2014 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 |
Richmond | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
AARP MedicareComplete Essential (HMO) - H3307-018-0 Benefit Details |
Richmond | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,900 | ||||||
AARP MedicareComplete Mosaic (HMO) - H3307-015-0 Benefit Details |
Richmond | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $6.00 Preferred Brand: $44.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,900 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 |
Richmond | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $44.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $5,900 Browse Formulary | |||||
AARP MedicareComplete Plan 2 (HMO) - H3379-001-0 Benefit Details |
Richmond | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $4,200 Browse Formulary | |||||
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Advantage Health NYC - SNP (HMO SNP) - H2773-017-0 Benefit Details |
Richmond | $0.00 | $0 | Some Generics | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $30.00 Non-Preferred Brand: $55.00 Specialty Tier: 33% | 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 | |||||||||
Advantage Silver - NY (HMO) - H2773-019-0 Benefit Details |
Richmond | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $30.00 Non-Preferred Brand: $55.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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Aetna Medicare Select Plan (HMO) - H3312-002-0 Benefit Details |
Richmond | $0.00 | $0 | Few Generics | Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $3,400 Browse Formulary | |||||
Amerivantage Balance + Rx (HMO) - H6181-009-0 Benefit Details |
Richmond | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $4.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 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 | |||||||||
Amida Care True Life Plus (HMO) - H6745-001-0 Benefit Details |
Richmond | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $0.00 Brand: $45.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
new | new | new | |||||||||
CPHL Advantage Care (HMO) - H6988-001-0 Benefit Details |
Richmond | $0.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% | $6,700 Browse Formulary | |||||
new | new | new | |||||||||
Easy Choice Diamond Rewards (HMO SNP) - H9285-003-0 Benefit Details |
Richmond | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | 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 | |||||||||
Easy Choice Rewards (HMO) - H9285-001-0 Benefit Details |
Richmond | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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Easy Choice Value (HMO) - H9285-002-0 Benefit Details |
Richmond | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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Elderplan Classic: Zero Premium (HMO) - H3347-005-0 Benefit Details |
Richmond | $0.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Generic: $4.00 Preferred Brand: $40.00 Non-Preferred Brand: $95.00 Specialty Tier: 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 | |||||||||
EmblemHealth Essential (HMO) - H3330-032-1 Benefit Details |
Richmond | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | $3,400 Browse Formulary | |||||
EmblemHealth PPO II (PPO) - H5528-002-0 Benefit Details |
Richmond | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | $3,400 Browse Formulary | |||||
EmblemHealth VIP (HMO) - H3330-021-1 Benefit Details |
Richmond | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $95.00 Specialty Tier: 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 | |||||||||
Empire MediBlue Essential (HMO) - H3370-019-0 Benefit Details |
Richmond | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,000 | ||||||
Empire MediBlue Plus (HMO) - H3370-001-0 Benefit Details |
Richmond | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Injectable Drugs: 33% Specialty Tier: 33% | $5,900 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Fidelis Medicare $0 Premium (HMO) - H3328-019-0 Benefit Details |
Richmond | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $18.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | $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 | |||||||||
Fidelis Medicare Advantage without Rx (HMO-POS) - H3328-001-0 Benefit Details |
Richmond | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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Healthfirst 65 Plus Plan (HMO) - H3359-001-0 Benefit Details |
Richmond | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Healthfirst Coordinated Benefits Plan (HMO) - H3359-027-0 Benefit Details |
Richmond | $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 | |||||||||
Humana Gold Plus H3533-007 (HMO) - H3533-007-0 Benefit Details |
Richmond | $0.00 | $0 | Few Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
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Liberty Health Advantage Preferred Choice (HMO) - H3337-001-0 Benefit Details |
Richmond | $0.00 | $0 | All Generics | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $25.00 Non-Preferred Brand: $75.00 Specialty Tier: 33% | $5,500 Browse Formulary | |||||
Touchstone Health Medicare Clear (HMO-POS) - H3327-039-0 Benefit Details |
Richmond | $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 Freedom (HMO-POS) - H3327-038-0 Benefit Details |
Richmond | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Touchstone Health Medicare Power (HMO) - H3327-001-0 Benefit Details |
Richmond | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $5.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
UnitedHealthcare MedicareComplete Choice (Regional PPO) - R5342-001-0 Benefit Details |
Richmond | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $5,200 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 Essential (Regional PPO) - R5342-002-0 Benefit Details |
Richmond | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,200 | ||||||
VNSNY CHOICE Medicare Enhanced (HMO) - H5549-004-0 Benefit Details |
Richmond | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Brand: $90.00 Specialty Tier: 25% | $6,700 Browse Formulary | |||||
WellCare Choice (HMO-POS) - H3361-106-0 Benefit Details |
Richmond | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
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 | |||||||||
Humana Gold Plus HMO-SNP-DE H3533-004 (HMO SNP) - H3533-004-0 Benefit Details |
Richmond | $0.00 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: $0.00 Non-Preferred Generic: $13.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
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WellCare Rx (HMO) - H3361-130-0 Benefit Details |
Richmond | $22.90 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
UnitedHealthcare Dual Complete (HMO SNP) - H3387-010-0 Benefit Details |
Richmond | $0.00 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% Tier 3: 0% Tier 4: 0% Tier 5: 0% | 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 | |||||||||
EmblemHealth PPO I (PPO) - H5528-001-0 Benefit Details |
Richmond | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
UnitedHealthcare Nursing Home Plan (HMO SNP) - H3379-002-0 Benefit Details |
Richmond | $28.30 | $310 | 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 | |||||
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Healthfirst Increased Benefits Plan (HMO) - H3359-019-0 Benefit Details |
Richmond | $30.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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 | |||||||||
Advantage Value One NY - Dual (HMO SNP) - H2773-018-0 Benefit Details |
Richmond | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | Some Generics | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $30.00 Non-Preferred Brand: $55.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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VNSNY CHOICE Medicare Maximum (HMO SNP) - H5549-006-0 Benefit Details |
Richmond | $0.00 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% Tier 3: 0% Tier 4: 0% Tier 5: 0% | n/a Browse Formulary | |||||
CenterLight Direct Total Plan (HMO SNP) - H5989-008-0 Benefit Details |
Richmond | $0.00 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: $4.00 Non-Preferred Generic: $9.00 Preferred Brand: $45.00 Specialty Tier: 25% | 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 | |||||||||
CenterLight Healthcare Direct Complete Plan (HMO SNP) - H5989-002-0 Benefit Details |
Richmond | $34.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $7.25 Preferred Brand: $45.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
-- | -- | ||||||||||
EmblemHealth Dual Eligible (HMO SNP) - H3330-029-0 Benefit Details |
Richmond | $0.00 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: $2.00 Non-Preferred Generic: $9.00 Preferred Brand: 25% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
EmblemHealth Dual Eligible (PPO SNP) - H5528-018-0 Benefit Details |
Richmond | $0.00 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: $2.00 Non-Preferred Generic: $9.00 Preferred Brand: 25% Non-Preferred Brand: 30% Specialty Tier: 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 | |||||||||
WellCare Access (HMO SNP) - H3361-109-0 Benefit Details |
Richmond | $0.00 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: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $20.00 Non-Preferred Brand: $45.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Affinity Medicare Solutions (HMO SNP) - H5991-002-0 Benefit Details |
Richmond | $0.00 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: $0.00 Non-Preferred Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
Affinity Medicare Ultimate (HMO SNP) - H5991-001-0 Benefit Details |
Richmond | $0.00 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: $0.00 Non-Preferred Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 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 | |||||||||
Amerivantage Specialty + Rx (HMO SNP) - H6181-007-0 Benefit Details |
Richmond | $0.00 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% Tier 3: 0% Tier 4: 0% Tier 5: 0% | n/a Browse Formulary | |||||
Amida Care Live Life Advantage (HMO SNP) - H6745-003-0 Benefit Details |
Richmond | $37.20 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a Browse Formulary | |||||
new | new | new | |||||||||
Amida Care True Life Advantage (HMO SNP) - H6745-002-0 Benefit Details |
Richmond | $0.00 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% Tier 3: 15% Tier 4: 15% | n/a Browse Formulary | |||||
new | new | new | |||||||||
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 Advantage (HMO SNP) - H1777-007-0 Benefit Details |
Richmond | $37.20 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | n/a Browse Formulary | |||||
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Elderplan Advantage For Nursing Home Residents (HMO SNP) - H3347-003-0 Benefit Details |
Richmond | $37.20 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% | n/a Browse Formulary | |||||
Elderplan Extra Help (HMO) - H3347-009-0 Benefit Details |
Richmond | $37.20 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 | |||||||||
Elderplan For Medicaid Beneficiaries (HMO SNP) - H3347-002-0 Benefit Details |
Richmond | $0.00 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% | n/a Browse Formulary | |||||
Elderplan Plus Long Term Care (HMO SNP) - H3347-007-0 Benefit Details |
Richmond | $0.00 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% | n/a Browse Formulary | |||||
Fidelis Dual Advantage (HMO SNP) - H3328-002-0 Benefit Details |
Richmond | $0.00 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: $0.00 Non-Preferred Generic: $16.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | 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 | |||||||||
Fidelis Dual Advantage Flex (HMO SNP) - H3328-017-0 Benefit Details |
Richmond | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | Some Generics | Preferred Generic: $0.00 Non-Preferred Generic: $23.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
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Fidelis Medicaid Advantage Plus (HMO SNP) - H3328-016-0 Benefit Details |
Richmond | $0.00 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: $0.00 Non-Preferred Generic: $29.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
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Fidelis Medicare Advantage Flex (HMO-POS) - H3328-003-0 Benefit Details |
Richmond | $37.20 | $240 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | $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 AssuredCare (HMO SNP) - H3359-035-0 Benefit Details |
Richmond | $37.20 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a Browse Formulary | |||||
Healthfirst CompleteCare (HMO SNP) - H3359-034-0 Benefit Details |
Richmond | $0.00 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% Tier 3: 0% Tier 4: 0% | n/a Browse Formulary | |||||
Healthfirst Life Improvement Plan (HMO SNP) - H3359-021-0 Benefit Details |
Richmond | $0.00 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% Tier 3: 15% Tier 4: 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 | |||||||||
Healthfirst Maximum Plan (HMO SNP) - H3359-033-0 Benefit Details |
Richmond | $0.00 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% Tier 3: 0% Tier 4: 0% | n/a Browse Formulary | |||||
Touchstone Health Medicare Grand (HMO SNP) - H3327-043-0 Benefit Details |
Richmond | $0.00 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% Tier 3: 0% Tier 4: 0% | n/a Browse Formulary | |||||
Touchstone Health Medicare Prestige (HMO SNP) - H3327-026-0 Benefit Details |
Richmond | $0.00 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% Tier 3: 0% Tier 4: 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 Prestige Plus (HMO SNP) - H3327-044-0 Benefit Details |
Richmond | $0.00 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% Tier 3: 0% Tier 4: 0% | n/a Browse Formulary | |||||
Touchstone Health Medicare Total (HMO) - H3327-002-0 Benefit Details |
Richmond | $37.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $0.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
VNSNY CHOICE Medicare Classic (HMO) - H5549-008-0 Benefit Details |
Richmond | $37.20 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
VNSNY CHOICE Medicare Preferred (HMO SNP) - H5549-002-0 Benefit Details |
Richmond | $0.00 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% Tier 3: 15% Tier 4: 15% Tier 5: 15% | n/a Browse Formulary | |||||
VNSNY CHOICE Total (HMO SNP) - H5549-003-0 Benefit Details |
Richmond | $0.00 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% Tier 3: 0% Tier 4: 0% Tier 5: 0% | n/a Browse Formulary | |||||
Elderplan Medicaid Advantage (HMO SNP) - H3347-008-0 Benefit Details |
Richmond | $0.00 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% | 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 | |||||||||
Aetna Medicare Value Plan (HMO) - H3312-061-0 Benefit Details |
Richmond | $41.00 | $0 | Few Generics | Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $3,200 Browse Formulary | |||||
Fidelis Long Term Care Advantage (HMO SNP) - H3328-018-0 Benefit Details |
Richmond | $44.50 | $310 | 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 | |||||
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Empire MediBlue Freedom I (PPO) - H3342-012-0 Benefit Details |
Richmond | $50.00 | $125 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $11.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Injectable Drugs: $95.00 Specialty Tier: 33% | $4,500 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
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) - H3342-013-0 Benefit Details |
Richmond | $56.00 | $100 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Injectable Drugs: $95.00 Tier 6: 33% | $4,300 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Advantage Platinum Plus NY (HMO) - H2773-015-0 Benefit Details |
Richmond | $63.00 | $0 | Some Generics | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $30.00 Non-Preferred Brand: $55.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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Aetna Medicare Standard Plan (PPO) - H5521-040-0 Benefit Details |
Richmond | $87.00 | $0 | Few Generics | Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $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 |
|||||
Service | Exper. | Cost Info | |||||||||
EmblemHealth PPO III (PPO) - H5528-003-0 Benefit Details |
Richmond | $89.00 | $0 | All Generics | Preferred Generic: $2.00 Non-Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | $3,400 Browse Formulary | |||||
Empire MediBlue Freedom III (PPO) - H3342-001-0 Benefit Details |
Richmond | $116.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Injectable Drugs: $95.00 Specialty Tier: 33% | $3,300 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
EmblemHealth VIP High Option (HMO) - H3330-033-1 Benefit Details |
Richmond | $161.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | $3,400 Browse Formulary | |||||
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