Advantage Health LI - SNP (HMO C-SNP) - H2773-003-0
Sanctioned Plan
|
Nassau |
$0.00 |
$150 Tier 1, 2, 4 and 5 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $30.00 Non-Preferred Drug: 25% Specialty Tier: 30%
| n/a Browse Formulary |
-- |
-- |
|
|
Advantage Silver - NY (HMO) - H2773-019-0
Sanctioned Plan
|
Nassau |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Drug: 25% Specialty Tier: 33%
| $6,590 Browse Formulary |
-- |
-- |
|
|
Aetna Medicare Elite Plan (PPO) - H5521-120-0
Benefit Details
|
Nassau |
$0.00 |
$300 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: 27%
| $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 |
Centers Plan for Medicare Advantage Care (HMO) - H6988-001-0
Benefit Details
|
Nassau |
$0.00 |
$395 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
-- |
|
|
EmblemHealth VIP Part B Saver (HMO) - H3330-040-0
Benefit Details
|
Nassau |
$0.00 |
$435 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:
|
EmblemHealth VIP Value (HMO) - H3330-036-0
Benefit Details
|
Nassau |
$0.00 |
$295 Tier 1 and 2 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: 27%
| $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 |
Healthfirst 65 Plus Plan (HMO) - H3359-001-0
Benefit Details
|
Nassau |
$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 Coordinated Benefits Plan (HMO) - H3359-027-0
Benefit Details
|
Nassau |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Humana Gold Plus H3533-027 (HMO) - H3533-027-0
Benefit Details
|
Nassau |
$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:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5970-016 (PPO) - H5970-016-0
Benefit Details
|
Nassau |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
HumanaChoice H5970-021 (PPO) - H5970-021-0
Benefit Details
|
Nassau |
$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:
|
PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan) - H9869-001-0
Benefit Details
|
Nassau |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: 0% Brand Drugs: 0% Non-Medicare Rx/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 |
Sunrise Advantage Plan (HMO I-SNP) - H3930-001-0
Benefit Details
|
Nassau |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $100.00 Specialty Tier: 33%
| n/a Browse Formulary |
-- |
-- |
|
|
UnitedHealthcare Medicare Advantage Essential (Regional PPO) - R5342-002-0
Benefit Details
|
Nassau |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
WellCare Today's Options Advantage Plus 550B (PPO) - H2775-106-0
Benefit Details
|
Nassau |
$10.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 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 |
Service |
Exper. |
Cost Info |
UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO) - R5342-001-0
Benefit Details
|
Nassau |
$16.00 |
$300 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: 27%
| $6,700 Browse Formulary |
|
|
|
|
Fidelis Medicaid Advantage Plus (HMO D-SNP) - H3328-023-1
Benefit Details
|
Nassau |
$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: $15.00 Preferred Brand: 23% Non-Preferred Drug: 25% Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
|
UnitedHealthcare Assisted Living Plan (PPO I-SNP) - H2292-003-0
Benefit Details
|
Nassau |
$20.30 |
$200 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| n/a Browse Formulary |
new |
new |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Advantage Value One NY - Dual (HMO D-SNP) - H2773-018-0
Sanctioned Plan
|
Nassau |
$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: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 40% Specialty Tier: 25%
| n/a Browse Formulary |
-- |
-- |
|
|
Fidelis Dual Advantage Flex (HMO D-SNP) - H3328-017-0
Benefit Details
|
Nassau |
$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: 33%
| n/a Browse Formulary |
|
|
|
|
WellCare Access (HMO D-SNP) - H4868-014-0
Benefit Details
|
Nassau |
$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: 50% 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 |
UnitedHealthcare Dual Complete (HMO D-SNP) - H3387-010-0
Benefit Details
|
Nassau |
$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 | : $0.00 Tier 2: $0.00 Tier 3: $0.00 Tier 4: $0.00 Tier 5: $0.00
| n/a Browse Formulary |
|
|
|
|
Humana Gold Plus H3533-010 (HMO) - H3533-010-0
Benefit Details
|
Nassau |
$30.00 |
$250 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: 28%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Elderplan For Medicaid Beneficiaries (HMO D-SNP) - H3347-002-0
Benefit Details
|
Nassau |
$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 | : 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 Passport (HMO) - H5991-003-0
Benefit Details
|
Nassau |
$32.00 |
$295 Tier 1 and 2 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: 27%
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Plus SNP-DE H3533-029 (HMO D-SNP) - H3533-029-1
Benefit Details
|
Nassau |
$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 |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP) - H2292-002-0
Benefit Details
|
Nassau |
$34.60 |
$435 |
No additional gap coverage, only the Donut Hole Discount | : 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25%
| n/a Browse Formulary |
new |
new |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Nursing Home Plan 2 (HMO I-SNP) - H3379-002-0
Benefit Details
|
Nassau |
$34.90 |
$435 |
No additional gap coverage, only the Donut Hole Discount | : 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25%
| n/a Browse Formulary |
|
|
|
|
Elderplan Plus Long Term Care (HMO D-SNP) - H3347-007-0
Benefit Details
|
Nassau |
$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 | : 15%
| n/a Browse Formulary |
|
|
|
|
AgeWell New York Advantage Plus (HMO D-SNP) - H4922-010-0
Benefit Details
|
Nassau |
$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 | : $0.00 Tier 2: $0.00 Tier 3: $0.00 Tier 4: $0.00 Tier 5: $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 |
AgeWell New York CareWell (HMO I-SNP) - H4922-004-0
Benefit Details
|
Nassau |
$36.60 |
$435 |
No additional gap coverage, only the Donut Hole Discount | : 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25%
| n/a Browse Formulary |
|
-- |
|
|
AgeWell New York FeelWell (HMO D-SNP) - H4922-003-0
Benefit Details
|
Nassau |
$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 | : $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 LiveWell (HMO) - H4922-011-0
Benefit Details
|
Nassau |
$36.60 |
$290 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 |
CenterLight Healthcare Direct Complete Plan (HMO I-SNP) - H5989-002-0
Benefit Details
|
Nassau |
$36.60 |
$435 |
No additional gap coverage, only the Donut Hole Discount | Generic: $5.25 Brand: 25%
| n/a Browse Formulary |
-- |
-- |
|
|
Centers Plan for Nursing Home Care (HMO I-SNP) - H6988-003-0
Benefit Details
|
Nassau |
$36.60 |
$435 |
No additional gap coverage, only the Donut Hole Discount | : 25%
| n/a Browse Formulary |
|
-- |
|
|
Elderplan Advantage For Nursing Home Residents (HMO I-SNP) - H3347-003-0
Benefit Details
|
Nassau |
$36.60 |
$435 |
No additional gap coverage, only the Donut Hole Discount | : 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 Assist (HMO I-SNP) - H3347-015-0
Benefit Details
|
Nassau |
$36.60 |
$435 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $19.00 Preferred Brand: $47.00 Non-Preferred Drug: 25% Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
|
EmblemHealth VIP Assist (HMO D-SNP) - H5991-008-0
Benefit Details
|
Nassau |
$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 | : $0.00 Tier 2: $0.00 Tier 3: $0.00 Tier 4: $0.00 Tier 5: $0.00
| n/a Browse Formulary |
|
-- |
|
|
EmblemHealth VIP Connect (HMO D-SNP) - H5991-007-0
Benefit Details
|
Nassau |
$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 | : $0.00 Tier 2: $0.00 Tier 3: $0.00 Tier 4: $0.00 Tier 5: $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 |
EmblemHealth VIP Dual (HMO D-SNP) - H3330-042-3
Benefit Details
|
Nassau |
$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 | : $0.00 Tier 2: $0.00 Tier 3: $0.00 Tier 4: $0.00 Tier 5: $0.00
| n/a Browse Formulary |
|
|
|
|
EmblemHealth VIP Dual Select (HMO D-SNP) - H5991-001-0
Benefit Details
|
Nassau |
$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 | : $0.00 Tier 2: $0.00 Tier 3: $0.00 Tier 4: $0.00 Tier 5: $0.00
| n/a Browse Formulary |
|
-- |
|
|
EmblemHealth VIP Solutions (HMO D-SNP) - H5991-002-0
Benefit Details
|
Nassau |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 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 |
Empire MediBlue Dual Advantage (HMO D-SNP) - H8432-007-0
Benefit Details
|
Nassau |
$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: $6.00 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 D-SNP) - H8432-028-0
Benefit Details
|
Nassau |
$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: $7.00 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:
|
Hamaspik Medicare Select (HMO D-SNP) - H0034-001-0
Benefit Details
|
Nassau |
$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 | : 15%
| n/a Browse Formulary |
new |
new |
|
|
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 I-SNP) - H1722-001-0
Benefit Details
|
Nassau |
$36.60 |
$435 |
No additional gap coverage, only the Donut Hole Discount | : 25%
| n/a Browse Formulary |
new |
new |
|
|
Healthfirst CompleteCare (HMO D-SNP) - H3359-034-0
Benefit Details
|
Nassau |
$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 | : $0.00
| n/a Browse Formulary |
|
|
|
|
Healthfirst Increased Benefits Plan (HMO) - H3359-019-0
Benefit Details
|
Nassau |
$36.60 |
$435 |
No additional gap coverage, only the Donut Hole Discount | : 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 |
Healthfirst Life Improvement Plan (HMO D-SNP) - H3359-021-0
Benefit Details
|
Nassau |
$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 | : $0.00
| n/a Browse Formulary |
|
|
|
|
Integra Harmony (HMO D-SNP) - H1205-005-0
Benefit Details
|
Nassau |
$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 | : 15%
| n/a Browse Formulary |
new |
new |
|
|
Integra Synergy Medicaid Advantage Plus (MAP) (HMO D-SNP) - H1205-006-0
Benefit Details
|
Nassau |
$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 | : $0.00
| n/a Browse Formulary |
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 I-SNP) - H8457-001-0
Benefit Details
|
Nassau |
$36.60 |
$435 |
No additional gap coverage, only the Donut Hole Discount | : 25%
| n/a Browse Formulary |
new |
new |
|
|
RiverSpring MAP (HMO D-SNP) - H6776-002-0
Benefit Details
|
Nassau |
$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 | : 15%
| n/a Browse Formulary |
-- |
-- |
|
|
RiverSpring Star (HMO I-SNP) - H6776-001-0
Benefit Details
|
Nassau |
$36.60 |
$435 |
No additional gap coverage, only the Donut Hole Discount | : 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 |
Senior Whole Health of New York NHC (HMO D-SNP) - H5992-007-0
Benefit Details
|
Nassau |
$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 | : 15%
| n/a Browse Formulary |
-- |
-- |
|
|
VNSNY CHOICE Total (HMO D-SNP) - H5549-003-0
Benefit Details
|
Nassau |
$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: $7.00 Generic: $19.00 Preferred Brand: $47.00 Non-Preferred Brand: 39% Specialty Tier: 25%
| n/a Browse Formulary |
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Reflections (HMO C-SNP) - H3930-002-0
Benefit Details
|
Nassau |
$39.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $100.00 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 |
Service |
Exper. |
Cost Info |
Sunrise Advantage Community Plan (HMO) - H3930-003-0
Benefit Details
|
Nassau |
$39.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $100.00 Specialty Tier: 33%
| $5,700 Browse Formulary |
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UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) - R5342-005-0
Benefit Details
|
Nassau |
$46.00 |
$275 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: 28%
| $6,700 Browse Formulary |
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Empire MediBlue Select (HMO) - H8432-032-0
Benefit Details
|
Nassau |
$47.00 |
$350 Tier 1, 2 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 |
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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 |
Aetna Medicare Value Plan (HMO) - H3312-064-0
Benefit Details
|
Nassau |
$48.00 |
$300 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: 27%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Plus H3533-023 (HMO) - H3533-023-0
Benefit Details
|
Nassau |
$48.00 |
$200 Tier 1, 2 and 3 exempt |
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: 29%
| $5,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Empire MediBlue Plus (HMO) - H8432-010-0
Benefit Details
|
Nassau |
$50.00 |
$350 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 26%
| $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 |
EmblemHealth VIP Essential (HMO) - H3330-032-2
Benefit Details
|
Nassau |
$55.00 |
$295 Tier 1 and 2 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: 27%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Choice (HMO) - H4868-007-0
Benefit Details
|
Nassau |
$55.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 33%
| $6,700 Browse Formulary |
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Empire MediBlue Choice (HMO-POS) - H8432-014-0
Benefit Details
|
Nassau |
$67.00 |
$350 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 26%
| $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 |
EmblemHealth VIP Go (HMO-POS) - H3330-041-1
Benefit Details
|
Nassau |
$71.00 |
$250 Tier 1 and 2 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: 28%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Centers Plan for Medicaid Advantage Plus (HMO D-SNP) - H6988-004-0
Benefit Details
|
Nassau |
$39.40 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 | : $0.00
| n/a Browse Formulary |
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Advantage Premium NY (HMO) - H2773-023-0
Sanctioned Plan
|
Nassau |
$78.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $25.00 Non-Preferred Drug: 25% Specialty Tier: 33%
| $6,590 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 |
UnitedHealthcare Medicare Advantage Choice Plan 4 (Regional PPO) - R5342-006-0
Benefit Details
|
Nassau |
$79.00 |
$150 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: 30%
| $6,700 Browse Formulary |
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Aetna Medicare Premier Plan (PPO) - H5521-040-0
Benefit Details
|
Nassau |
$83.00 |
$250 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5970-022 (PPO) - H5970-022-0
Benefit Details
|
Nassau |
$98.00 |
$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%
| $4,400 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 |
EmblemHealth VIP Gold (HMO) - H3330-021-2
Benefit Details
|
Nassau |
$122.50 |
$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:
|
WellCare Today's Options Advantage Plus 150A (PPO) - H2775-105-0
Benefit Details
|
Nassau |
$136.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Drug: $75.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5970-023 (PPO) - H5970-023-0
Benefit Details
|
Nassau |
$207.00 |
$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:
|
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
|
Nassau |
$301.00 |
$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:
|