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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. |
RxCost Info Rating |
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CCM Direct Value Plan (HMO) - H5989-004-0 Benefit Details |
Suffolk | $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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Fidelis Medicare Advantage without Rx (HMO-POS) - H3328-001-0 Benefit Details |
Suffolk | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 228 members | ||||||
HIP VIP Dual Eligible (HMO) - H3330-029-0 Benefit Details |
Suffolk | $ 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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HIP VIP Medicaid Advantage (HMO) - H3330-031-2 Benefit Details |
Suffolk | $ 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 | |||||
MediBlue Value (PPO) - H3342-012-0 Benefit Details |
Suffolk | $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 | |||||
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 (Regional PPO) - R5342-001-0 Benefit Details |
Suffolk | $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 Essential (Regional PPO) - R5342-002-0 Benefit Details |
Statewide | $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 |
Suffolk | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 748 members | ||||||
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) - H5528-009-0 Benefit Details |
Suffolk | $20.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 645 members | ||||||
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 | |||||
Evercare Plan RDP (Regional PPO) - R5342-003-0 Benefit Details |
Suffolk | $ 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 |
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 | |||||
Evercare Plan RMP (Regional PPO) - R5342-004-0 Benefit Details |
Suffolk | $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 IH (HMO) - H3379-002-0 Benefit Details |
Suffolk | $27.70 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 3,492 members Browse Formulary | |||||
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 |
Suffolk | $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 |
Suffolk | $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 |
Suffolk | $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 Flex Plan (HMO) - H3328-013-0 Benefit Details |
Suffolk | $ 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 |
Suffolk | $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 | |||||
Independent Health Medicare Anywhere Basic (PFFS) - H9519-003-0 Benefit Details |
Suffolk | $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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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 |
Suffolk | $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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GHI Medicare PPO II (PPO) - H5528-010-0 Benefit Details |
Suffolk | $34.00 | $0 | No Gap Coverage | Tier 1: $5.00 Tier 2: $20.00 Tier 3: 50% Tier 4: 33% | 2,924 members Browse Formulary | |||||
MediBlue Essential (HMO) - H3370-009-0 Benefit Details |
Suffolk | $58.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
MediBlue Plus (HMO) - H3370-004-0 Benefit Details |
Suffolk | $63.00 | $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% | 12,311 members Browse Formulary | |||||
Aetna Medicare Value Plan (HMO) - H3312-057-0 Benefit Details |
Suffolk | $67.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $6.00 Tier 2 - Non-Preferred Generic: $33.00 Tier 3 - Preferred Brand: $36.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | 191 members Browse Formulary | |||||
GHI Medicare PPO III (PPO) - H5528-011-0 Benefit Details |
Suffolk | $72.00 | $0 | Many Generics | Tier 1: $7.00 Tier 2: $20.00 Tier 3: 50% Tier 4: 33% | 2,659 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) - H3330-025-3 Benefit Details |
Suffolk | $75.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 969 members | ||||||
Aetna Medicare Select Plan (HMO) - H3312-059-0 Benefit Details |
Suffolk | $76.00 | $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% | 249 members Browse Formulary | |||||
Today's Options Value (PFFS) - H3333-146-0 Benefit Details |
Suffolk | $90.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 304 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HIP VIP (HMO) - H3330-021-3 Benefit Details |
Suffolk | $98.90 | $0 | No Gap Coverage | Tier 1: $5.00 Tier 2: $25.00 Tier 3: 50% Tier 4: 25% | 48,264 members Browse Formulary | |||||
Today's Options Value powered by CCRx (PFFS) - H3333-147-0 Benefit Details |
Suffolk | $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 |
Suffolk | $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 | |||||||||
Aetna Medicare Premier Plan (HMO) - H3312-058-0 Benefit Details |
Suffolk | $115.00 | $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% | 152 members Browse Formulary | |||||
Advantage Platinum NY - Suffolk (HMO) - H2773-005-0 Benefit Details |
Suffolk | $119.00 | $0 | No Gap Coverage | Generic: $4.00 Preferred Brand: $30.00 Brand: $60.00 Non-Preferred Brand: 25% Specialty: 33% | < 10 members Browse Formulary | |||||
Aetna Medicare Standard Plan (PPO) - H5521-043-0 Benefit Details |
Suffolk | $119.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $6.00 Tier 2 - Non-Preferred Generic: $27.00 Tier 3 - Preferred Brand: $35.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | 101 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 Plus (HMO) - H3330-023-3 Benefit Details |
Suffolk | $127.00 | $0 | No Gap Coverage | Tier 1: $5.00 Tier 2: $25.00 Tier 3: 50% Tier 4: 25% | 4,917 members Browse Formulary | |||||
Today's Options Premier (PFFS) - H3333-144-0 Benefit Details |
Suffolk | $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 |
Suffolk | $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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Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
MediBlue Plus (PPO) - H3342-004-0 Benefit Details |
Suffolk | $144.00 | $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% | 439 members Browse Formulary | |||||
Aetna Medicare Premier Plan (PPO) - H5521-044-0 Benefit Details |
Suffolk | $154.00 | $0 | Many Generics | Tier 1 - Preferred Generic: $5.00 Tier 2 - Non-Preferred Generic: $30.00 Tier 3 - Preferred Brand: $40.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | 144 members Browse Formulary | |||||
Sterling Option II (PFFS) - H5006-017-3 Benefit Details |
Suffolk | $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 |
Suffolk | $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 |
Suffolk | $183.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 43,891 members | ||||||
Advantage Health Suffolk - SNP (HMO) - H2773-006-0 Benefit Details |
Suffolk | $191.00 | $0 | No Gap Coverage | Generic: $4.00 Preferred Brand: $30.00 Brand: $60.00 Non-Preferred Brand: 25% Specialty: 33% | < 10 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Sterling Option IV (PFFS) - H5006-016-3 Benefit Details |
Suffolk | $196.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $36.00 Specialty: 25% | 3,337 members Browse Formulary | |||||
Evercare Plan IH (HMO) - H3379-037-0 Benefit Details |
Suffolk | $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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