UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Albany |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Allegany |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Bronx |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Broome |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Cattaraugus |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Cayuga |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Chautauqua |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Chemung |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Chenango |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Clinton |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Columbia |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Cortland |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Delaware |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Dutchess |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Erie |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Essex |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Franklin |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Fulton |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Genesee |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Greene |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Hamilton |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Herkimer |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Jefferson |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Kings |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Lewis |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Livingston |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Madison |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Monroe |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Montgomery |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Nassau |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
New York |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Niagara |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Oneida |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Onondaga |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Ontario |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Orange |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Orleans |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Oswego |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Otsego |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Putnam |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Queens |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Rensselaer |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Richmond |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Rockland |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
St. Lawrence |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Saratoga |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Schenectady |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Schoharie |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Schuyler |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Seneca |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Steuben |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Suffolk |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Sullivan |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Tioga |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Tompkins |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Ulster |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Warren |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Washington |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Wayne |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Westchester |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Wyoming |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) in NY - R5342-005-0
Benefit Details
|
Yates |
$44.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
|