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 |
Rockland | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | N/A | ||||||
AARP MedicareComplete (HMO) - H3307-012-0 Benefit Details |
Rockland | $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 Essential (HMO) - H3307-018-0 Benefit Details |
Rockland | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,900 | ||||||
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 |
Rockland | $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 |
Rockland | $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 | |||||
Fidelis Medicare Advantage without Rx (HMO-POS) - H3328-001-0 Benefit Details |
Rockland | $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 | |||||||||
SecureHorizons MedicareComplete Choice (Regional PPO) - R5342-001-0 Benefit Details |
Rockland | $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 | |||||
SecureHorizons MedicareComplete Choice Essential (Regional PPO) - R5342-002-0 Benefit Details |
Rockland | $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 | |||||||||
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 | ||||||
WellCare Advance (HMO) - H3361-059-0 Benefit Details |
Rockland | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
WellCare Value (HMO) - H3361-099-0 Benefit Details |
Rockland | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $3.00 Preferred Brand Drugs: $39.00 Non-Preferred Brand Drugs: $79.00 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 | |||||||||
WellCare Liberty (HMO SNP) - H3361-098-0 Benefit Details |
Rockland | $ 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: $38.00 Non-Preferred Brand Drugs: $89.00 Specialty Tier Drugs: 25% | n/a Browse Formulary | |||||
Evercare Plan IH (HMO SNP) - H3379-002-0 Benefit Details |
Rockland | $22.10 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
Aetna Medicare Value Plan (HMO) - H3312-018-0 Sanctioned Plan |
Rockland | $26.80 | $0 | n/a | Tier 1: Preferred Generic Drugs: $7.00 Tier 2: Non-Preferred Generic Drugs: $30.00 Tier 3: Preferred Brand Drugs: $40.00 Tier 4: Non-Preferred Brand Drugs: $80.00 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 | |||||||||
Empire MediBlue Select (HMO) - H3370-002-0 Benefit Details |
Rockland | $28.00 | $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 | |||||
Evercare Plan RDP (Regional PPO SNP) - R5342-003-0 Benefit Details |
Rockland | $ 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 | |||||
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 Access (HMO SNP) - H3361-065-0 Benefit Details |
Rockland | $ 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: $4.00 Preferred Brand Drugs: $43.00 Non-Preferred Brand Drugs: $95.00 Specialty Tier Drugs: 25% | n/a Browse Formulary | |||||
Empire MediBlue Freedom II (PPO) - H3342-014-0 Benefit Details |
Rockland | $35.00 | $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 | |||||
Fidelis Medicare Advantage Flex (HMO-POS) - H3328-003-0 Benefit Details |
Rockland | $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 | |||||
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 I (PPO) - H5528-004-0 Benefit Details |
Rockland | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
PPO II (PPO) - H5528-005-0 Benefit Details |
Rockland | $54.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,700 Browse Formulary | |||||
Dual Eligible (PPO SNP) - H5528-018-0 Benefit Details |
Rockland | $ 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 | |||||||||
PPO III (PPO) - H5528-008-0 Benefit Details |
Rockland | $97.00 | $0 | Many Generics | Tier 1: tbd | $6,700 Browse Formulary | |||||
Empire MediBlue Freedom III (PPO) - H3342-002-0 Benefit Details |
Rockland | $99.00 | $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 | |||||
PPO High Option (PPO) - H5528-020-0 Benefit Details |
Rockland | $178.00 | $0 | Many Generics | 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 | |||||||||
Evercare Plan IH (HMO SNP) - H3379-037-0 Benefit Details |
Rockland | $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 | |||||
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