AARP MedicareComplete Essential (HMO) - H3307-018-0
Benefit Details
|
Bronx |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Aetna Medicare Elite Plan (PPO) - H5521-120-0
Benefit Details
|
Bronx |
$0.00 |
$245 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Value Plan (HMO) - H3312-002-0
Benefit Details
|
Bronx |
$0.00 |
$195 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $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 NYC (HMO) - H5991-006-0
Benefit Details
|
Bronx |
$0.00 |
$295 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $1.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 27%
| $5,700 Browse Formulary |
|
|
|
|
Centers Plan for FIDA Care Complete (Medicare-Medicaid Plan) - H3018-001-0
Benefit Details
|
Bronx |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: 0% Brand Drugs: 0% Non-Medicare Rx Drugs: 0% Non-Medicare OTC Drugs: 0%
| n/a Browse Formulary |
-- |
-- |
-- |
|
Centers Plan for Medicare Advantage Care (HMO) - H6988-001-0
Benefit Details
|
Bronx |
$0.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 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 FIDA Total Care (Medicare-Medicaid Plan) - H8029-001-0
Benefit Details
|
Bronx |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: 0% Brand Drugs: 0% Non-Medicare Rx/OTC Drugs: 0%
| n/a Browse Formulary |
-- |
-- |
-- |
|
EmblemHealth VIP Essential (HMO) - H3330-032-1
Benefit Details
|
Bronx |
$0.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
EmblemHealth VIP Part B Saver (HMO) - H3330-040-0
Benefit Details
|
Bronx |
$0.00 |
$415 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $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 |
Empire MediBlue Core (HMO) - H8432-012-0
Benefit Details
|
Bronx |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Empire MediBlue Plus (HMO) - H8432-008-5
Benefit Details
|
Bronx |
$0.00 |
$350 Tier 1 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $94.00 Specialty Tier: 26% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Empire MediBlue Select (HMO) - H8432-027-0
Benefit Details
|
Bronx |
$0.00 |
$350 Tier 1 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $94.00 Specialty Tier: 26% Select Care Drugs: $0.00
| $6,400 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 |
Healthfirst 65 Plus Plan (HMO) - H3359-001-0
Benefit Details
|
Bronx |
$0.00 |
$350 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26%
| $6,700 Browse Formulary |
|
|
|
|
Healthfirst AbsoluteCare FIDA Plan (Medicare-Medicaid Plan) - H5441-001-0
Benefit Details
|
Bronx |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: 0% Brand Drugs: 0% Non-Medicare Rx/OTC Drugs: 0%
| n/a 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 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Plus H3533-027 (HMO) - H3533-027-0
Benefit Details
|
Bronx |
$0.00 |
$400 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5970-016 (PPO) - H5970-016-0
Benefit Details
|
Bronx |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
HumanaChoice H5970-021 (PPO) - H5970-021-0
Benefit Details
|
Bronx |
$0.00 |
$350 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26%
| $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 |
PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan) - H9869-001-0
Benefit Details
|
Bronx |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: 0% Brand Drugs: 0% Non-Medicare Rx/OTC Drugs: 0%
| n/a Browse Formulary |
-- |
-- |
-- |
|
RiverSpring FIDA Plan (Medicare-Medicaid Plan) - H6435-001-0
Benefit Details
|
Bronx |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: 0% Brand Drugs: 0% Non-Medicare Rx/OTC Drugs: 0%
| n/a Browse Formulary |
-- |
-- |
-- |
|
SWH Whole Health FIDA (Medicare-Medicaid Plan) - H8851-001-0
Benefit Details
|
Bronx |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: 0% Brand Drugs: 0% Non-Medicare Rx Drugs: 0% Non-Medicare OTC Drugs: 0%
| 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 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 |
|
|
|
|
VNSNY CHOICE FIDA Complete (Medicare-Medicaid Plan) - H8490-001-0
Benefit Details
|
Bronx |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: 0% Brand Drugs: 0% Non-Medicare Rx Drugs: 0% Non-Medicare OTC Drugs: 0%
| n/a Browse Formulary |
-- |
-- |
-- |
|
WellCare Choice (HMO) - H4868-012-1
Benefit Details
|
Bronx |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 33%
| $6,700 Browse Formulary |
new |
new |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Rx (HMO) - H4868-006-4
Benefit Details
|
Bronx |
$14.70 |
$415 Tier 1 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
| $6,700 Browse Formulary |
new |
new |
new |
|
UnitedHealthcare MedicareComplete Choice Plan 1 (Regional PPO) - R5342-001-0
Benefit Details
|
Bronx |
$16.00 |
$350 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00
| $6,700 Browse Formulary |
|
|
|
|
AgeWell New York LiveWell (HMO) - H4922-011-0
Benefit Details
|
Bronx |
$19.00 |
$275 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 27%
| $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 |
Humana Gold Plus H3533-021 (HMO) - H3533-021-0
Benefit Details
|
Bronx |
$21.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AARP MedicareComplete Plan 2 (HMO) - H3379-001-0
Benefit Details
|
Bronx |
$26.00 |
$415 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 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 | All Formulary Drugs: $0.00 All Formulary Drugs: $0.00 All Formulary Drugs: $0.00 All Formulary Drugs: $0.00 All Formulary Drugs: $0.00
| 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 |
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 Generic: $14.50 Preferred Brand: 23% Non-Preferred Drug: 25% Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
|
WellCare Access (HMO SNP) - H4868-005-4
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 Generic: $1.00 Preferred Brand: $44.00 Non-Preferred Drug: 50% Specialty Tier: 25%
| n/a Browse Formulary |
new |
new |
new |
|
UnitedHealthcare Nursing Home Plan 2 (HMO SNP) - H3379-002-0
Benefit Details
|
Bronx |
$35.40 |
$415 |
No additional gap coverage, only the Donut Hole Discount | All Formulary Drugs: 25% All Formulary Drugs: 25% All Formulary Drugs: 25% All Formulary Drugs: 25% All Formulary Drugs: 25%
| 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 |
Humana Gold Plus SNP-DE H3533-004 (HMO SNP) - H3533-004-0
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 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
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. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
|
UnitedHealthcare Nursing Home Plan 1 (PPO SNP) - H2292-002-0
Benefit Details
|
Bronx |
$36.30 |
$415 |
No additional gap coverage, only the Donut Hole Discount | All Formulary Drugs: 25% All Formulary Drugs: 25% All Formulary Drugs: 25% All Formulary Drugs: 25% All Formulary Drugs: 25%
| 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 |
Service |
Exper. |
Cost Info |
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 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
|
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 | All Formulary Drugs: 15%
| n/a 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 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 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 |
Service |
Exper. |
Cost Info |
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 Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
|
AgeWell New York Advantage Plus (HMO SNP) - H4922-010-0
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 | All Formulary Drugs: $0.00 Tier 2: $0.00 Tier 3: $0.00 Tier 4: $0.00 Tier 5: $0.00
| n/a Browse Formulary |
|
|
|
|
AgeWell New York CareWell (HMO SNP) - H4922-004-0
Benefit Details
|
Bronx |
$39.30 |
$415 |
No additional gap coverage, only the Donut Hole Discount | All Formulary Drugs: 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 |
Service |
Exper. |
Cost Info |
AgeWell New York 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 | All Formulary Drugs: $0.00 Tier 2: $0.00 Tier 3: $0.00 Tier 4: $0.00 Tier 5: $0.00
| n/a Browse Formulary |
|
|
|
|
ArchCare Advantage (HMO SNP) - H1777-007-0
Benefit Details
|
Bronx |
$39.30 |
$415 |
No additional gap coverage, only the Donut Hole Discount | All Formulary Drugs: 25%
| n/a Browse Formulary |
|
-- |
|
|
CenterLight Healthcare Direct Complete Plan (HMO SNP) - H5989-002-0
Benefit Details
|
Bronx |
$39.30 |
$415 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Generic: $5.75 Brand: 25%
| 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 |
Centers Plan for Dual Coverage Care (HMO SNP) - H6988-002-0
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 | All Formulary Drugs: 15%
| n/a Browse Formulary |
|
-- |
|
|
Centers Plan for Nursing Home Care (HMO SNP) - H6988-003-0
Benefit Details
|
Bronx |
$39.30 |
$415 |
No additional gap coverage, only the Donut Hole Discount | All Formulary Drugs: 25%
| n/a Browse Formulary |
|
-- |
|
|
Elderplan Advantage For Nursing Home Residents (HMO SNP) - H3347-003-0
Benefit Details
|
Bronx |
$39.30 |
$415 |
No additional gap coverage, only the Donut Hole Discount | All Formulary Drugs: 25%
| 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 |
Elderplan Extra Help (HMO) - H3347-009-0
Benefit Details
|
Bronx |
$39.30 |
$415 |
No additional gap coverage, only the Donut Hole Discount | All Formulary Drugs: 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 | All Formulary Drugs: 15%
| n/a Browse Formulary |
|
|
|
|
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 | All Formulary Drugs: 15%
| 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 |
EmblemHealth VIP Dual (HMO SNP) - H3330-042-1
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 | All Formulary Drugs: $0.00 Tier 2: $0.00 Tier 3: $0.00 Tier 4: $0.00 Tier 5: $0.00
| n/a Browse Formulary |
|
|
|
|
Empire MediBlue Dual Advantage (HMO SNP) - H8432-007-0
Benefit Details
|
Bronx |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Empire MediBlue Dual Advantage Select (HMO SNP) - H8432-028-0
Benefit Details
|
Bronx |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a 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 |
Health Pointe Direct Complete Plan (HMO SNP) - H1722-001-0
Benefit Details
|
Bronx |
$39.30 |
$415 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Generic: $4.70 Brand: 25%
| n/a Browse Formulary |
new |
new |
new |
|
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 | All Formulary Drugs: $0.00
| n/a Browse Formulary |
|
|
|
|
Healthfirst Increased Benefits Plan (HMO) - H3359-019-0
Benefit Details
|
Bronx |
$39.30 |
$415 |
No additional gap coverage, only the Donut Hole Discount | All Formulary Drugs: 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 |
Service |
Exper. |
Cost Info |
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 | All Formulary Drugs: $0.00
| n/a Browse Formulary |
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Integra Harmony Plan (HMO SNP) - H1205-001-0
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 | All Formulary Drugs: 15%
| n/a Browse Formulary |
new |
new |
new |
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Integra Synergy Plan (HMO SNP) - H1205-002-0
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 | All Formulary Drugs: $0.00
| 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 |
Service |
Exper. |
Cost Info |
Longevity Health Plan (HMO SNP) - H8457-001-0
Benefit Details
|
Bronx |
$39.30 |
$415 |
No additional gap coverage, only the Donut Hole Discount | All Formulary Drugs: 25%
| n/a Browse Formulary |
new |
new |
new |
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RiverSpring MAP (HMO SNP) - H6776-002-0
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 | All Formulary Drugs: 15%
| n/a Browse Formulary |
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-- |
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RiverSpring Star (HMO SNP) - H6776-001-0
Benefit Details
|
Bronx |
$39.30 |
$415 |
No additional gap coverage, only the Donut Hole Discount | All Formulary Drugs: 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 |
Service |
Exper. |
Cost Info |
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 | All Formulary Drugs: 15%
| n/a Browse Formulary |
-- |
-- |
-- |
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VillageCareMAX Medicare Health Advantage (HMO SNP) - H2168-001-0
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 | All Formulary Drugs: 15%
| n/a Browse Formulary |
-- |
-- |
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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 | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: 25% Non-Preferred Brand: 50% 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 |
Service |
Exper. |
Cost Info |
AARP MedicareComplete Plan 1 (HMO) - H3307-002-0
Benefit Details
|
Bronx |
$46.00 |
$395 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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UnitedHealthcare MedicareComplete Choice Plan 3 (Regional PPO) - R5342-005-0
Benefit Details
|
Bronx |
$46.00 |
$275 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00
| $6,700 Browse Formulary |
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WellCare Preferred (HMO) - H4868-010-0
Benefit Details
|
Bronx |
$53.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 33%
| $6,700 Browse Formulary |
new |
new |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
EmblemHealth VIP Rx Saver (HMO) - H3330-039-1
Benefit Details
|
Bronx |
$55.00 |
$395 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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VillageCareMAX Medicare Total Advantage (HMO SNP) - H2168-002-0
Benefit Details
|
Bronx |
$20.70 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 | All Formulary Drugs: $0.00
| n/a Browse Formulary |
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-- |
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Aetna Medicare Premier Plan (PPO) - H5521-121-0
Benefit Details
|
Bronx |
$67.00 |
$195 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
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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 |
Humana Gold Plus H3533-023 (HMO) - H3533-023-0
Benefit Details
|
Bronx |
$67.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $3,300 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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EmblemHealth VIP Go (HMO-POS) - H3330-041-1
Benefit Details
|
Bronx |
$68.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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UnitedHealthcare MedicareComplete Choice Plan 4 (Regional PPO) - R5342-006-0
Benefit Details
|
Bronx |
$76.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00
| $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 |
AgeWell New York PlanWell (HMO) - H4922-008-0
Benefit Details
|
Bronx |
$86.00 |
$250 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
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EmblemHealth VIP Gold (HMO) - H3330-021-1
Benefit Details
|
Bronx |
$88.50 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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HumanaChoice H5970-022 (PPO) - H5970-022-0
Benefit Details
|
Bronx |
$95.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $3,500 Browse Formulary |
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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 |
Centers Plan for Medicaid Advantage Plus (HMO SNP) - H6988-004-0
Benefit Details
|
Bronx |
$95.70 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 | All Formulary Drugs: $0.00
| n/a Browse Formulary |
|
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HumanaChoice H5970-023 (PPO) - H5970-023-0
Benefit Details
|
Bronx |
$199.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $3,000 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
MetroPlus Platinum (HMO) - H0423-004-0
Benefit Details
|
Bronx |
$253.50 |
$415 |
No additional gap coverage, only the Donut Hole Discount | All Formulary Drugs: 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 |
Service |
Exper. |
Cost Info |
EmblemHealth VIP Gold Plus (HMO) - H3330-038-0
Benefit Details
|
Bronx |
$298.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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