2012 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 |
Orange | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
AARP MedicareComplete (HMO) - H3307-012-0 Benefit Details |
Orange | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $6.00 Tier 3: $45.00 Tier 4: $89.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
AARP MedicareComplete Essential (HMO) - H3307-018-0 Benefit Details |
Orange | $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 | |||||||||
ArchCare - Instititutional Equiv SNP - NonNYC (HMO SNP) - H1777-010-0 Benefit Details |
Orange | $0.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | n/a Browse Formulary | |||||
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ArchCare - Institutional SNP - NonNYC (HMO SNP) - H1777-008-0 Benefit Details |
Orange | $0.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | n/a Browse Formulary | |||||
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Empire MediBlue Essential (HMO) - H3370-019-0 Benefit Details |
Orange | $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 | |||||||||
Empire MediBlue Freedom I (PPO) - H3342-012-0 Benefit Details |
Orange | $0.00 | $60 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $85.00 Tier 4: 33% Tier 5: 33% Tier 6: $9.00 | $4,500 Browse Formulary | |||||
Fidelis Medicare Advantage without Rx (HMO-POS) - H3328-001-0 Benefit Details |
Orange | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Touchstone Health Medicare Clear (HMO-POS) - H3327-022-0 Benefit Details |
Orange | $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 Core (HMO) - H3327-037-0 Benefit Details |
Orange | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $8.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
Touchstone Health Medicare Freedom (HMO-POS) - H3327-038-0 Benefit Details |
Orange | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
Touchstone Health Medicare Power (HMO) - H3327-001-0 Benefit Details |
Orange | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $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 | |||||||||
UnitedHealthcare MedicareComplete Choice (Regional PPO) - R5342-001-0 Benefit Details |
Orange | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $6.00 Tier 3: $45.00 Tier 4: $95.00 Tier 5: 33% | $4,900 Browse Formulary | |||||
UnitedHealthcare MedicareComplete Choice Essential (Regional PPO) - R5342-002-0 Benefit Details |
Orange | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,900 | ||||||
WellCare Advance (HMO) - H3361-059-0 Benefit Details |
Orange | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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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 | |||||||||
WellCare Choice (HMO-POS) - H3361-129-0 Benefit Details |
Orange | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $39.00 Tier 3: $79.00 Tier 4: 33% | $6,700 Browse Formulary | |||||
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WellCare Value (HMO-POS) - H3361-099-0 Benefit Details |
Orange | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $39.00 Tier 3: $79.00 Tier 4: 33% | $6,700 Browse Formulary | |||||
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UnitedHealthcare Dual Complete RP (Regional PPO SNP) - R5342-003-0 Benefit Details |
Orange | $ 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: 15% Tier 2: 15% | 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 Liberty (HMO SNP) - H3361-098-0 Benefit Details |
Orange | $ 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: $0.00 Tier 2: $44.00 Tier 3: $95.00 Tier 4: 25% | n/a Browse Formulary | |||||
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WellCare Access (HMO SNP) - H3361-065-0 Benefit Details |
Orange | $ 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: $0.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 25% | n/a Browse Formulary | |||||
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Touchstone Health Medicare Prestige (HMO SNP) - H3327-026-0 Benefit Details |
Orange | $ 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: 0% Tier 2: 0% | 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 | |||||||||
Touchstone Health Medicare Total (HMO) - H3327-002-0 Benefit Details |
Orange | $35.40 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $30.00 Tier 3: $70.00 Tier 4: 25% | $1,700 Browse Formulary | |||||
Empire MediBlue Select (HMO) - H3370-002-0 Benefit Details |
Orange | $36.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $80.00 Tier 4: 33% Tier 5: 33% Tier 6: $7.00 | $3,400 Browse Formulary | |||||
UnitedHealthcare Nursing Home Plan (HMO SNP) - H3379-002-0 Benefit Details |
Orange | $36.30 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 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 | |||||||||
Fidelis Dual Advantage Flex (HMO SNP) - H3328-013-0 Benefit Details |
Orange | $ 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: 0% Tier 2: 0% | n/a Browse Formulary | |||||
Fidelis Medicare Advantage Flex (HMO-POS) - H3328-003-0 Benefit Details |
Orange | $39.80 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $2.00 Tier 2: $15.00 Tier 3: $35.00 Tier 4: $95.00 Tier 5: 25% | $6,700 Browse Formulary | |||||
Senior Whole Health of New York (HMO SNP) - H5992-005-0 Benefit Details |
Orange | $ 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: $0.00 Tier 2: $45.00 Tier 3: $95.00 | 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 | |||||||||
Empire MediBlue Freedom II (PPO) - H3342-014-0 Benefit Details |
Orange | $47.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $8.00 Tier 2: $45.00 Tier 3: $85.00 Tier 4: 33% Tier 5: 33% Tier 6: $8.00 | $3,400 Browse Formulary | |||||
Empire MediBlue Freedom III (PPO) - H3342-002-0 Benefit Details |
Orange | $106.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $42.00 Tier 3: $80.00 Tier 4: 33% Tier 5: 33% Tier 6: $3.00 | $2,800 Browse Formulary | |||||
Preferred Gold Rx (HMO-POS) - H9859-004-0 Benefit Details |
Orange | $122.30 | $0 | Few Generics | Tier 1: $8.00 Tier 2: $35.00 Tier 3: $90.00 Tier 4: 33% Tier 5: $0.00 | $3,800 Browse Formulary | |||||
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