ActiveSaver MSA (MSA) - H9788-004-0
Benefit Details
|
Bronx |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a |
|
|
|
|
AARP MedicareComplete Essential (HMO) - H3307-018-0
Benefit Details
|
Bronx |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,200 |
|
|
|
|
AARP MedicareComplete Mosaic (HMO) - H3307-015-0
Benefit Details
|
Bronx |
$0.00 |
$150 |
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 |
Service |
Exper. |
Cost Info |
AARP MedicareComplete Plan 2 (HMO) - H3379-001-0
Benefit Details
|
Bronx |
$0.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
-- |
|
|
|
Advantage Care (HMO) - H6988-001-0
Benefit Details
|
Bronx |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Generic: $2.00 Preferred Brand: $35.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
-- |
-- |
-- |
|
Aetna Medicare Select Plan (HMO) - H3312-002-0
Benefit Details
|
Bronx |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: 50% 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 |
Service |
Exper. |
Cost Info |
Affinity Medicare Passport Essentials (HMO) - H5991-003-0
Benefit Details
|
Bronx |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $5,800 Browse Formulary |
-- |
|
|
|
AlphaCare Renew (HMO) - H9122-001-0
Benefit Details
|
Bronx |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
-- |
-- |
|
Amerivantage Balance + Rx (HMO) - H6181-009-0
Benefit Details
|
Bronx |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $3,400 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 |
Amerivantage Specialty + Rx (HMO SNP) - H6181-007-0
Benefit Details
|
Bronx |
$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: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: $0.00 Select Care Drugs: $0.00
| $6,700 Browse Formulary |
-- |
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Amida Care True Life Plus (HMO) - H6745-001-0
Benefit Details
|
Bronx |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
-- |
-- |
|
Easy Choice Diamond Rewards (HMO SNP) - H9285-003-0
Benefit Details
|
Bronx |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 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 |
Service |
Exper. |
Cost Info |
Easy Choice Rewards (HMO) - H9285-001-0
Benefit Details
|
Bronx |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Preferred Brand: $39.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
-- |
|
|
Elderplan Classic: Zero Premium (HMO) - H3347-005-0
Benefit Details
|
Bronx |
$0.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount | Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
-- |
|
|
|
Elderplan Diabetes Care (HMO SNP) - H3347-012-0
Benefit Details
|
Bronx |
$0.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount | Generic: $5.00 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 |
Service |
Exper. |
Cost Info |
EmblemHealth Essential (HMO) - H3330-032-1
Benefit Details
|
Bronx |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Empire Dual Advantage (HMO SNP) - H3370-028-0
Benefit Details
|
Bronx |
$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: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: $0.00 Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Empire MediBlue Essential (HMO) - H3370-033-0
Benefit Details
|
Bronx |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Empire MediBlue Plus (HMO) - H3370-029-1
Benefit Details
|
Bronx |
$0.00 |
$257 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $22.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Select Care Drugs: $2.00
| $5,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Fidelis Medicare $0 Premium (HMO) - H3328-019-0
Benefit Details
|
Bronx |
$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 |
|
|
|
|
Fidelis Medicare Advantage without Rx (HMO-POS) - H3328-001-0
Benefit Details
|
Bronx |
$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 |
Service |
Exper. |
Cost Info |
Healthfirst 65 Plus Plan (HMO) - H3359-001-0
Benefit Details
|
Bronx |
$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: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Healthfirst Coordinated Benefits Plan (HMO) - H3359-027-0
Benefit Details
|
Bronx |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Humana Gold Plus H3533-016 (HMO) - H3533-016-0
Benefit Details
|
Bronx |
$0.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $8.00 Non-Preferred Generic: $18.00 Preferred Brand: $45.00 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 |
Service |
Exper. |
Cost Info |
Liberty Health Advantage Preferred Choice (HMO) - H3337-001-0
Benefit Details
|
Bronx |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $75.00 Specialty Tier: 33%
| $5,500 Browse Formulary |
-- |
|
|
|
Touchstone Health Medicare Clear (HMO-POS) - H3327-039-0
Benefit Details
|
Bronx |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 |
-- |
|
|
|
Touchstone Health Medicare Freedom (HMO-POS) - H3327-038-0
Benefit Details
|
Bronx |
$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: $80.00 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 |
Service |
Exper. |
Cost Info |
Touchstone Health Medicare Power (HMO) - H3327-001-0
Benefit Details
|
Bronx |
$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: $80.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
|
|
|
UnitedHealthcare MedicareComplete Choice (Regional PPO) - R5342-001-0
Benefit Details
|
Bronx |
$0.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
UnitedHealthcare MedicareComplete Choice Essential (Regional PPO) - R5342-002-0
Benefit Details
|
Bronx |
$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 |
Service |
Exper. |
Cost Info |
VNSNY CHOICE Medicare Enhanced (HMO) - H5549-004-0
Benefit Details
|
Bronx |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
-- |
|
|
|
WellCare Choice (HMO-POS) - H3361-106-0
Benefit Details
|
Bronx |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $14.00 Preferred Brand: $43.00 Non-Preferred Brand: $84.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Fidelis Long Term Care Advantage (HMO SNP) - H3328-018-0
Benefit Details
|
Bronx |
$3.00 |
$320 |
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 |
Service |
Exper. |
Cost Info |
Access Medicare Gold (HMO) - H4866-003-0
Benefit Details
|
Bronx |
$12.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $35.00 Non-Preferred Brand: $75.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
-- |
|
|
|
Humana Gold Plus SNP-DE H3533-018 (HMO SNP) - H3533-018-0
Benefit Details
|
Bronx |
$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: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: $0.00
| $6,700 Browse Formulary |
-- |
-- |
|
|
AARP MedicareComplete Plan 1 (HMO) - H3307-002-0
Benefit Details
|
Bronx |
$29.00 |
$230 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 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 |
Service |
Exper. |
Cost Info |
EmblemHealth PPO I (PPO) - H5528-001-0
Benefit Details
|
Bronx |
$30.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
WellCare Rx (HMO) - H3361-130-0
Benefit Details
|
Bronx |
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Non-Preferred Generic: $29.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
UnitedHealthcare Nursing Home Plan (HMO SNP) - H3379-002-0
Benefit Details
|
Bronx |
$30.30 |
$320 |
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 |
Service |
Exper. |
Cost Info |
LiveWell (HMO) - H4922-001-0
Benefit Details
|
Bronx |
$32.90 |
$250 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
new |
new |
new |
|
Fidelis Dual Advantage (HMO SNP) - H3328-002-0
Benefit Details
|
Bronx |
$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: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: $0.00
| $6,700 Browse Formulary |
|
|
|
|
Healthfirst Increased Benefits Plan (HMO) - H3359-019-0
Benefit Details
|
Bronx |
$34.00 |
$320 |
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 |
Service |
Exper. |
Cost Info |
VNSNY CHOICE Medicare Classic (HMO) - H5549-008-0
Benefit Details
|
Bronx |
$34.10 |
$320 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| $6,700 Browse Formulary |
-- |
|
|
|
Fidelis Dual Advantage Flex (HMO SNP) - H3328-017-0
Benefit Details
|
Bronx |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: $0.00
| $6,700 Browse Formulary |
|
|
|
|
Healthfirst AssuredCare (HMO SNP) - H3359-035-0
Benefit Details
|
Bronx |
$36.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| $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 |
Healthfirst CompleteCare (HMO SNP) - H3359-034-0
Benefit Details
|
Bronx |
$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: $0.00
| $3,400 Browse Formulary |
|
|
|
|
Healthfirst Life Improvement Plan (HMO SNP) - H3359-021-0
Benefit Details
|
Bronx |
$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: tbd
| $3,400 Browse Formulary |
|
|
|
|
AlphaCare Resilience (HMO SNP) - H9122-002-0
Benefit Details
|
Bronx |
$36.10 |
$320 |
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 |
Service |
Exper. |
Cost Info |
AlphaCare Total (HMO SNP) - H9122-003-0
Benefit Details
|
Bronx |
$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: tbd
| $3,400 Browse Formulary |
-- |
-- |
-- |
|
VNSNY CHOICE Medicare Preferred (HMO SNP) - H5549-002-0
Benefit Details
|
Bronx |
$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: tbd
| $6,700 Browse Formulary |
-- |
|
|
|
Access Medicare Pearl (HMO SNP) - H4866-005-0
Benefit Details
|
Bronx |
$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: $0.00
| $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 |
Access Medicare Platinum (HMO) - H4866-002-0
Benefit Details
|
Bronx |
$36.90 |
$320 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| $6,700 Browse Formulary |
-- |
|
|
|
Affinity Medicare Solutions (HMO SNP) - H5991-002-0
Benefit Details
|
Bronx |
$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: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: $0.00
| $3,400 Browse Formulary |
-- |
|
|
|
Affinity Medicare Ultimate (HMO SNP) - H5991-001-0
Benefit Details
|
Bronx |
$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: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: $0.00
| $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 |
Amida Care Live Life Advantage (HMO SNP) - H6745-003-0
Benefit Details
|
Bronx |
$36.90 |
$320 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
-- |
-- |
-- |
|
Amida Care True Life Advantage (HMO SNP) - H6745-002-0
Benefit Details
|
Bronx |
$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: $0.00
| $6,700 Browse Formulary |
-- |
-- |
-- |
|
ArchCare Advantage (HMO SNP) - H1777-007-0
Benefit Details
|
Bronx |
$36.90 |
$320 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| $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 |
BeWell (HMO SNP) - H4922-002-0
Benefit Details
|
Bronx |
$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: $0.00
| $3,400 Browse Formulary |
new |
new |
new |
|
CareWell (HMO SNP) - H4922-004-0
Benefit Details
|
Bronx |
$36.90 |
$320 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| $6,700 Browse Formulary |
new |
new |
new |
|
CenterLight Healthcare Direct Complete Plan (HMO SNP) - H5989-002-0
Benefit Details
|
Bronx |
$36.90 |
$320 |
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%
| $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 |
Elderplan Advantage For Nursing Home Residents (HMO SNP) - H3347-003-0
Benefit Details
|
Bronx |
$36.90 |
$320 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| $6,700 Browse Formulary |
-- |
|
|
|
Elderplan Extra Help (HMO) - H3347-009-0
Benefit Details
|
Bronx |
$36.90 |
$320 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| $6,700 Browse Formulary |
-- |
|
|
|
Elderplan For Medicaid Beneficiaries (HMO SNP) - H3347-002-0
Benefit Details
|
Bronx |
$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: tbd
| $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 |
Elderplan Plus Long Term Care (HMO SNP) - H3347-007-0
Benefit Details
|
Bronx |
$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: tbd
| $6,700 Browse Formulary |
-- |
|
|
|
EmblemHealth Dual Eligible (HMO SNP) - H3330-029-0
Benefit Details
|
Bronx |
$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: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: $0.00
| $6,700 Browse Formulary |
|
|
|
|
EmblemHealth Dual Eligible (PPO SNP) - H5528-018-0
Benefit Details
|
Bronx |
$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: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: $0.00
| $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 |
EmblemHealth MLTC PLUS (HMO SNP) - H3330-035-0
Benefit Details
|
Bronx |
$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: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: $0.00
| $6,700 Browse Formulary |
|
|
|
|
FeelWell (HMO SNP) - H4922-003-0
Benefit Details
|
Bronx |
$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: tbd
| $3,400 Browse Formulary |
new |
new |
new |
|
Fidelis Medicaid Advantage Plus (HMO SNP) - H3328-016-0
Benefit Details
|
Bronx |
$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: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: $0.00
| $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 |
Fidelis Medicare Advantage Flex (HMO-POS) - H3328-003-0
Benefit Details
|
Bronx |
$36.90 |
$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 |
|
|
|
|
GuildNet Gold (HMO-POS SNP) - H6864-001-0
Benefit Details
|
Bronx |
$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: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: $0.00
| $3,400 Browse Formulary |
-- |
-- |
|
|
Liberty Health Advantage Dual Power (HMO SNP) - H3337-003-0
Benefit Details
|
Bronx |
$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: tbd
| $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 |
MetroPlus Advantage Plan (HMO SNP) - H0423-001-0
Benefit Details
|
Bronx |
$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: tbd
| $6,700 Browse Formulary |
-- |
|
|
|
Senior Whole Health of New York NHC (HMO SNP) - H5992-007-0
Benefit Details
|
Bronx |
$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: $0.00
| $6,700 Browse Formulary |
-- |
-- |
-- |
|
Touchstone Health Medicare Grand (HMO SNP) - H3327-043-0
Benefit Details
|
Bronx |
$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: $0.00
| $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 |
Touchstone Health Medicare Prestige (HMO SNP) - H3327-026-0
Benefit Details
|
Bronx |
$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: $0.00
| $3,400 Browse Formulary |
-- |
|
|
|
Touchstone Health Medicare Total (HMO) - H3327-002-0
Benefit Details
|
Bronx |
$36.90 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $7.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
|
|
|
UnitedHealthcare Dual Complete (HMO SNP) - H3387-010-0
Benefit Details
|
Bronx |
$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: $0.00
| $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 Maximum (HMO SNP) - H5549-006-0
Benefit Details
|
Bronx |
$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: $0.00
| $6,700 Browse Formulary |
-- |
|
|
|
VNSNY CHOICE Total (HMO SNP) - H5549-003-0
Benefit Details
|
Bronx |
$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: $0.00
| $6,700 Browse Formulary |
-- |
|
|
|
WellCare Access (HMO SNP) - H3361-109-0
Benefit Details
|
Bronx |
$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: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: $0.00
| $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 |
Service |
Exper. |
Cost Info |
Affinity Medicare Passport Select (HMO) - H5991-004-0
Benefit Details
|
Bronx |
$46.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $8.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $5,000 Browse Formulary |
-- |
|
|
|
Aetna Medicare Value Plan (HMO) - H3312-061-0
Benefit Details
|
Bronx |
$49.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,500 Browse Formulary |
-- |
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
EmblemHealth VIP (HMO) - H3330-021-1
Benefit Details
|
Bronx |
$49.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $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 |
EmblemHealth Advantage (PPO) - H5528-022-0
Benefit Details
|
Bronx |
$62.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Empire MediBlue Freedom I (PPO) - H3342-019-0
Benefit Details
|
Bronx |
$71.00 |
$304 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $22.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Select Care Drugs: $2.00
| $4,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
MetroPlus Platinum (HMO) - H0423-004-0
Benefit Details
|
Bronx |
$101.10 |
$320 |
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 |
Service |
Exper. |
Cost Info |
MetroPlus Select Plan (HMO SNP) - H0423-003-0
Benefit Details
|
Bronx |
$86.40 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
| $6,700 Browse Formulary |
-- |
|
|
|
Affinity Medicare Passport Elite (HMO) - H5991-005-0
Benefit Details
|
Bronx |
$126.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
|
|
|
EmblemHealth VIP High Option (HMO) - H3330-033-1
Benefit Details
|
Bronx |
$233.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $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 |
MetroPlus Medicare Partnership in Care Plan (HMO SNP) - H0423-002-0
Benefit Details
|
Bronx |
$244.20 |
$320 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| $6,700 Browse Formulary |
-- |
|
|
|