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2010 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
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Plan Name | County | Monthly Prem. (Parts C & D) |
Deduct- ible |
(Donut Hole) Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance 30-Day Supply |
Members In This Plan ID | |||||
Cust. Service Rating |
Member Plan Exper. |
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AARP MedicareComplete Balance (HMO) - H3307-011-0 Benefit Details |
Kings | $0.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $6.00 Tier 2 Generic Preferred Brand: $38.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $72.00 Tier 4 Specialty: 33% | 5,267 members Browse Formulary | |||||
AARP MedicareComplete Essential (HMO) - H3307-018-0 Benefit Details |
Kings | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 2,280 members | ||||||
AARP MedicareComplete Mosaic (HMO) - H3307-015-0 Benefit Details |
Kings | $0.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $6.00 Tier 2 Generic Preferred Brand: $38.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $72.00 Tier 4 Specialty: 33% | 18,535 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
AARP MedicareComplete Plan 1 (HMO) - H3307-002-0 Benefit Details |
Kings | $0.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $6.00 Tier 2 Generic Preferred Brand: $38.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $72.00 Tier 4 Specialty: 33% | 33,254 members Browse Formulary | |||||
AARP MedicareComplete Plan 2 (HMO) - H3379-001-0 Benefit Details |
Kings | $0.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $6.00 Tier 2 Generic Preferred Brand: $38.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $72.00 Tier 4 Specialty: 33% | 2,008 members Browse Formulary | |||||
AARP MedicareComplete Plan 3 (HMO) - H3379-005-0 Benefit Details |
Kings | $0.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $6.00 Tier 2 Generic Preferred Brand: $38.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $72.00 Tier 4 Specialty: 33% | 928 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
AARP MedicareComplete Plan 4 (HMO) - H3307-021-0 Benefit Details |
Kings | $0.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $8.00 Tier 2 Generic Preferred Brand: $42.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $72.00 Tier 4 Specialty: 33% | 3,682 members Browse Formulary | |||||
Aetna Medicare Value Plan (HMO) - H3312-002-0 Benefit Details |
Kings | $0.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $6.00 Tier 2 - Non-Preferred Generic: $25.00 Tier 3 - Preferred Brand: $34.00 Tier 4 - Non-Preferred Brand: $74.00 Tier 5 - Specialty: 33% | 2,062 members Browse Formulary | |||||
Amerivantage Balance + Rx (HMO) - H6181-009-0 Benefit Details |
Kings | $0.00 | $0 | Many Generics | Preferred Generic Drugs: $0.00 Non-Preferred Generic Drugs: $3.00 Preferred Brand Drugs: $20.00 Non-Preferred Brand Drugs: $80.00 Specialty Drugs: 33% | 285 members Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Amerivantage Classic + Rx (HMO) - H6181-008-0 Benefit Details |
Kings | $0.00 | $0 | Some Generics | Preferred Generic Drugs: $0.00 Non-Preferred Generic Drugs: $3.00 Preferred Brand Drugs: $20.00 Non-Preferred Brand Drugs: $80.00 Specialty Drugs: 33% | 76 members Browse Formulary | |||||
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CCM Direct Value Plan (HMO) - H5989-004-0 Benefit Details |
Kings | $0.00 | $0 | No Gap Coverage | Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Brand: $60.00 Specialty: 33% | 14 members Browse Formulary | |||||
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Elderplan Classic I: Medicare Extra Needs (HMO) - H9101-007-0 Benefit Details |
Kings | $0.00 | $0 | No Gap Coverage | Generic: $0.00 Preferred: $25.00 Brand: $75.00 Specialty: 25% | 3,520 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Elderplan Classic II: Medicare Zero Premium (HMO) - H3347-005-0 Benefit Details |
Kings | $0.00 | $0 | Many Generics | Generic: $0.00 Preferred: $25.00 Brand: $75.00 Specialty: 25% | 11,164 members Browse Formulary | |||||
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Elderplan Medicare Part B Premium Reduction (HMO) - H3347-004-0 Benefit Details |
Kings | $0.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 159 members Browse Formulary | |||||
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Elderplan Medicare Part B Premium Reduction w/o Rx (HMO) - H3347-011-0 Benefit Details |
Kings | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 27 members | ||||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Evercare Plan MH (HMO) - H3307-022-0 Benefit Details |
Kings | $0.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $5.00 Tier 2 Generic Preferred Brand: $42.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $79.00 Tier 4 Specialty: 33% | < 10 members Browse Formulary | |||||
Fidelis Medicare Advantage (HMO-POS) - H3328-012-0 Benefit Details |
Kings | $0.00 | $310 | Many Generics | Generic: $4.00 Preferred Brand: 40% Non-Preferred Brand: 60% Specialty: 25% | n/a Browse Formulary | |||||
Fidelis Medicare Advantage Part B Reduction (HMO-POS) - H3328-014-0 Benefit Details |
Kings | $0.00 | $310 | No Gap Coverage | Generic: $5.00 Preferred Brand: $45.00 Non-preferred Brand: $95.00 Specialty: 25% | 56 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Fidelis Medicare Advantage without Rx (HMO-POS) - H3328-001-0 Benefit Details |
Kings | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 228 members | ||||||
Fresenius Medical Care Health Plan (PFFS) - H5909-005-0 Benefit Details |
Kings | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 81 members | ||||||
GHI Medicare PPO Any Dual (PPO) - H5528-018-0 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Tier 1: $4.00 Tier 2: 25% Tier 3: 40% Tier 4: 25% | 329 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
GHI Medicare PPO I (PPO) - H5528-001-0 Benefit Details |
Kings | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 382 members | ||||||
GHI Medicare PPO II (PPO) - H5528-002-0 Benefit Details |
Kings | $0.00 | $0 | No Gap Coverage | Tier 1: $5.00 Tier 2: $20.00 Tier 3: 50% Tier 4: 33% | 7,194 members Browse Formulary | |||||
GHI Medicare PPO Value (PPO) - H5528-013-0 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Tier 1: $4.00 Tier 2: 25% Tier 3: 40% Tier 4: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Healthfirst 65 Plus Plan (HMO) - H3359-001-0 Benefit Details |
Kings | $0.00 | $0 | No Gap Coverage | Tier 1: $0.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | 21,401 members Browse Formulary | |||||
Healthfirst Coordinated Benefits Plan (HMO) - H3359-027-0 Benefit Details |
Kings | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Healthfirst Jade Benefits Plan (HMO) - H3359-032-0 Benefit Details |
Kings | $0.00 | $0 | No Gap Coverage | Tier 1: $0.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | 335 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HIP VIP (HMO) - H3330-021-1 Benefit Details |
Kings | $0.00 | $0 | No Gap Coverage | Tier 1: $5.00 Tier 2: $25.00 Tier 3: 50% Tier 4: 25% | 48,264 members Browse Formulary | |||||
HIP VIP Dual Eligible (HMO) - H3330-029-0 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Tier 1: $4.00 Tier 2: 25% Tier 3: 40% Tier 4: 25% | 6,147 members Browse Formulary | |||||
HIP VIP Medicaid Advantage (HMO) - H3330-031-1 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Tier 1: $4.00 Tier 2: 25% Tier 3: 40% Tier 4: 25% | 2,709 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HIP VIP Rx Carveout (HMO) - H3330-025-1 Benefit Details |
Kings | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 969 members | ||||||
Liberty Health Advantage Preferred Choice (HMO) - H3337-001-0 Benefit Details |
Kings | $0.00 | $0 | All Generics, Few Brand | Preferred Generics: $0.00 Generics: $10.00 Liberty Choice Drugs: $10.00 Preferred Brands: $25.00 Brands: $50.00 Specialty Drugs: 25% | 2,639 members Browse Formulary | |||||
MediBlue Essential (HMO) - H3370-019-0 Benefit Details |
Kings | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 682 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
MediBlue Plus (HMO) - H3370-001-0 Benefit Details |
Kings | $0.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $42.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $80.00 Tier 4 Non-Specialty Injectable Drugs: 33% Tier 5 Specialty Drugs: 33% | 26,528 members Browse Formulary | |||||
MediBlue Value (HMO) - H3370-021-0 Benefit Details |
Kings | $0.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $0.00 Tier 2 Preferred Brand Certain Generic Drugs: $42.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $80.00 Tier 4 Non-Specialty Injectable Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
MediBlue Value (PPO) - H3342-012-0 Benefit Details |
Kings | $0.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $42.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $80.00 Tier 4 Non-Specialty Injectable Drugs: 33% Tier 5 Specialty Drugs: 33% | 14,833 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
MetroPlus Platinum (HMO) - H0423-004-0 Benefit Details |
Kings | $0.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% | 449 members Browse Formulary | |||||
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SecureHorizons MedicareComplete Choice (Regional PPO) - R5342-001-0 Benefit Details |
Kings | $0.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $6.00 Tier 2 Generic Preferred Brand: $42.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $79.00 Tier 4 Specialty: 33% | 13,222 members Browse Formulary | |||||
SecureHorizons MedicareComplete Choice (Regional PPO) - R5342-001-0 Benefit Details |
Statewide | $0.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $6.00 Tier 2 Generic Preferred Brand: $42.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $79.00 Tier 4 Specialty: 33% | 13,222 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareComplete Choice Essential (Regional PPO) - R5342-002-0 Benefit Details |
Kings | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 748 members | ||||||
SecureHorizons MedicareComplete Choice Essential (Regional PPO) - R5342-002-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 748 members | ||||||
Touchstone Grand (HMO) - H3366-022-0 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 138 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Touchstone Health Medicare Clear (HMO-POS) - H3327-022-0 Benefit Details |
Kings | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 799 members | ||||||
Touchstone Health Medicare Power (HMO) - H3327-001-0 Benefit Details |
Kings | $0.00 | $0 | Many Generics | Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Biological and Specialty Injectables: 25% | 6,458 members Browse Formulary | |||||
VNS CHOICE Medicare Option 5 (HMO) - H5549-004-0 Benefit Details |
Kings | $0.00 | $0 | No Gap Coverage | TIER #1: $5.00 TIER #2: $30.00 TIER #3: $60.00 TIER #4: 25% | n/a Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
AmeriChoice Personal Care Plus (HMO) - H3387-005-0 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Tier 1: 25% Tier 2: 25% | n/a Browse Formulary | |||||
HIP VIP Plus (HMO) - H3330-023-1 Benefit Details |
Kings | $22.00 | $0 | No Gap Coverage | Tier 1: $5.00 Tier 2: $25.00 Tier 3: 50% Tier 4: 25% | 4,917 members Browse Formulary | |||||
Evercare Plan DH (HMO) - H3307-020-0 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Evercare Plan DH-U (HMO) - H3379-036-0 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 53 members Browse Formulary | |||||
Evercare Plan RDP (Regional PPO) - R5342-003-0 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 4,933 members Browse Formulary | |||||
Evercare Plan RDP (Regional PPO) - R5342-003-0 Benefit Details |
Statewide | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 4,933 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Evercare Plan RMP (Regional PPO) - R5342-004-0 Benefit Details |
Kings | $25.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $5.00 Tier 2 Generic Preferred Brand: $45.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $85.00 Tier 4 Specialty: 33% | n/a Browse Formulary | |||||
Evercare Plan RMP (Regional PPO) - R5342-004-0 Benefit Details |
Statewide | $25.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $5.00 Tier 2 Generic Preferred Brand: $45.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $85.00 Tier 4 Specialty: 33% | n/a Browse Formulary | |||||
MetroPlus Advantage Plan (HMO) - H0423-001-0 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Tier 1: 25% Tier 2: 25% | 2,305 members Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
MetroPlus Medicare Partnership in Care Plan (HMO) - H0423-002-0 Benefit Details |
Kings | $26.50 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% | 297 members Browse Formulary | |||||
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Evercare Plan IH (HMO) - H3379-002-0 Benefit Details |
Kings | $27.70 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 3,492 members Browse Formulary | |||||
Elderplan Medicare Extra Help (HMO) - H3347-009-0 Benefit Details |
Kings | $30.60 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 217 members Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Elderplan Medicare For Medicaid Beneficiaries (HMO) - H3347-002-0 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 324 members Browse Formulary | |||||
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Elderplan Medicare For Nursing Home Residents (HMO) - H3347-003-0 Benefit Details |
Kings | $30.60 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 211 members Browse Formulary | |||||
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VNS CHOICE Medicare Option 1 (HMO) - H5549-001-0 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
VNS CHOICE Medicare Option 2 (HMO) - H5549-002-0 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 2,089 members Browse Formulary | |||||
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GHI Medicare PPO III (PPO) - H5528-003-0 Benefit Details |
Kings | $32.00 | $0 | Many Generics | Tier 1: $7.00 Tier 2: $20.00 Tier 3: 50% Tier 4: 33% | 2,488 members Browse Formulary | |||||
ArchCare - Institutional Equiv SNP - NYC (HMO) - H1777-009-0 Benefit Details |
Kings | $32.60 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% | < 10 members Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
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Service | Exper. | Cost Info | |||||||||
ArchCare - Institutional SNP - NYC (HMO) - H1777-007-0 Benefit Details |
Kings | $32.60 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% | 642 members Browse Formulary | |||||
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Healthfirst Increased Benefits Plan (HMO) - H3359-019-0 Benefit Details |
Kings | $33.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 20,919 members Browse Formulary | |||||
Healthfirst Life Improvement Plan (HMO) - H3359-021-0 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 44,819 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Affinity Medicare Solutions (HMO) - H5991-002-0 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% | 300 members Browse Formulary | |||||
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Affinity Medicare Ultimate (HMO) - H5991-001-0 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% | n/a Browse Formulary | |||||
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Amerivantage Specialty + Rx (HMO) - H6181-007-0 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Preferred Generic Drugs: $0.00 Non-Preferred Generic Drugs: $0.00 Preferred Brand Drugs: $47.00 Non-Preferred Brand Drugs: $90.00 Specialty Drugs: 25% | 359 members Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
CCM Direct Advantage Plan (HMO) - H5989-003-0 Benefit Details |
Kings | $33.30 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | < 10 members Browse Formulary | |||||
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CCM Direct Choice Plan (HMO) - H5989-005-0 Benefit Details |
Kings | $33.30 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | < 10 members Browse Formulary | |||||
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CCM Direct Complete Plan (HMO) - H5989-002-0 Benefit Details |
Kings | $33.30 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 126 members Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Fidelis Dual Advantage (HMO) - H3328-002-0 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Generic: 0% Preferred Brand: 37% Non-preferred Brand: 50% Specialty: 25% | 378 members Browse Formulary | |||||
Fidelis Dual Advantage Flex Plan (HMO) - H3328-013-0 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Generic: $0.00 Preferred Brand: 10% Non-Preferred Brand: 55% Specialty: 25% | n/a Browse Formulary | |||||
Fidelis Medicare Advantage Flex Plan (HMO-POS) - H3328-003-0 Benefit Details |
Kings | $33.30 | $310 | No Gap Coverage | Generic: $6.00 Preferred Brand: $35.00 Non-preferred Brand: $55.00 Specialty: 25% | 3,840 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Health Plus Elite - MAPD (HMO) - H6264-001-0 Benefit Details |
Kings | $33.30 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% | 424 members Browse Formulary | |||||
new | new | new | |||||||||
Independent Health Medicare Anywhere Basic (PFFS) - H9519-003-0 Benefit Details |
Kings | $33.30 | $0 | Few Generics, Few Brand | Tier 1: $8.00 Tier 2: $45.00 Tier 3: $75.00 Specialty Tier 4: 33% | 79 members Browse Formulary | |||||
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Liberty Health Advantage Dual Power - NYC (HMO) - H3337-003-0 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% Tier 6: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
MAP (HMO) - H5989-006-0 Benefit Details |
Kings | $33.30 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | < 10 members Browse Formulary | |||||
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Touchstone Health Medicare Total (HMO) - H3327-002-0 Benefit Details |
Kings | $33.30 | $0 | Many Generics | Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Biological and Specialty Injectables: 25% | 5,037 members Browse Formulary | |||||
Touchstone Health Medicare Freedom (HMO-POS) - H3327-023-0 Benefit Details |
Kings | $42.00 | $0 | Many Generics | Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Biological and Specialty Injectables: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Aetna Medicare Premier Plan (HMO) - H3312-028-0 Benefit Details |
Kings | $59.00 | $0 | Many Generics | Tier 1 - Preferred Generic: $5.00 Tier 2 - Non-Preferred Generic: $30.00 Tier 3 - Preferred Brand: $35.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 33% | 438 members Browse Formulary | |||||
Elderplan Medicare Premium Benefit (HMO-POS) - H3347-010-0 Benefit Details |
Kings | $61.00 | $0 | Many Generics | Generic: $0.00 Preferred: $25.00 Brand: $75.00 Specialty: 25% | 34 members Browse Formulary | |||||
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MediBlue Plus (PPO) - H3342-001-0 Benefit Details |
Kings | $77.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $42.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $80.00 Tier 4 Non-Specialty Injectable Drugs: 33% Tier 5 Specialty Drugs: 33% | 2,484 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Today's Options Value (PFFS) - H3333-146-0 Benefit Details |
Kings | $90.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 304 members | ||||||
Today's Options Value powered by CCRx (PFFS) - H3333-147-0 Benefit Details |
Kings | $104.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 372 members Browse Formulary | |||||
Sterling Basic Plus (PFFS) - H5006-018-3 Benefit Details |
Kings | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 10,911 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Today's Options Premier (PFFS) - H3333-144-0 Benefit Details |
Kings | $134.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 587 members | ||||||
Independent Health Medicare Anywhere (PFFS) - H9519-001-0 Benefit Details |
Kings | $135.00 | $0 | Few Generics, Few Brand | Tier 1: $8.00 Tier 2: $40.00 Tier 3: $70.00 Specialty Tier 4: 33% | 156 members Browse Formulary | |||||
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Sterling Option II (PFFS) - H5006-017-3 Benefit Details |
Kings | $170.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $34.00 Specialty: 25% | 8,639 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Today's Options Premier powered by CCRx (PFFS) - H3333-145-0 Benefit Details |
Kings | $175.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 402 members Browse Formulary | |||||
Sterling Option I (PFFS) - H5006-014-3 Benefit Details |
Kings | $183.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 43,891 members | ||||||
Sterling Option IV (PFFS) - H5006-016-3 Benefit Details |
Kings | $196.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $36.00 Specialty: 25% | 3,337 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Evercare Plan IH (HMO) - H3379-037-0 Benefit Details |
Kings | $200.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $7.00 Tier 2 Generic Preferred Brand: $42.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $80.00 Tier 4 Specialty: 33% | < 10 members Browse Formulary | |||||
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