MVP SmartFund (MSA) - H5613-002-0
Benefit Details
|
Rensselaer |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a |
|
|
|
|
Aetna Medicare Credit Plan (PPO) - H5521-313-0
Benefit Details
|
Rensselaer |
$0.00 |
$250 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
| $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Eagle Plan (PPO) - H5521-323-0
Benefit Details
|
Rensselaer |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $7,550 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
BlueShield Freedom Nation (PPO) - H5526-021-0
Benefit Details
|
Rensselaer |
$0.00 |
$375 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $12.00 Preferred Brand: $42.00 Non-Preferred Drug: $94.00 Specialty Tier: 26%
| $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueShield Freedom No Rx (HMO) - H3384-066-0
Benefit Details
|
Rensselaer |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
BlueShield Freedom Value (HMO) - H3384-063-0
Benefit Details
|
Rensselaer |
$0.00 |
$295 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: $94.00 Specialty Tier: 27%
| $7,550 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 |
CDPHP $0 Medicare Rx (HMO) - H3388-014-0
Benefit Details
|
Rensselaer |
$0.00 |
$300 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 27%
select insulin pay $35 copay | $7,500 Browse Formulary |
|
|
|
|
CDPHP Flex (PPO) - H5042-012-0
Benefit Details
|
Rensselaer |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,500 |
|
|
|
|
CDPHP Vital Rx (PPO) - H5042-009-0
Benefit Details
|
Rensselaer |
$0.00 |
$350 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26%
select insulin pay $35 copay | $7,500 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 Part B Saver (HMO) - H3330-040-0
Benefit Details
|
Rensselaer |
$0.00 |
$445 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
EmblemHealth VIP Rx Saver (HMO) - H3330-039-2
Benefit Details
|
Rensselaer |
$0.00 |
$395 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Fidelis Medicare $0 Premium (HMO) - H5599-009-0
Benefit Details
|
Rensselaer |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
| $7,550 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 |
Humana Gold Plus H3533-006 (HMO) - H3533-006-0
Benefit Details
|
Rensselaer |
$0.00 |
$300 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: 27%
select insulin pay $35 copay | $7,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Honor (PPO) - H5970-016-0
Benefit Details
|
Rensselaer |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
HumanaChoice H5970-015 (PPO) - H5970-015-0
Benefit Details
|
Rensselaer |
$0.00 |
$250 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: 28%
| $6,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5970-018 (PPO) - H5970-018-0
Benefit Details
|
Rensselaer |
$0.00 |
$310 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: 27%
| $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
MVP Medicare WellSelect with Part D (PPO) - H9615-008-0
Benefit Details
|
Rensselaer |
$0.00 |
$325 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: 25% Specialty Tier: 27%
| $7,550 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Patriot (Regional PPO) - R5342-002-0
Benefit Details
|
Rensselaer |
$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 |
WellCare Absolute (PPO) - H2775-111-0
Benefit Details
|
Rensselaer |
$0.00 |
$150 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30%
| $7,550 Browse Formulary |
|
|
|
|
WellCare Today's Options Advantage Plus 550B (PPO) - H2775-106-0
Benefit Details
|
Rensselaer |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 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:
|
WellCare Today's Options Premier 300 (PFFS) - H2816-038-0
Benefit Details
|
Rensselaer |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Value (HMO) - H4868-019-0
Benefit Details
|
Rensselaer |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 33%
| $6,700 Browse Formulary |
|
new |
|
|
WellCare Summit (PPO) - H2775-113-0
Benefit Details
|
Rensselaer |
$5.10 |
$445 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
Fidelis Medicare Advantage Flex (HMO-POS) - H5599-007-0
Benefit Details
|
Rensselaer |
$10.90 |
$445 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
| $7,550 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 Imperial (PPO D-SNP) - H2775-112-0
Benefit Details
|
Rensselaer |
$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: $9.00 Preferred Brand: $45.00 Non-Preferred Drug: 49% Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO) - R5342-001-0
Benefit Details
|
Rensselaer |
$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%
select insulin coverage $35 or less | $6,700 Browse Formulary |
|
|
|
|
Aetna Medicare Value Plan (HMO) - H3312-062-0
Benefit Details
|
Rensselaer |
$21.00 |
$250 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
| $7,550 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 |
Fidelis Dual Advantage Flex (HMO D-SNP) - H5599-001-0
Benefit Details
|
Rensselaer |
$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: $10.00 Preferred Brand: 24% Non-Preferred Drug: 39% Specialty Tier: 25%
| n/a Browse Formulary |
new |
new |
new |
|
Fidelis Dual Advantage (HMO D-SNP) - H5599-006-0
Benefit Details
|
Rensselaer |
$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: 47% Specialty Tier: 25%
| n/a Browse Formulary |
new |
new |
new |
|
HumanaChoice H5970-019 (PPO) - H5970-019-0
Benefit Details
|
Rensselaer |
$23.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $8.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
| $5,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Fidelis Medicaid Advantage Plus (HMO D-SNP) - H5599-008-0
Benefit Details
|
Rensselaer |
$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: $40.00 Non-Preferred Drug: 50% Specialty Tier: 25%
| n/a Browse Formulary |
new |
new |
new |
|
Humana Gold Plus H3533-013 (HMO) - H3533-013-0
Benefit Details
|
Rensselaer |
$25.00 |
$275 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
select insulin pay $35 copay | $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Assure Plan (HMO D-SNP) - H3312-070-0
Benefit Details
|
Rensselaer |
$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: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| 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 |
WellCare Liberty (HMO D-SNP) - H4868-002-0
Benefit Details
|
Rensselaer |
$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: $10.00 Preferred Brand: $45.00 Non-Preferred Drug: 50% Specialty Tier: 25%
| n/a Browse Formulary |
|
new |
|
|
Humana Gold Plus SNP-DE H3533-002 (HMO D-SNP) - H3533-002-0
Benefit Details
|
Rensselaer |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Elite Plan (PPO) - H5521-119-0
Benefit Details
|
Rensselaer |
$29.00 |
$100 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: 31%
| $7,550 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 |
CDPHP Basic RX (HMO) - H3388-013-0
Benefit Details
|
Rensselaer |
$31.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Drug: $97.00 Specialty Tier: 33%
select insulin pay $35 copay | $6,700 Browse Formulary |
|
|
|
|
UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP) - H2292-001-0
Benefit Details
|
Rensselaer |
$34.10 |
$445 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25%
| n/a Browse Formulary |
|
new |
|
|
MVP Medicare Patriot Plan with Part D (PPO) - H9615-014-0
Benefit Details
|
Rensselaer |
$36.00 |
$250 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: 27% Specialty Tier: 27%
| $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP) - H3379-022-0
Benefit Details
|
Rensselaer |
$36.00 |
$445 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25%
| n/a Browse Formulary |
|
|
|
|
Empire MediBlue Dual Advantage (HMO D-SNP) - H8432-039-2
Benefit Details
|
Rensselaer |
$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: $5.00 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:
|
CDPHP Choice (HMO) - H3388-001-0
Benefit Details
|
Rensselaer |
$39.90 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
MVP Medicare Secure with Part D (HMO-POS) - H3305-032-0
Benefit Details
|
Rensselaer |
$40.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: 26% Specialty Tier: 30%
| $7,550 Browse Formulary |
|
|
|
|
Empire MediBlue Plus (HMO) - H8432-038-2
Benefit Details
|
Rensselaer |
$41.00 |
$325 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: $95.00 Specialty Tier: 27%
| $5,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
CDPHP Flex Rx (PPO) - H5042-011-0
Benefit Details
|
Rensselaer |
$41.80 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $14.00 Preferred Brand: $44.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,500 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
|
Rensselaer |
$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 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
|
Rensselaer |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
-- |
|
|
Hamaspik Medicare Select (HMO D-SNP) - H0034-001-0
Benefit Details
|
Rensselaer |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 15%
| n/a Browse Formulary |
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 |
UnitedHealthcare Dual Complete (HMO D-SNP) - H3387-010-0
Benefit Details
|
Rensselaer |
$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 Tier 2: $0.00 Tier 3: $0.00 Tier 4: $0.00 Tier 5: $0.00
| n/a Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) - R5342-005-0
Benefit Details
|
Rensselaer |
$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%
select insulin coverage $35 or less | $6,700 Browse Formulary |
|
|
|
|
Aetna Medicare Premier Plan (PPO) - H5521-110-0
Benefit Details
|
Rensselaer |
$51.00 |
$200 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: 29%
| $7,550 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 |
WellCare Today's Options Premier Plus 650B (PFFS) - H2816-019-0
Benefit Details
|
Rensselaer |
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueShield Freedom Plus (HMO) - H3384-059-0
Benefit Details
|
Rensselaer |
$56.00 |
$275 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $8.00 Preferred Brand: $42.00 Non-Preferred Drug: $94.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
CDPHP Value Rx (HMO) - H3388-004-0
Benefit Details
|
Rensselaer |
$60.80 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Drug: $93.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,800 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 |
MVP Medicare Preferred Gold without Part D (HMO-POS) - H3305-020-0
Benefit Details
|
Rensselaer |
$62.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $7,550 |
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WellCare Today's Options Premier 200 (PFFS) - H2816-037-0
Benefit Details
|
Rensselaer |
$71.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a |
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EmblemHealth VIP Go (HMO-POS) - H3330-041-1
Benefit Details
|
Rensselaer |
$72.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 28%
| $7,550 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 |
UnitedHealthcare Medicare Advantage Choice Plan 4 (Regional PPO) - R5342-006-0
Benefit Details
|
Rensselaer |
$84.00 |
$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%
select insulin coverage $35 or less | $6,700 Browse Formulary |
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Empire MediBlue Access (PPO) - H3342-023-2
Benefit Details
|
Rensselaer |
$90.00 |
$310 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $38.00 Non-Preferred Drug: $88.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,200 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
MVP Medicare Secure Plus with Part D (HMO-POS) - H3305-022-0
Benefit Details
|
Rensselaer |
$90.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Drug: 27% Specialty Tier: 33%
| $7,550 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 |
BlueShield Freedom Premier (HMO) - H3384-064-0
Benefit Details
|
Rensselaer |
$111.00 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $94.00 Specialty Tier: 31%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
MVP Medicare WellSelect Plus with Part D (PPO) - H9615-007-0
Benefit Details
|
Rensselaer |
$116.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: 27% Specialty Tier: 33%
| $6,500 Browse Formulary |
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WellCare Today's Options Advantage Plus 150A (PPO) - H2775-105-0
Benefit Details
|
Rensselaer |
$121.00 |
$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:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
CDPHP Choice Rx (HMO) - H3388-002-0
Benefit Details
|
Rensselaer |
$130.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $11.00 Preferred Brand: $40.00 Non-Preferred Drug: $90.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,000 Browse Formulary |
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BlueShield Senior Blue 652 (HMO) - H3384-013-0
Benefit Details
|
Rensselaer |
$135.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: $94.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
MVP Medicare Preferred Gold with Part D (HMO-POS) - H3305-021-0
Benefit Details
|
Rensselaer |
$140.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: 27% Specialty Tier: 33%
| $5,800 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 |
WellCare Today's Options Premier Plus 250A (PFFS) - H2816-013-0
Benefit Details
|
Rensselaer |
$156.00 |
$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%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
BlueShield Forever Blue 770 (PPO) - H5526-018-0
Benefit Details
|
Rensselaer |
$200.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $12.00 Preferred Brand: $42.00 Non-Preferred Drug: $94.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|