2012 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
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 |
|||||||||
BlueSaver MSA (MSA) - H9788-002-0 Benefit Details |
Saratoga | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Care Improvement Plus Gold Rx (PPO SNP) - H0084-023-0 Benefit Details |
Saratoga | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $8.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 33% | n/a Browse Formulary | |||||
Empire MediBlue Essential (HMO) - H3370-019-0 Benefit Details |
Saratoga | $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 |
|||||
Service | Exper. | Cost Info | |||||||||
Empire MediBlue Freedom I (PPO) - H3342-012-0 Benefit Details |
Saratoga | $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 | |||||
Today's Options Premier 300 (PFFS) - H2816-007-0 Benefit Details |
Saratoga | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,400 | ||||||
-- | -- | -- | |||||||||
UnitedHealthcare MedicareComplete Choice (Regional PPO) - R5342-001-0 Benefit Details |
Saratoga | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UnitedHealthcare MedicareComplete Choice Essential (Regional PPO) - R5342-002-0 Benefit Details |
Saratoga | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,900 | ||||||
Preferred Gold (HMO-POS) - H9859-001-0 Benefit Details |
Saratoga | $14.60 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,800 | ||||||
CDPHP Choice (HMO) - H3388-001-0 Benefit Details |
Saratoga | $20.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Today's Options Premier 100 (PFFS) - H2816-001-0 Benefit Details |
Saratoga | $20.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
-- | -- | -- | |||||||||
Today's Options Premier Plus 350B (PFFS) - H2816-019-0 Benefit Details |
Saratoga | $21.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $4,400 Browse Formulary | |||||
-- | -- | -- | |||||||||
CDPHP Value Rx (HMO) - H3388-004-0 Benefit Details |
Saratoga | $25.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $9.00 Tier 3: $45.00 Tier 4: $95.00 Tier 5: 33% | $3,300 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UnitedHealthcare Dual Complete RP (Regional PPO SNP) - R5342-003-0 Benefit Details |
Saratoga | $ 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 | |||||
Care Improvement Plus Silver Rx (PPO SNP) - H0084-022-0 Benefit Details |
Saratoga | $39.80 | $210 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 27% | n/a Browse Formulary | |||||
Senior Whole Health of New York (HMO SNP) - H5992-005-0 Benefit Details |
Saratoga | $ 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 | |||||
-- | |||||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UnitedHealthcare Nursing Home Plan (HMO SNP) - H3379-022-0 Benefit Details |
Saratoga | $39.80 | $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 | |||||
BlueShield Senior Blue HMO 601 (HMO) - H3384-015-0 Benefit Details |
Saratoga | $40.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
GoldValue Rx (HMO-POS) - H9859-013-0 Benefit Details |
Saratoga | $46.20 | $0 | Few Generics | Tier 1: $8.00 Tier 2: $35.00 Tier 3: $90.00 Tier 4: 33% Tier 5: $0.00 | $4,600 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Empire MediBlue Freedom II (PPO) - H3342-014-0 Benefit Details |
Saratoga | $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 | |||||
Care Improvement Plus Medicare Advantage (PPO) - H0084-025-0 Benefit Details |
Saratoga | $53.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $43.00 Tier 3: $95.00 Tier 4: 33% | $6,700 Browse Formulary | |||||
Empire MediBlue Plus (HMO) - H3370-014-0 Benefit Details |
Saratoga | $61.00 | $0 | Many Generics | 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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
BlueShield Senior Blue HMO 651 PartD (HMO) - H3384-053-0 Benefit Details |
Saratoga | $65.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $7.00 Tier 3: $40.00 Tier 4: 45% Tier 5: 33% | $3,400 Browse Formulary | |||||
Today's Options Premier Plus 150A (PFFS) - H2816-013-0 Benefit Details |
Saratoga | $72.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,400 Browse Formulary | |||||
-- | -- | -- | |||||||||
Preferred Gold Rx (HMO-POS) - H9859-002-0 Benefit Details |
Saratoga | $72.10 | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
CDPHP Choice Rx (HMO) - H3388-002-0 Benefit Details |
Saratoga | $75.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $8.00 Tier 3: $40.00 Tier 4: $90.00 Tier 5: 30% | $2,500 Browse Formulary | |||||
CDPHP Classic (PPO) - H5042-004-0 Benefit Details |
Saratoga | $95.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
BlueShield Senior Blue HMO 652 PartD (HMO) - H3384-013-0 Benefit Details |
Saratoga | $99.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $7.00 Tier 3: $40.00 Tier 4: 50% Tier 5: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
CDPHP Core Rx (PPO) - H5042-005-0 Benefit Details |
Saratoga | $99.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $9.00 Tier 3: $45.00 Tier 4: $95.00 Tier 5: 33% | $3,300 Browse Formulary | |||||
Empire MediBlue Freedom III (PPO) - H3342-002-0 Benefit Details |
Saratoga | $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 | |||||
GoldAnywhere Rx (PPO) - H9615-002-0 Benefit Details |
Saratoga | $138.40 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $90.00 Tier 4: 33% Tier 5: $0.00 | $2,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
CDPHP Classic Rx (PPO) - H5042-001-0 Benefit Details |
Saratoga | $145.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $8.00 Tier 3: $40.00 Tier 4: $90.00 Tier 5: 30% | $2,500 Browse Formulary | |||||
CDPHP Prime Rx (PPO) - H5042-007-0 Benefit Details |
Saratoga | $199.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $5.00 Tier 3: $40.00 Tier 4: $75.00 Tier 5: 30% | $2,000 Browse Formulary | |||||
BlueShield Forever Blue Medicare PPO 751 (PPO) - H5526-003-0 Benefit Details |
Saratoga | $240.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $7.25 Tier 3: $45.00 Tier 4: 40% Tier 5: 32% | $3,400 Browse Formulary | |||||
|