CLOZAPINE ODT 150 MG TABLET (NDC: 00093308601)
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 |
Advantage Health NY - SNP (HMO SNP)
![Email Prescription and/or Health Benefit details for Advantage Health NY - SNP (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,666.64 |
Browse Plan Formulary |
Advantage Silver - NY (HMO)
![Email Prescription and/or Health Benefit details for Advantage Silver - NY (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,666.64 |
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 |
1 |
Generic Drugs |
0% | 0% | None | $1,714.06 |
Browse Plan Formulary |
Affinity Medicare Passport Essentials (HMO)
![Email Prescription and/or Health Benefit details for Affinity Medicare Passport Essentials (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
to be determined |
5 |
Specialty Tier |
26% | n/a | P Q:180 /30Days | $1,649.68 |
Browse Plan Formulary |
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 |
1 |
Generic Drugs |
0% | 0% | None | $1,489.44 |
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 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 |
2 |
Generic |
$15.00 | $37.50 | None | $1,489.44 |
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% | None | $1,648.07 |
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 |
1 |
Preferred Generic |
$5.00 | $12.50 | None | $1,640.77 |
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 |
1 |
Generic Drugs |
0% | 0% | None | $1,635.69 |
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 Q:180 /30Days | $1,735.57 |
Browse Plan Formulary |
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 Q:180 /30Days | $1,735.57 |
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 |
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% | None | $1,687.50 |
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 Q:180 /30Days | $1,669.79 |
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 Q:180 /30Days | $1,664.33 |
Browse Plan Formulary |
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 |
2 |
Generic |
$10.00 | $30.00 | Q:120 /30Days | $1,697.60 |
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 Q:180 /30Days | $1,674.78 |
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. |
1 |
Tier 1 |
0% | n/a | Q:180 /30Days | $1,474.75 |
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 |
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 |
1 |
Generic Drugs |
0% | 0% | None | $1,574.56 |
Browse Plan Formulary |
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 |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:180 /30Days | $1,417.72 |
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 |
1 |
Generic Drugs |
0% | 0% | S | $1,698.44 |
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 |
2 |
Generic |
$9.00 | $27.00 | S | $1,698.44 |
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 Q:180 /30Days | $1,722.32 |
Browse Plan Formulary |
WellCare Choice (HMO)
![Email Prescription and/or Health Benefit details for WellCare 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 Q:180 /30Days | $1,725.97 |
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 |
Humana Gold Plus SNP-DE H3533-022 (HMO SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H3533-022 (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.70 |
$360 |
to be determined |
4 |
Non-Preferred Brand |
$80.00 | $230.00 | S | $1,596.95 |
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 Q:180 /30Days | $1,669.79 |
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) |
$32.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None | $1,687.50 |
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) |
$32.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None | $1,687.50 |
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) |
$32.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None | $1,687.50 |
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) |
$32.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None | $1,687.50 |
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 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 Q:180 /30Days | $1,725.97 |
Browse Plan Formulary |
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 Q:180 /30Days | $1,669.79 |
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 |
3 |
Tier 3 |
$0.00 | $0.00 | Q:180 /30Days | $1,417.72 |
Browse Plan Formulary |
Humana Gold Plus H3533-010 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H3533-010 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.00 |
$360 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | S | $1,596.95 |
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 Q:180 /30Days | $1,669.79 |
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 Q:180 /30Days | $1,669.79 |
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 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 |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:180 /30Days | $1,417.72 |
Browse Plan Formulary |
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 |
3 |
Tier 3 |
25% | 25% | Q:180 /30Days | $1,417.72 |
Browse Plan Formulary |
Advantage Value One NY - Dual (HMO SNP)
![Email Prescription and/or Health Benefit details for Advantage Value One NY - Dual (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.70 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,666.64 |
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 Q:180 /30Days | $1,649.68 |
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 Q:180 /30Days | $1,649.68 |
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 | $1,489.44 |
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)
![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 | $1,489.44 |
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 | $1,489.44 |
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% | None | $1,648.07 |
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% | None | $1,640.77 |
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% | None | $1,640.77 |
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% | None | $1,640.77 |
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 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% | None | $1,640.77 |
Browse Plan Formulary |
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 |
4 |
Non-Preferred Brand |
30% | 30% | None | $1,687.50 |
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 |
4 |
Non-Preferred Brand |
30% | 30% | None | $1,687.50 |
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 |
4 |
Non-Preferred Brand |
$94.00 | $282.00 | Q:180 /30Days | $1,688.06 |
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 Q:180 /30Days | $1,735.57 |
Browse Plan Formulary |
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 Q:180 /30Days | $1,735.57 |
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 |
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 |
4 |
Non-Preferred Brand |
25% | 25% | None | $1,687.50 |
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 |
2 |
Tier 2 |
15% | 15% | Q:120 /30Days | $1,691.13 |
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% | None | $1,574.56 |
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 |
2 |
Tier 2 |
25% | 25% | S | $1,698.44 |
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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 |
2 |
Tier 2 |
15% | 15% | S | $1,698.44 |
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 |
2 |
Tier 2 |
$0.00 | $0.00 | S | $1,698.44 |
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 |
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 Q:180 /30Days | $1,649.68 |
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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) |
$49.00 |
$290 |
to be determined |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | Q:180 /30Days | $1,688.06 |
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 |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:180 /30Days | $1,417.72 |
Browse Plan Formulary |
Advantage Platinum Plus NY (HMO)
![Email Prescription and/or Health Benefit details for Advantage Platinum Plus NY (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$85.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,666.64 |
Browse Plan Formulary |
Elderplan Healthy Balance (HMO-POS)
![Email Prescription and/or Health Benefit details for Elderplan Healthy Balance (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$85.00 |
$0 |
to be determined |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $1,640.77 |
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 |
2 |
Generic |
$9.00 | $27.00 | S | $1,698.44 |
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)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$103.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None | $1,687.50 |
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) |
$103.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None | $1,687.50 |
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) |
$103.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None | $1,687.50 |
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) |
$103.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None | $1,687.50 |
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 |
2 |
Tier 2 |
$0.00 | $0.00 | S | $1,698.44 |
Browse Plan Formulary |
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) |
$137.00 |
$225 |
to be determined |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $1,589.46 |
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 Connect Plus (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Connect Plus (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$188.00 |
$0 |
to be determined |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,589.46 |
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) |
$223.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None | $1,687.50 |
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) |
$306.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None | $1,687.50 |
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) |
$306.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None | $1,687.50 |
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) |
$306.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None | $1,687.50 |
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) |
$306.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None | $1,687.50 |
Browse Plan Formulary |