2011 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) Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance 30-Day Supply |
MOOP for Part A & B Benefits | |||||
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
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ActiveSaver MSA (MSA) - H9788-004-0 Benefit Details |
Kings | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | N/A | ||||||
AARP MedicareComplete Essential (HMO) - H3307-018-0 Benefit Details |
Kings | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,900 | ||||||
AARP MedicareComplete Mosaic (HMO) - H3307-015-0 Benefit Details |
Kings | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $3.00 Generic and Preferred Brand Drugs: $42.00 Non-Preferred Generic and Non-Preferred Brand Drug: $79.00 Specialty Tier Drugs: 33% | $2,900 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
AARP MedicareComplete Plan 1 (HMO) - H3307-002-0 Benefit Details |
Kings | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $42.00 Non-Preferred Generic and Non-Preferred Brand Drug: $79.00 Specialty Tier Drugs: 33% | $5,900 Browse Formulary | |||||
AARP MedicareComplete Plan 2 (HMO) - H3379-001-0 Benefit Details |
Kings | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $42.00 Non-Preferred Generic and Non-Preferred Brand Drug: $79.00 Specialty Tier Drugs: 33% | $4,200 Browse Formulary | |||||
Aetna Medicare Value Plan (HMO) - H3312-002-0 Sanctioned Plan |
Kings | $0.00 | $0 | n/a | Tier 1: Preferred Generic Drugs: $6.00 Tier 2: Non-Preferred Generic Drugs: $34.00 Tier 3: Preferred Brand Drugs: $40.00 Tier 4: Non-Preferred Brand Drugs: $85.00 Tier 5: Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Amerivantage Balance + Rx (HMO) - H6181-009-0 Benefit Details |
Kings | $0.00 | $0 | Some Generics | Preferred Generic Drugs: 0% Non-Preferred Generic Drugs: $4.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
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CCM Direct Value Plan (HMO) - H5989-004-0 Benefit Details |
Kings | $0.00 | $0 | Many Generics | Generic Drugs: 0% Preferred Brand Drugs: $25.00 Non-Preferred Brand Drugs: $60.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
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Elderplan Classic: Zero Premium (HMO) - H3347-005-0 Benefit Details |
Kings | $0.00 | $0 | Many Generics | Generic Drugs: $3.00 Preferred Brand Drugs: $25.00 Non-Preferred Brand Drugs: $75.00 Specialty Tier Drugs: 25% | $3,400 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Empire MediBlue Essential (HMO) - H3370-019-0 Benefit Details |
Kings | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Empire MediBlue Freedom I (PPO) - H3342-012-0 Benefit Details |
Kings | $0.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $42.00 Non-Preferred Brand Drugs: $80.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $7.00 | $3,500 Browse Formulary | |||||
Empire MediBlue Plus (HMO) - H3370-001-0 Benefit Details |
Kings | $0.00 | $0 | Many Generics | Generic Drugs: 0% Preferred Brand Drugs: $42.00 Non-Preferred Brand Drugs: $80.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: 0% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Fidelis Medicare Advantage (HMO-POS) - H3328-012-0 Benefit Details |
Kings | $0.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: 100% Non-Preferred Generic Drugs: $6.00 Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $94.00 Specialty Tier Drugs: 25% | $6,700 Browse Formulary | |||||
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. | $6,700 | ||||||
Health Plus Elite - MAPD (HMO) - H6264-001-0 Benefit Details |
Kings | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Brand Drugs: $40.00 Specialty Tier Drugs: $65.00 | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Healthfirst 65 Plus Plan (HMO) - H3359-001-0 Benefit Details |
Kings | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: 0% Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $80.00 Specialty Tier Drugs: 33% | $6,700 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. | $6,700 | ||||||
Healthfirst Jade Benefits Plan (HMO) - H3359-032-0 Benefit Details |
Kings | $0.00 | $0 | Many Generics | Generic Drugs: 0% Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $80.00 Specialty Tier Drugs: 33% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Liberty Health Advantage Preferred Choice (HMO) - H3337-001-0 Benefit Details |
Kings | $0.00 | $0 | All Generics, Few Brands | Preferred Generic Drugs: 0% Non-Preferred Generic Drugs: $10.00 Brand Drugs: $10.00 Preferred Brand Drugs: $25.00 Non-Preferred Brand Drugs: $50.00 Specialty Tier Drugs: 25% | $6,700 Browse Formulary | |||||
MetroPlus Choice (HMO) - H0423-005-0 Benefit Details |
Kings | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
PPO I (PPO) - H5528-001-0 Benefit Details |
Kings | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
PPO II (PPO) - H5528-002-0 Benefit Details |
Kings | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,700 Browse Formulary | |||||
SecureHorizons MedicareComplete Choice (Regional PPO) - R5342-001-0 Benefit Details |
Kings | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $85.00 Specialty Tier Drugs: 33% | $4,400 Browse Formulary | |||||
SecureHorizons MedicareComplete Choice (Regional PPO) - R5342-001-0 Benefit Details |
Statewide | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $85.00 Specialty Tier Drugs: 33% | $4,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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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. | $3,400 | ||||||
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. | $3,400 | ||||||
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. | $3,400 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Touchstone Health Medicare Power (HMO) - H3327-001-0 Benefit Details |
Kings | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $6.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
VIP (HMO) - H3330-021-1 Benefit Details |
Kings | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,700 Browse Formulary | |||||
VIP Essential (HMO) - H3330-032-1 Benefit Details |
Kings | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
VNSNY CHOICE Medicare Option 5 (HMO) - H5549-004-0 Benefit Details |
Kings | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $30.00 Non-Preferred Brand Drugs: $60.00 Specialty Tier Drugs: 25% | $3,400 Browse Formulary | |||||
WellCare Choice (HMO-POS) - H3361-106-0 Benefit Details |
Kings | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: 0% Preferred Brand Drugs: $39.00 Non-Preferred Brand Drugs: $79.00 Specialty Tier Drugs: 33% | $6,700 Browse Formulary | |||||
WellCare Dividend (HMO) - H3361-039-0 Benefit Details |
Kings | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
MetroPlus Platinum (HMO) - H0423-004-0 Benefit Details |
Kings | $19.40 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,700 Browse Formulary | |||||
Evercare Plan IH (HMO SNP) - H3379-002-0 Benefit Details |
Kings | $22.10 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
Empire MediBlue Freedom II (PPO) - H3342-013-0 Benefit Details |
Kings | $25.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $42.00 Non-Preferred Brand Drugs: $80.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $7.00 | $3,300 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Evercare Plan RDP (Regional PPO SNP) - 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 additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
Evercare Plan RDP (Regional PPO SNP) - 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 additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
Evercare Plan DH (HMO SNP) - 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 additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
WellCare Advocate Complete (HMO SNP) - H3361-105-0 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $3.00 Preferred Brand Drugs: $37.00 Non-Preferred Brand Drugs: $77.00 Specialty Tier Drugs: 25% | n/a Browse Formulary | |||||
UnitedHealthcare Dual Complete (HMO SNP) - H3387-010-0 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
Elderplan Advantage For Nursing Home Residents (HMO SNP) - H3347-003-0 Benefit Details |
Kings | $33.70 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Elderplan For Medicaid Beneficiaries (HMO SNP) - 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 additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
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Elderplan Medicaid Advantage (HMO SNP) - H3347-008-0 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
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Elderplan Plus Long Term Care (HMO SNP) - H3347-007-0 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Elderplan Extra Help (HMO) - H3347-009-0 Benefit Details |
Kings | $34.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,400 Browse Formulary | |||||
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Health Plus Elite - Dual Special Needs Plan (HMO SNP) - H6264-002-0 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
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VNSNY CHOICE Medicare Option 2 (HMO SNP) - 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 additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
VNSNY CHOICE Medicare Option 1 (HMO SNP) - 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 additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
GuildNet Gold (HMO-POS SNP) - H6864-001-0 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: 0% Preferred Brand Drugs: $43.00 Non-Preferred Generic and Non-Preferred Brand Drug: $77.00 Specialty Tier Drugs: 25% | n/a Browse Formulary | |||||
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Touchstone Health Medicare Total (HMO) - H3327-002-0 Benefit Details |
Kings | $37.10 | $200 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: 0% Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 25% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Dual Eligible (HMO SNP) - 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 additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
Amerivantage Specialty + Rx (HMO SNP) - 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. | Many Generics | Preferred Generic Drugs: 0% Non-Preferred Generic Drugs: 0% Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: 25% Specialty Tier Drugs: 25% | n/a Browse Formulary | |||||
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CCM Direct Choice Plan (HMO) - H5989-005-0 Benefit Details |
Kings | $38.60 | $310 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: 0% Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $95.00 Specialty Tier Drugs: 25% | $3,400 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
CCM Direct Complete Plan (HMO SNP) - H5989-002-0 Benefit Details |
Kings | $38.60 | $310 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: 0% Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $95.00 Specialty Tier Drugs: 25% | n/a Browse Formulary | |||||
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Touchstone Grand (HMO SNP) - 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 additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $95.00 Specialty Tier Drugs: 25% | n/a Browse Formulary | |||||
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Touchstone Health Medicare Prestige (HMO SNP) - H3327-026-0 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $43.00 Non-Preferred Brand Drugs: $95.00 Specialty Tier Drugs: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Affinity Medicare Solutions (HMO SNP) - 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 additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
Affinity Medicare Ultimate (HMO SNP) - 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 additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
ArchCare - Institutional SNP - NYC (HMO SNP) - H1777-007-0 Benefit Details |
Kings | $38.70 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Fidelis Medicare Advantage Flex (HMO-POS) - H3328-003-0 Benefit Details |
Kings | $38.70 | $310 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: 0% Non-Preferred Generic Drugs: $11.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $94.00 Specialty Tier Drugs: 25% | $6,700 Browse Formulary | |||||
Fidelis Medicare Flex (HMO) - H3328-015-0 Benefit Details |
Kings | $38.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $4.00 Non-Preferred Generic Drugs: $11.00 Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $95.00 Specialty Tier Drugs: 25% | $6,700 Browse Formulary | |||||
Healthfirst Increased Benefits Plan (HMO) - H3359-019-0 Benefit Details |
Kings | $38.70 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Healthfirst Life Improvement Plan (HMO SNP) - 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 additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
Healthfirst Maximum Plan (HMO SNP) - H3359-033-0 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
MetroPlus Advantage Plan (HMO SNP) - 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 additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
MetroPlus Medicare Partnership in Care Plan (HMO SNP) - H0423-002-0 Benefit Details |
Kings | $38.70 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
MetroPlus Select Plan (HMO SNP) - H0423-003-0 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
WellCare Access (HMO SNP) - H3361-109-0 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $3.00 Preferred Brand Drugs: $39.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
PPO III (PPO) - H5528-003-0 Benefit Details |
Kings | $52.00 | $0 | Many Generics | Tier 1: tbd | $6,700 Browse Formulary | |||||
Touchstone Health Medicare Freedom (HMO-POS) - H3327-023-0 Benefit Details |
Kings | $58.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $6.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
Dual Eligible (PPO SNP) - 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 additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Elderplan Independence Choice (HMO-POS) - H3347-010-0 Benefit Details |
Kings | $62.00 | $0 | Many Generics | Generic Drugs: $4.00 Preferred Brand Drugs: $25.00 Non-Preferred Brand Drugs: $75.00 Specialty Tier Drugs: 25% | $3,400 Browse Formulary | |||||
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VNSNY CHOICE Managed Long Term Care Plus (HMO SNP) - H5549-003-0 Benefit Details |
Kings | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
Empire MediBlue Freedom III (PPO) - H3342-001-0 Benefit Details |
Kings | $89.00 | $0 | Many Generics | Generic Drugs: 0% Preferred Brand Drugs: $42.00 Non-Preferred Brand Drugs: $80.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: 0% | $2,500 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
PPO High Option (PPO) - H5528-019-0 Benefit Details |
Kings | $92.00 | $0 | Many Generics | Tier 1: tbd | $6,700 Browse Formulary | |||||
VIP High Option (HMO) - H3330-033-1 Benefit Details |
Kings | $152.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,700 Browse Formulary | |||||
Evercare Plan IH (HMO SNP) - H3379-037-0 Benefit Details |
Kings | $200.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $42.00 Non-Preferred Generic and Non-Preferred Brand Drug: $84.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
VNSNY CHOICE Medicare Option 6 (HMO) - H5549-005-0 Benefit Details |
Kings | $227.00 | $0 | Many Generics | Generic Drugs: 100% Preferred Brand Drugs: $30.00 Non-Preferred Brand Drugs: $60.00 Specialty Tier Drugs: 25% | $3,400 Browse Formulary | |||||
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