NEUPOGEN 300 MCG/ML VIAL (1 ML ) (NDC: 55513053010)
2016 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Additional Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP MedicareComplete Mosaic (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Mosaic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$245 |
to be determined |
5 |
Specialty Tier |
27% | 27% | P | $3,063.97 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$330 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P | $3,063.97 |
Browse Plan Formulary |
Aetna Better Health FIDA Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Aetna Better Health FIDA Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P | $3,113.87 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Select Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$200 |
to be determined |
5 |
Specialty Tier |
28% | n/a | P | $3,094.56 |
Browse Plan Formulary |
Affinity Medicare Passport Essentials NYC (HMO)
![Email Prescription and/or Health Benefit details for Affinity Medicare Passport Essentials NYC (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150 |
to be determined |
5 |
Specialty Tier |
29% | n/a | P | $3,100.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AgeWell New York FIDA Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for AgeWell New York FIDA Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | None | $3,088.10 |
Browse Plan Formulary |
AgeWell New York LiveWell (HMO)
![Email Prescription and/or Health Benefit details for AgeWell New York LiveWell (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$275 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $3,088.10 |
Browse Plan Formulary |
AlphaCare Renew (HMO)
![Email Prescription and/or Health Benefit details for AlphaCare Renew (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $3,089.51 |
Browse Plan Formulary |
AlphaCare Signature FIDA Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for AlphaCare Signature FIDA Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand Drugs |
0% | 0% | P | $3,089.51 |
Browse Plan Formulary |
Amida Care True Life Plus (HMO)
![Email Prescription and/or Health Benefit details for Amida Care True Life Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Specialty Tier |
33% | 33% | P | $3,035.98 |
Browse Plan Formulary |
CenterLight Healthcare FIDA Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for CenterLight Healthcare FIDA Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P | $3,064.34 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Centers Plan for FIDA Care Complete (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Centers Plan for FIDA Care Complete (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | None | $3,093.97 |
Browse Plan Formulary |
Centers Plan for Medicare Advantage Care (HMO)
![Email Prescription and/or Health Benefit details for Centers Plan for Medicare Advantage Care (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Specialty Tier |
33% | 33% | None | $3,102.62 |
Browse Plan Formulary |
Elderplan Diabetes Care (HMO SNP)
![Email Prescription and/or Health Benefit details for Elderplan Diabetes Care (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P Q:4 /28Days | $3,091.86 |
Browse Plan Formulary |
Elderplan FIDA Total Care (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Elderplan FIDA Total Care (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P Q:4 /28Days | $3,091.86 |
Browse Plan Formulary |
EmblemHealth Essential (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth Essential (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P | $3,069.79 |
Browse Plan Formulary |
EmblemHealth Essential (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth Essential (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P | $3,070.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
EmblemHealth Essential (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth Essential (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P | $3,035.58 |
Browse Plan Formulary |
EmblemHealth Essential (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth Essential (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P | $3,044.69 |
Browse Plan Formulary |
Empire MediBlue Plus (HMO)
![Email Prescription and/or Health Benefit details for Empire MediBlue Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$245 |
to be determined |
5 |
Specialty Tier |
27% | n/a | P | $3,041.12 |
Browse Plan Formulary |
Empire MediBlue Plus (HMO)
![Email Prescription and/or Health Benefit details for Empire MediBlue Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$245 |
to be determined |
5 |
Specialty Tier |
27% | n/a | P | $3,079.22 |
Browse Plan Formulary |
Empire MediBlue Plus (HMO)
![Email Prescription and/or Health Benefit details for Empire MediBlue Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$245 |
to be determined |
5 |
Specialty Tier |
27% | n/a | P | $3,017.14 |
Browse Plan Formulary |
Fidelis Fully Integrated Dual Advantage Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Fidelis Fully Integrated Dual Advantage Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | n/a | P | $3,101.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Medicare $0 Premium (HMO)
![Email Prescription and/or Health Benefit details for Fidelis Medicare $0 Premium (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P | $3,102.18 |
Browse Plan Formulary |
GuildNet Gold Plus FIDA Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for GuildNet Gold Plus FIDA Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P | $3,051.87 |
Browse Plan Formulary |
Healthfirst 65 Plus Plan (HMO)
![Email Prescription and/or Health Benefit details for Healthfirst 65 Plus Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $3,023.81 |
Browse Plan Formulary |
Healthfirst AbsoluteCare FIDA Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Healthfirst AbsoluteCare FIDA Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P | $3,021.93 |
Browse Plan Formulary |
Humana Gold Plus H3533-005 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H3533-005 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | P Q:14 /30Days | $3,059.23 |
Browse Plan Formulary |
ICS Community Care Plus FIDA MMP (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for ICS Community Care Plus FIDA MMP (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | None | $3,093.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Liberty Health Advantage Preferred Choice (HMO)
![Email Prescription and/or Health Benefit details for Liberty Health Advantage Preferred Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P | $3,159.01 |
Browse Plan Formulary |
MetroPlus FIDA (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for MetroPlus FIDA (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P | $3,113.24 |
Browse Plan Formulary |
North Shore-LIJ FIDA LiveWell (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for North Shore-LIJ FIDA LiveWell (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P | $3,103.11 |
Browse Plan Formulary |
PHP Care Complete FIDA (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for PHP Care Complete FIDA (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | n/a | P | $3,049.84 |
Browse Plan Formulary |
RiverSpring FIDA Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for RiverSpring FIDA Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P | $3,132.35 |
Browse Plan Formulary |
SWH Whole Health FIDA (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for SWH Whole Health FIDA (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P | $3,036.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UnitedHealthcare MedicareComplete Choice Plan 1 (Regional PPO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare MedicareComplete Choice Plan 1 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$290 |
to be determined |
5 |
Specialty Tier |
26% | 26% | P | $3,088.59 |
Browse Plan Formulary |
VillageCareMAX Full Advantage FIDA (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for VillageCareMAX Full Advantage FIDA (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | None | $3,093.97 |
Browse Plan Formulary |
VNSNY CHOICE FIDA Complete (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for VNSNY CHOICE FIDA Complete (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | None | $3,042.24 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Enhanced (HMO)
![Email Prescription and/or Health Benefit details for VNSNY CHOICE Medicare Enhanced (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $3,042.24 |
Browse Plan Formulary |
WellCare Advocate Complete FIDA (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for WellCare Advocate Complete FIDA (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P | $3,117.65 |
Browse Plan Formulary |
WellCare Choice (HMO-POS)
![Email Prescription and/or Health Benefit details for WellCare Choice (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P | $3,117.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
WellCare Rx (HMO)
![Email Prescription and/or Health Benefit details for WellCare Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | P | $3,117.65 |
Browse Plan Formulary |
Humana Gold Plus H3533-021 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H3533-021 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.10 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | P Q:14 /30Days | $3,059.56 |
Browse Plan Formulary |
AARP MedicareComplete Plan 1 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 1 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$230 |
to be determined |
5 |
Specialty Tier |
27% | 27% | P | $3,063.97 |
Browse Plan Formulary |
Healthfirst AssuredCare (HMO SNP)
![Email Prescription and/or Health Benefit details for Healthfirst AssuredCare (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$360 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $3,023.81 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H3533-004 (HMO SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H3533-004 (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.50 |
$165 |
to be determined |
5 |
Specialty Tier |
29% | n/a | P Q:14 /30Days | $3,059.56 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
![Email Prescription and/or Health Benefit details for WellCare Access (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.30 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | P | $3,117.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Healthfirst Increased Benefits Plan (HMO)
![Email Prescription and/or Health Benefit details for Healthfirst Increased Benefits Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.00 |
$360 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $3,023.81 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$360 |
to be determined |
5 |
Tier 5 |
$0.00 | $0.00 | P | $3,092.51 |
Browse Plan Formulary |
MetroPlus Advantage Plan (HMO SNP)
![Email Prescription and/or Health Benefit details for MetroPlus Advantage Plan (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.70 |
$360 |
to be determined |
1 |
Tier 1 |
15% | 15% | P | $3,026.15 |
Browse Plan Formulary |
Healthfirst CompleteCare (HMO SNP)
![Email Prescription and/or Health Benefit details for Healthfirst CompleteCare (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.00 |
$360 |
to be determined |
4 |
Tier 4 |
$0.00 | $0.00 | P | $3,021.94 |
Browse Plan Formulary |
Healthfirst Life Improvement Plan (HMO SNP)
![Email Prescription and/or Health Benefit details for Healthfirst Life Improvement Plan (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.00 |
$360 |
to be determined |
4 |
Tier 4 |
15% | 15% | P | $3,021.94 |
Browse Plan Formulary |
UnitedHealthcare MedicareComplete Choice Plan 3 (Regional PPO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare MedicareComplete Choice Plan 3 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.00 |
$150 |
to be determined |
5 |
Specialty Tier |
29% | 29% | P | $3,088.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UnitedHealthcare Nursing Home Plan (HMO SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Nursing Home Plan (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.30 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,068.77 |
Browse Plan Formulary |
Affinity Medicare Solutions (HMO SNP)
![Email Prescription and/or Health Benefit details for Affinity Medicare Solutions (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | P | $3,102.00 |
Browse Plan Formulary |
Affinity Medicare Ultimate (HMO SNP)
![Email Prescription and/or Health Benefit details for Affinity Medicare Ultimate (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | P | $3,102.00 |
Browse Plan Formulary |
AgeWell New York BeWell (HMO SNP)
![Email Prescription and/or Health Benefit details for AgeWell New York BeWell (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $3,088.10 |
Browse Plan Formulary |
AgeWell New York CareWell (HMO SNP)
![Email Prescription and/or Health Benefit details for AgeWell New York CareWell (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $3,088.10 |
Browse Plan Formulary |
AgeWell New York FeelWell (HMO SNP)
![Email Prescription and/or Health Benefit details for AgeWell New York FeelWell (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $3,088.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AlphaCare Resilience (HMO SNP)
![Email Prescription and/or Health Benefit details for AlphaCare Resilience (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,089.51 |
Browse Plan Formulary |
AlphaCare Total (HMO SNP)
![Email Prescription and/or Health Benefit details for AlphaCare Total (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$360 |
to be determined |
5 |
Tier 5 |
15% | 15% | P | $3,089.51 |
Browse Plan Formulary |
Amida Care Live Life Advantage (HMO SNP)
![Email Prescription and/or Health Benefit details for Amida Care Live Life Advantage (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P | $3,035.98 |
Browse Plan Formulary |
Amida Care True Life Advantage (HMO SNP)
![Email Prescription and/or Health Benefit details for Amida Care True Life Advantage (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$360 |
to be determined |
5 |
Tier 5 |
15% | 15% | P | $3,035.98 |
Browse Plan Formulary |
ArchCare Advantage (HMO SNP)
![Email Prescription and/or Health Benefit details for ArchCare Advantage (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
25% | 25% | P | $3,101.38 |
Browse Plan Formulary |
CenterLight Healthcare Direct Complete Plan (HMO SNP)
![Email Prescription and/or Health Benefit details for CenterLight Healthcare Direct Complete Plan (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$360 |
to be determined |
2 |
Brand |
25% | 25% | P | $3,064.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Centers Plan for Dual Coverage Care (HMO SNP)
![Email Prescription and/or Health Benefit details for Centers Plan for Dual Coverage Care (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$360 |
to be determined |
4 |
Tier 4 |
15% | 15% | None | $3,093.97 |
Browse Plan Formulary |
Centers Plan for Nursing Home Care (HMO SNP)
![Email Prescription and/or Health Benefit details for Centers Plan for Nursing Home Care (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$360 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $3,102.62 |
Browse Plan Formulary |
Elderplan Advantage For Nursing Home Residents (HMO SNP)
![Email Prescription and/or Health Benefit details for Elderplan Advantage For Nursing Home Residents (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:4 /28Days | $3,091.87 |
Browse Plan Formulary |
Elderplan Extra Help (HMO)
![Email Prescription and/or Health Benefit details for Elderplan Extra Help (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:4 /28Days | $3,091.86 |
Browse Plan Formulary |
Elderplan For Medicaid Beneficiaries (HMO SNP)
![Email Prescription and/or Health Benefit details for Elderplan For Medicaid Beneficiaries (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
15% | 15% | P Q:4 /28Days | $3,091.86 |
Browse Plan Formulary |
Elderplan Plus Long Term Care (HMO SNP)
![Email Prescription and/or Health Benefit details for Elderplan Plus Long Term Care (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
15% | 15% | P Q:4 /28Days | $3,091.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
EmblemHealth Dual Eligible (HMO SNP)
![Email Prescription and/or Health Benefit details for EmblemHealth Dual Eligible (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P | $3,051.87 |
Browse Plan Formulary |
EmblemHealth Dual Eligible (PPO SNP)
![Email Prescription and/or Health Benefit details for EmblemHealth Dual Eligible (PPO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P | $3,051.87 |
Browse Plan Formulary |
Empire MediBlue Dual Advantage (HMO SNP)
![Email Prescription and/or Health Benefit details for Empire MediBlue Dual Advantage (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | P | $3,047.01 |
Browse Plan Formulary |
Fidelis Dual Advantage (HMO SNP)
![Email Prescription and/or Health Benefit details for Fidelis Dual Advantage (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | P | $3,101.72 |
Browse Plan Formulary |
Fidelis Dual Advantage Flex (HMO SNP)
![Email Prescription and/or Health Benefit details for Fidelis Dual Advantage Flex (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | P | $3,102.30 |
Browse Plan Formulary |
Fidelis Medicaid Advantage Plus (HMO SNP)
![Email Prescription and/or Health Benefit details for Fidelis Medicaid Advantage Plus (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | P | $3,100.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Medicare Advantage Flex (HMO-POS)
![Email Prescription and/or Health Benefit details for Fidelis Medicare Advantage Flex (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$250 |
to be determined |
5 |
Specialty Tier |
27% | n/a | P | $3,102.30 |
Browse Plan Formulary |
GuildNet Gold (HMO SNP)
![Email Prescription and/or Health Benefit details for GuildNet Gold (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P | $3,052.83 |
Browse Plan Formulary |
Liberty Health Advantage Dual Power (HMO SNP)
![Email Prescription and/or Health Benefit details for Liberty Health Advantage Dual Power (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$360 |
to be determined |
5 |
Tier 5 |
15% | 15% | P | $3,159.01 |
Browse Plan Formulary |
RiverSpring Star (HMO SNP)
![Email Prescription and/or Health Benefit details for RiverSpring Star (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
25% | 25% | P | $3,149.87 |
Browse Plan Formulary |
Senior Whole Health of New York NHC (HMO SNP)
![Email Prescription and/or Health Benefit details for Senior Whole Health of New York NHC (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P | $3,035.98 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Classic (HMO)
![Email Prescription and/or Health Benefit details for VNSNY CHOICE Medicare Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $3,042.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
VNSNY CHOICE Medicare Preferred (HMO SNP)
![Email Prescription and/or Health Benefit details for VNSNY CHOICE Medicare Preferred (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$360 |
to be determined |
5 |
Tier 5 |
15% | 15% | None | $3,042.24 |
Browse Plan Formulary |
VNSNY CHOICE Total (HMO SNP)
![Email Prescription and/or Health Benefit details for VNSNY CHOICE Total (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$360 |
to be determined |
5 |
Tier 5 |
$0.00 | $0.00 | None | $3,042.24 |
Browse Plan Formulary |
Affinity Medicare Passport Select (HMO)
![Email Prescription and/or Health Benefit details for Affinity Medicare Passport Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$41.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P | $3,102.00 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 3 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$69.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $3,063.97 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$69.00 |
$200 |
to be determined |
5 |
Specialty Tier |
28% | n/a | P | $3,094.56 |
Browse Plan Formulary |
UnitedHealthcare MedicareComplete Choice Plan 4 (Regional PPO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare MedicareComplete Choice Plan 4 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$69.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $3,088.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Empire MediBlue Access (PPO)
![Email Prescription and/or Health Benefit details for Empire MediBlue Access (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$70.00 |
$240 |
to be determined |
5 |
Specialty Tier |
27% | n/a | P | $3,035.51 |
Browse Plan Formulary |
EmblemHealth VIP (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$78.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P | $3,044.69 |
Browse Plan Formulary |
EmblemHealth VIP (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$78.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P | $3,069.79 |
Browse Plan Formulary |
EmblemHealth VIP (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$78.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P | $3,070.31 |
Browse Plan Formulary |
EmblemHealth VIP (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$78.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P | $3,035.58 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Ultra (HMO-POS)
![Email Prescription and/or Health Benefit details for VNSNY CHOICE Medicare Ultra (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$96.40 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $3,042.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$108.00 |
$300 |
to be determined |
5 |
Specialty Tier |
26% | n/a | P | $3,087.20 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Maximum (HMO SNP)
![Email Prescription and/or Health Benefit details for VNSNY CHOICE Medicare Maximum (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$115.80 |
$360 |
to be determined |
5 |
Tier 5 |
$0.00 | $0.00 | None | $3,042.24 |
Browse Plan Formulary |
EmblemHealth Advantage (PPO)
![Email Prescription and/or Health Benefit details for EmblemHealth Advantage (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$122.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P | $3,018.82 |
Browse Plan Formulary |
MetroPlus Platinum (HMO)
![Email Prescription and/or Health Benefit details for MetroPlus Platinum (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$184.30 |
$360 |
to be determined |
1 |
Tier 1 |
25% | 25% | P | $3,026.15 |
Browse Plan Formulary |
EmblemHealth VIP High Option (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP High Option (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$290.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P | $3,069.79 |
Browse Plan Formulary |
EmblemHealth VIP High Option (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP High Option (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$290.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P | $3,070.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
EmblemHealth VIP High Option (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP High Option (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$290.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P | $3,035.58 |
Browse Plan Formulary |
EmblemHealth VIP High Option (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP High Option (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$290.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P | $3,044.69 |
Browse Plan Formulary |