in VT - H9615-007-0 Benefit Details |
Bennington | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
GoldAnywhere Rx Option 2 (PPO) in VT - H9615-007-0 Benefit Details |
Chittenden | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
GoldAnywhere Rx Option 2 (PPO) in VT - H9615-007-0 Benefit Details |
Rutland | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
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