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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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CDPHP Value (HMO) - H3388-003-0 Benefit Details |
Ulster | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 182 members | ||||||
Fidelis Medicare Advantage (HMO-POS) - H3328-012-0 Benefit Details |
Ulster | $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 |
Ulster | $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 |
Ulster | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 228 members | ||||||
GHI Medicare PPO I (PPO) - H5528-004-0 Benefit Details |
Ulster | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 485 members | ||||||
MediBlue Essential (HMO) - H3370-010-0 Benefit Details |
Ulster | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 462 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
MediBlue Value (PPO) - H3342-012-0 Benefit Details |
Ulster | $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 | |||||
SecureHorizons MedicareComplete Choice (Regional PPO) - R5342-001-0 Benefit Details |
Ulster | $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 |
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 |
Ulster | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 748 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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Evercare Plan RDP (Regional PPO) - R5342-003-0 Benefit Details |
Ulster | $ 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 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 |
Ulster | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
CDPHP Core (PPO) - H5042-002-0 Benefit Details |
Ulster | $28.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 88 members | ||||||
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MediBlue Select (HMO) - H3370-002-0 Benefit Details |
Ulster | $28.00 | $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% | 11,351 members Browse Formulary | |||||
GHI Medicare PPO II (PPO) - H5528-005-0 Benefit Details |
Ulster | $29.00 | $0 | No Gap Coverage | Tier 1: $5.00 Tier 2: $20.00 Tier 3: 50% Tier 4: 33% | 4,096 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
CDPHP Value Rx (HMO) - H3388-004-0 Benefit Details |
Ulster | $29.70 | $310 | No Gap Coverage | Tier 1 Formulary Preferred Generics: $2.00 Tier 2 Formulary Non-Preferred Generics: $4.00 Tier 3 Formulary Preferred Brand: $35.00 Tier 4 Formulary Non-Preferred Brand: $70.00 Tier 5 Formulary Specialty: 25% | n/a Browse Formulary | |||||
Evercare Plan IH (HMO) - H3379-022-0 Benefit Details |
Ulster | $33.30 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a Browse Formulary | |||||
Fidelis Dual Advantage (HMO) - H3328-002-0 Benefit Details |
Ulster | $ 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 | |||||
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 |
Ulster | $ 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 |
Ulster | $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 |
Ulster | $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 | |||||||||
CDPHP Choice (HMO) - H3388-001-0 Benefit Details |
Ulster | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 3,534 members | ||||||
Preferred Gold (HMO) - H9859-003-0 Benefit Details |
Ulster | $37.60 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 80 members | ||||||
Humana Gold Choice H4774-002 (PFFS) - H4774-002-0 Benefit Details |
Ulster | $40.00 | $0 | Few Generics, Few Brand | Preferred Generic: $10.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty: 33% | 716 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
CDPHP Classic (PPO) - H5042-004-0 Benefit Details |
Ulster | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 136 members | ||||||
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CDPHP Core Rx (PPO) - H5042-005-0 Benefit Details |
Ulster | $49.60 | $310 | No Gap Coverage | Tier 1 Formulary Preferred Generics: $2.00 Tier 2 Formulary Non-Preferred Generics: $4.00 Tier 3 Formulary Preferred Brand: $35.00 Tier 4 Formulary Non-Preferred Brand: $70.00 Tier 5 Formulary Specialty: 25% | 290 members Browse Formulary | |||||
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Humana Gold Choice H4774-005 (PFFS) - H4774-005-0 Benefit Details |
Ulster | $52.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 943 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 III (PPO) - H5528-008-0 Benefit Details |
Ulster | $63.00 | $0 | Many Generics | Tier 1: $7.00 Tier 2: $20.00 Tier 3: 50% Tier 4: 33% | n/a Browse Formulary | |||||
Humana Gold Choice H4774-001 (PFFS) - H4774-001-0 Benefit Details |
Ulster | $72.00 | $0 | Few Generics, Few Brand | Preferred Generic: $10.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 2,202 members Browse Formulary | |||||
CDPHP Classic Rx (PPO) - H5042-001-0 Benefit Details |
Ulster | $79.60 | $0 | Many Generics | Tier 1 Formulary Preferred Generics: $2.00 Tier 2 Formulary Non-Preferred Generics: $4.00 Tier 3 Formulary Preferred Brand: $35.00 Tier 4 Formulary Non-Preferred Brand: $70.00 Tier 5 Formulary Specialty: 30% | 2,229 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 | |||||||||
CDPHP Choice Rx (HMO) - H3388-002-0 Benefit Details |
Ulster | $89.60 | $0 | Many Generics | Tier 1 Formulary Preferred Generics: $2.00 Tier 2 Formulary Non-Preferred Generics: $4.00 Tier 3 Formulary Preferred Brand: $35.00 Tier 4 Formulary Non-Preferred Brand: $70.00 Tier 5 Formulary Specialty: 30% | 9,365 members Browse Formulary | |||||
MediBlue Plus (PPO) - H3342-002-0 Benefit Details |
Ulster | $90.00 | $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% | 791 members Browse Formulary | |||||
Today's Options Value (PFFS) - H3333-146-0 Benefit Details |
Ulster | $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 | |||||||||
Today's Options Value powered by CCRx (PFFS) - H3333-147-0 Benefit Details |
Ulster | $104.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 372 members Browse Formulary | |||||
Preferred Gold Rx (HMO) - H9859-004-0 Benefit Details |
Ulster | $109.00 | $0 | No Gap Coverage | Tier 1: $10.00 Tier 2: $33.00 Tier 3: $90.00 Tier 4: 33% Tier 5: 8,000% | 421 members Browse Formulary | |||||
Sterling Basic Plus (PFFS) - H5006-018-3 Benefit Details |
Ulster | $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 | |||||||||
CDPHP Prime (PPO) - H5042-006-0 Benefit Details |
Ulster | $120.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | < 10 members | ||||||
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Today's Options Premier (PFFS) - H3333-144-0 Benefit Details |
Ulster | $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 |
Ulster | $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 | |||||||||
Sterling Option II (PFFS) - H5006-017-3 Benefit Details |
Ulster | $170.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $34.00 Specialty: 25% | 8,639 members Browse Formulary | |||||
CDPHP Prime Rx (PPO) - H5042-007-0 Benefit Details |
Ulster | $170.60 | $0 | Many Generics | Tier 1 Formulary Preferred Generics: $2.00 Tier 2 Formulary Non-Preferred Generics: $4.00 Tier 3 Formulary Preferred Brand: $35.00 Tier 4 Formulary Non-Preferred Brand: $70.00 Tier 5 Formulary Specialty: 30% | 168 members Browse Formulary | |||||
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Today's Options Premier powered by CCRx (PFFS) - H3333-145-0 Benefit Details |
Ulster | $175.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 402 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 I (PFFS) - H5006-014-3 Benefit Details |
Ulster | $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 |
Ulster | $196.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $36.00 Specialty: 25% | 3,337 members Browse Formulary | |||||
GoldAnywhere Rx (PPO) - H9615-004-0 Benefit Details |
Ulster | $206.10 | $0 | Many Generics | Tier 1: $9.00 Tier 2: $30.00 Tier 3: $85.00 Tier 4: 33% Tier 5: 8,000% | 189 members Browse Formulary | |||||
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