SOVALDI 400 MG TABLET (NDC: 61958150101)
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)
|
$0.00 |
$245 |
to be determined |
5 |
Specialty Tier |
27% | 27% | P Q:30 /30Days | $83,915.62 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$330 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P Q:30 /30Days | $83,915.62 |
Browse Plan Formulary |
Advantage Health NYC - SNP (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $86,010.65 |
Browse Plan Formulary |
Advantage Silver - NY City (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $86,010.65 |
Browse Plan Formulary |
Aetna Better Health FIDA Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P Q:28 /28Days | $85,469.03 |
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 Value Plan (HMO)
|
$0.00 |
$160 |
to be determined |
5 |
Specialty Tier |
29% | n/a | P Q:28 /28Days | $85,120.10 |
Browse Plan Formulary |
Affinity Medicare Passport Essentials NYC (HMO)
|
$0.00 |
$150 |
to be determined |
5 |
Specialty Tier |
29% | n/a | P | $85,172.13 |
Browse Plan Formulary |
AgeWell New York FIDA Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P | $83,936.03 |
Browse Plan Formulary |
AgeWell New York LiveWell (HMO)
|
$0.00 |
$275 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P | $83,936.03 |
Browse Plan Formulary |
AlphaCare Renew (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days | $84,766.39 |
Browse Plan Formulary |
AlphaCare Signature FIDA Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand Drugs |
0% | 0% | P Q:30 /30Days | $84,766.39 |
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 |
Amida Care True Life Plus (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Specialty Tier |
33% | 33% | P Q:28 /28Days | $83,807.25 |
Browse Plan Formulary |
CenterLight Healthcare FIDA Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P Q:30 /30Days | $83,917.20 |
Browse Plan Formulary |
Centers Plan for FIDA Care Complete (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P Q:28 /28Days | $84,214.06 |
Browse Plan Formulary |
Centers Plan for Medicare Advantage Care (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Specialty Tier |
33% | 33% | P Q:28 /28Days | $84,225.30 |
Browse Plan Formulary |
Elderplan Diabetes Care (HMO SNP)
|
$0.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P | $84,873.40 |
Browse Plan Formulary |
Elderplan FIDA Total Care (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P | $84,873.40 |
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 Plus (HMO)
|
$0.00 |
$245 |
to be determined |
5 |
Specialty Tier |
27% | n/a | P | $83,621.63 |
Browse Plan Formulary |
Empire MediBlue Plus (HMO)
|
$0.00 |
$245 |
to be determined |
5 |
Specialty Tier |
27% | n/a | P | $83,988.54 |
Browse Plan Formulary |
Empire MediBlue Plus (HMO)
|
$0.00 |
$245 |
to be determined |
5 |
Specialty Tier |
27% | n/a | P | $83,130.05 |
Browse Plan Formulary |
Fidelis Fully Integrated Dual Advantage Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | n/a | P | $85,172.71 |
Browse Plan Formulary |
Fidelis Medicare $0 Premium (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P | $85,168.69 |
Browse Plan Formulary |
GuildNet Gold Plus FIDA Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P Q:30 /30Days | $83,773.65 |
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 65 Plus Plan (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $82,687.64 |
Browse Plan Formulary |
Healthfirst AbsoluteCare FIDA Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P | $82,681.24 |
Browse Plan Formulary |
Humana Gold Plus H3533-005 (HMO)
|
$0.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | P Q:28 /28Days | $83,965.10 |
Browse Plan Formulary |
ICS Community Care Plus FIDA MMP (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P Q:28 /28Days | $84,197.06 |
Browse Plan Formulary |
Liberty Health Advantage Preferred Choice (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $86,689.50 |
Browse Plan Formulary |
MetroPlus FIDA (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P | $85,526.80 |
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 |
North Shore-LIJ FIDA LiveWell (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P | $85,168.48 |
Browse Plan Formulary |
PHP Care Complete FIDA (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | n/a | P | $83,437.30 |
Browse Plan Formulary |
RiverSpring FIDA Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P | $85,710.62 |
Browse Plan Formulary |
SWH Whole Health FIDA (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P Q:28 /28Days | $83,809.05 |
Browse Plan Formulary |
UnitedHealthcare MedicareComplete Choice Plan 1 (Regional PPO)
|
$0.00 |
$290 |
to be determined |
5 |
Specialty Tier |
26% | 26% | P Q:30 /30Days | $83,946.61 |
Browse Plan Formulary |
VillageCareMAX Full Advantage FIDA (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P Q:28 /28Days | $84,197.06 |
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 FIDA Complete (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P Q:28 /28Days | $83,538.13 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Enhanced (HMO)
|
$0.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P Q:28 /28Days | $83,539.37 |
Browse Plan Formulary |
WellCare Advocate Complete FIDA (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P | $85,579.73 |
Browse Plan Formulary |
WellCare Choice (HMO-POS)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P | $85,579.73 |
Browse Plan Formulary |
Access Medicare Gold (HMO)
|
$10.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P Q:28 /28Days | $84,439.40 |
Browse Plan Formulary |
WellCare Rx (HMO)
|
$19.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | P | $85,579.73 |
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 |
Humana Gold Plus H3533-021 (HMO)
|
$24.10 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | P Q:28 /28Days | $83,963.48 |
Browse Plan Formulary |
AARP MedicareComplete Plan 1 (HMO)
|
$29.00 |
$230 |
to be determined |
5 |
Specialty Tier |
27% | 27% | P Q:30 /30Days | $83,915.62 |
Browse Plan Formulary |
Healthfirst AssuredCare (HMO SNP)
|
$30.80 |
$360 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $82,687.64 |
Browse Plan Formulary |
EmblemHealth Essential (HMO)
|
$32.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P Q:30 /30Days | $83,787.37 |
Browse Plan Formulary |
EmblemHealth Essential (HMO)
|
$32.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P Q:30 /30Days | $83,859.37 |
Browse Plan Formulary |
EmblemHealth Essential (HMO)
|
$32.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P Q:30 /30Days | $84,072.66 |
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)
|
$32.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P Q:30 /30Days | $82,519.85 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H3533-004 (HMO SNP)
|
$32.50 |
$165 |
to be determined |
5 |
Specialty Tier |
29% | n/a | P Q:28 /28Days | $83,963.48 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$34.30 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | P | $85,579.73 |
Browse Plan Formulary |
Healthfirst Increased Benefits Plan (HMO)
|
$35.00 |
$360 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $82,687.64 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
|
$35.90 |
$360 |
to be determined |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:30 /30Days | $83,937.66 |
Browse Plan Formulary |
MetroPlus Advantage Plan (HMO SNP)
|
$38.70 |
$360 |
to be determined |
1 |
Tier 1 |
15% | 15% | P | $82,675.62 |
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 CompleteCare (HMO SNP)
|
$39.00 |
$360 |
to be determined |
4 |
Tier 4 |
$0.00 | $0.00 | P | $82,681.25 |
Browse Plan Formulary |
Healthfirst Life Improvement Plan (HMO SNP)
|
$39.00 |
$360 |
to be determined |
4 |
Tier 4 |
15% | 15% | P | $82,681.25 |
Browse Plan Formulary |
UnitedHealthcare MedicareComplete Choice Plan 3 (Regional PPO)
|
$39.00 |
$150 |
to be determined |
5 |
Specialty Tier |
29% | 29% | P Q:30 /30Days | $83,946.61 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (HMO SNP)
|
$39.30 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:30 /30Days | $83,940.38 |
Browse Plan Formulary |
Access Medicare Pearl (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Tier 5 |
15% | 15% | P Q:28 /28Days | $84,439.40 |
Browse Plan Formulary |
Access Medicare Pearl Advantage (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Tier 5 |
15% | 15% | P Q:28 /28Days | $84,439.40 |
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 |
Access Medicare Platinum (HMO)
|
$39.70 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:28 /28Days | $84,439.40 |
Browse Plan Formulary |
Access Medicare Platinum Advantage (HMO)
|
$39.70 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:28 /28Days | $84,439.40 |
Browse Plan Formulary |
Advantage Value One NY - Dual (HMO SNP)
|
$39.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $86,916.91 |
Browse Plan Formulary |
Affinity Medicare Solutions (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | P | $85,173.02 |
Browse Plan Formulary |
Affinity Medicare Ultimate (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | P | $85,173.02 |
Browse Plan Formulary |
AgeWell New York BeWell (HMO SNP)
|
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
15% | 15% | P | $83,936.03 |
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 CareWell (HMO SNP)
|
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
25% | 25% | P | $83,936.03 |
Browse Plan Formulary |
AgeWell New York FeelWell (HMO SNP)
|
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P | $83,936.03 |
Browse Plan Formulary |
AlphaCare Resilience (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:30 /30Days | $84,766.39 |
Browse Plan Formulary |
AlphaCare Total (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Tier 5 |
15% | 15% | P Q:30 /30Days | $84,766.39 |
Browse Plan Formulary |
Amida Care Live Life Advantage (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P Q:28 /28Days | $83,807.25 |
Browse Plan Formulary |
Amida Care True Life Advantage (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Tier 5 |
15% | 15% | P Q:28 /28Days | $83,807.25 |
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 |
ArchCare Advantage (HMO SNP)
|
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
25% | 25% | P | $85,172.65 |
Browse Plan Formulary |
CenterLight Healthcare Direct Complete Plan (HMO SNP)
|
$39.70 |
$360 |
to be determined |
2 |
Brand |
25% | 25% | P Q:30 /30Days | $83,917.20 |
Browse Plan Formulary |
Centers Plan for Dual Coverage Care (HMO SNP)
|
$39.70 |
$360 |
to be determined |
4 |
Tier 4 |
15% | 15% | P Q:28 /28Days | $84,214.06 |
Browse Plan Formulary |
Centers Plan for Nursing Home Care (HMO SNP)
|
$39.70 |
$360 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:28 /28Days | $84,225.30 |
Browse Plan Formulary |
Elderplan Advantage For Nursing Home Residents (HMO SNP)
|
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
25% | 25% | P | $84,873.45 |
Browse Plan Formulary |
Elderplan Extra Help (HMO)
|
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
25% | 25% | P | $84,873.70 |
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 |
Elderplan For Medicaid Beneficiaries (HMO SNP)
|
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
15% | 15% | P | $84,873.70 |
Browse Plan Formulary |
Elderplan Plus Long Term Care (HMO SNP)
|
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
15% | 15% | P | $84,873.33 |
Browse Plan Formulary |
EmblemHealth Dual Eligible (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P Q:30 /30Days | $83,773.65 |
Browse Plan Formulary |
EmblemHealth Dual Eligible (PPO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P Q:30 /30Days | $83,773.65 |
Browse Plan Formulary |
Empire MediBlue Dual Advantage (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | P | $83,875.40 |
Browse Plan Formulary |
Fidelis Dual Advantage (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | P | $85,168.26 |
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 Dual Advantage Flex (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | P | $85,170.23 |
Browse Plan Formulary |
Fidelis Medicaid Advantage Plus (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | P | $85,171.22 |
Browse Plan Formulary |
Fidelis Medicare Advantage Flex (HMO-POS)
|
$39.70 |
$250 |
to be determined |
5 |
Specialty Tier |
27% | n/a | P | $85,170.23 |
Browse Plan Formulary |
GuildNet Gold (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P Q:30 /30Days | $83,699.75 |
Browse Plan Formulary |
Liberty Health Advantage Dual Power (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Tier 5 |
15% | 15% | P Q:30 /30Days | $86,689.50 |
Browse Plan Formulary |
RiverSpring Star (HMO SNP)
|
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
25% | 25% | P | $85,647.24 |
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 |
Senior Whole Health of New York NHC (HMO SNP)
|
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:28 /28Days | $83,807.84 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Classic (HMO)
|
$39.70 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:28 /28Days | $83,539.37 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Preferred (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Tier 5 |
15% | 15% | P Q:28 /28Days | $83,539.37 |
Browse Plan Formulary |
VNSNY CHOICE Total (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:28 /28Days | $83,538.13 |
Browse Plan Formulary |
Affinity Medicare Passport Select (HMO)
|
$41.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P | $85,173.02 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$69.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days | $83,915.62 |
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 4 (Regional PPO)
|
$69.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days | $83,946.61 |
Browse Plan Formulary |
Advantage Platinum Plus NY (HMO)
|
$85.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $86,916.91 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$96.00 |
$150 |
to be determined |
5 |
Specialty Tier |
29% | n/a | P Q:28 /28Days | $85,122.30 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Ultra (HMO-POS)
|
$96.40 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P Q:28 /28Days | $83,539.37 |
Browse Plan Formulary |
EmblemHealth VIP (HMO)
|
$103.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P Q:30 /30Days | $82,519.85 |
Browse Plan Formulary |
EmblemHealth VIP (HMO)
|
$103.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P Q:30 /30Days | $83,787.37 |
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 (HMO)
|
$103.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P Q:30 /30Days | $83,859.37 |
Browse Plan Formulary |
EmblemHealth VIP (HMO)
|
$103.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P Q:30 /30Days | $84,072.66 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Maximum (HMO SNP)
|
$115.80 |
$360 |
to be determined |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:28 /28Days | $83,538.13 |
Browse Plan Formulary |
MetroPlus Platinum (HMO)
|
$184.30 |
$360 |
to be determined |
1 |
Tier 1 |
25% | 25% | P | $82,675.62 |
Browse Plan Formulary |
Aetna Medicare Connect Plus (PPO)
|
$188.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P Q:28 /28Days | $85,227.48 |
Browse Plan Formulary |
EmblemHealth Advantage (PPO)
|
$223.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P Q:30 /30Days | $83,718.09 |
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)
|
$306.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P Q:30 /30Days | $83,787.37 |
Browse Plan Formulary |
EmblemHealth VIP High Option (HMO)
|
$306.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P Q:30 /30Days | $83,859.37 |
Browse Plan Formulary |
EmblemHealth VIP High Option (HMO)
|
$306.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P Q:30 /30Days | $84,072.66 |
Browse Plan Formulary |
EmblemHealth VIP High Option (HMO)
|
$306.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P Q:30 /30Days | $82,519.85 |
Browse Plan Formulary |