MVP SmartFund (MSA) - H5613-002-0
Benefit Details
|
Broome |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a |
|
|
|
|
AARP Medicare Advantage (HMO) - H3379-039-0
Benefit Details
|
Broome |
$0.00 |
$195 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: 29%
select insulin pay $35 copay | $7,550 Browse Formulary |
|
|
|
|
Aetna Medicare Credit Plan (PPO) - H5521-313-0
Benefit Details
|
Broome |
$0.00 |
$350 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: 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 |
Aetna Medicare Eagle Plan (PPO) - H5521-323-0
Benefit Details
|
Broome |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $7,550 |
|
|
|
|
Aetna Medicare Premier Plan (PPO) - H5521-077-0
Benefit Details
|
Broome |
$0.00 |
$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:
|
Aetna Medicare Value Plan (HMO) - H3312-048-0
Benefit Details
|
Broome |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $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
|
Broome |
$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
|
Broome |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,500 |
|
|
|
|
CDPHP Vital Rx (PPO) - H5042-009-0
Benefit Details
|
Broome |
$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 Rx Saver (HMO) - H3330-039-2
Benefit Details
|
Broome |
$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:
|
Humana Gold Plus H3533-001 (HMO) - H3533-001-0
Benefit Details
|
Broome |
$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: 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
|
Broome |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5970-015 (PPO) - H5970-015-0
Benefit Details
|
Broome |
$0.00 |
$250 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: 28%
select insulin pay $35 copay | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5970-018 (PPO) - H5970-018-0
Benefit Details
|
Broome |
$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%
select insulin pay $35 copay | $4,800 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare BlueActive (PPO) - H3335-055-0
Benefit Details
|
Broome |
$0.00 |
$350 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: 28% 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 |
Medicare BlueBasic (PPO) - H3335-043-0
Benefit Details
|
Broome |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medicare BlueEssential (PPO) - H3335-053-0
Benefit Details
|
Broome |
$0.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30%
| $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
MVP Medicare WellSelect with Part D (PPO) - H9615-008-0
Benefit Details
|
Broome |
$0.00 |
$300 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 |
|
|
|
|
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 Patriot (Regional PPO) - R5342-002-0
Benefit Details
|
Broome |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Wellcare Advantage No Premium (PFFS) - H2816-038-0
Benefit Details
|
Broome |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a |
|
-- |
|
|
Wellcare Fidelis No Premium (HMO) - H5599-004-0
Benefit Details
|
Broome |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $37.00 Non-Preferred Drug: 42% Specialty Tier: 33% Select Care Drugs: $0.00
| $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 Fidelis Patriot No Premium (HMO-POS) - H5599-005-0
Benefit Details
|
Broome |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $7,550 |
|
|
|
|
Wellcare Giveback Open (PPO) - H2775-111-0
Benefit Details
|
Broome |
$0.00 |
$325 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $1.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 27% Select Care Drugs: $0.00
| $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) - H4868-019-0
Benefit Details
|
Broome |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 33% Select Care Drugs: $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 |
Wellcare No Premium Open (PPO) - H2775-106-0
Benefit Details
|
Broome |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 42% Specialty Tier: 33% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Patriot No Premium (HMO) - H4868-003-0
Benefit Details
|
Broome |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
-- |
|
|
UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO) - R5342-001-0
Benefit Details
|
Broome |
$16.00 |
$300 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: 28%
select insulin coverage $35 or less | $7,200 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5970-001 (PPO) - H5970-001-0
Benefit Details
|
Broome |
$17.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $8.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | $4,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Fidelis Assist (HMO-POS) - H5599-002-0
Benefit Details
|
Broome |
$17.10 |
$480 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: 22% Non-Preferred Drug: 37% Specialty Tier: 25% Select Care Drugs: $0.00
| $7,550 Browse Formulary |
|
|
|
|
HumanaChoice SNP-DE H5970-020 (PPO D-SNP) - H5970-020-0
Benefit Details
|
Broome |
$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: $19.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Fidelis Dual Access (HMO D-SNP) - H5599-001-0
Benefit Details
|
Broome |
$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: 33% Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
|
|
|
Wellcare Fidelis Dual Plus (HMO D-SNP) - H5599-008-0
Benefit Details
|
Broome |
$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: 33% Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
|
|
|
Aetna Medicare Assure Plan (HMO D-SNP) - H3312-070-0
Benefit Details
|
Broome |
$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: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: 25% Specialty Tier: 25%
| 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 |
Aetna Medicare Discover Value Plan (PPO) - H5521-340-0
Benefit Details
|
Broome |
$25.00 |
$300 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:
|
Humana Gold Plus H3533-013 (HMO) - H3533-013-0
Benefit Details
|
Broome |
$26.00 |
$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:
|
Humana Gold Plus SNP-DE H3533-002 (HMO D-SNP) - H3533-002-0
Benefit Details
|
Broome |
$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: $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:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist Open (PPO) - H2775-113-0
Benefit Details
|
Broome |
$30.70 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Drug: 44% Specialty Tier: 25% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
|
|
|
Wellcare Dual Access (HMO D-SNP) - H4868-004-0
Benefit Details
|
Broome |
$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: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
-- |
|
|
CDPHP Basic RX (HMO) - H3388-013-0
Benefit Details
|
Broome |
$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 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Dual Access Open (PPO D-SNP) - H2775-112-0
Benefit Details
|
Broome |
$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: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 49% Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
|
|
|
UnitedHealthcare Dual Complete Plan 2 (HMO D-SNP) - H3387-015-1
Benefit Details
|
Broome |
$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
| n/a Browse Formulary |
|
|
|
|
Medicare BlueClassic (PPO) - H3335-038-0
Benefit Details
|
Broome |
$38.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $7,200 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 Choice (HMO) - H3388-001-0
Benefit Details
|
Broome |
$39.90 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 |
|
|
|
|
MVP Medicare Secure with Part D (HMO-POS) - H3305-032-0
Benefit Details
|
Broome |
$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: 25% Specialty Tier: 30%
| $7,550 Browse Formulary |
|
|
|
|
CDPHP Flex Rx (PPO) - H5042-011-0
Benefit Details
|
Broome |
$42.00 |
$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
|
Broome |
$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
| n/a Browse Formulary |
|
-- |
|
|
EmblemHealth VIP Solutions (HMO D-SNP) - H5991-002-0
Benefit Details
|
Broome |
$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 |
|
-- |
|
|
Nascentia Dual Advantage (HMO D-SNP) - H9066-003-0
Benefit Details
|
Broome |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 15%
| n/a Browse Formulary |
|
-- |
-- |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Nascentia Medicaid Advantage Plus (HMO D-SNP) - H9066-001-0
Sanctioned Plan
|
Broome |
$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
| n/a Browse Formulary |
|
-- |
-- |
|
Nascentia Skilled Nursing Facility (HMO I-SNP) - H9066-002-0
Benefit Details
|
Broome |
$42.40 |
$480 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| n/a Browse Formulary |
|
-- |
-- |
|
UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP) - H3387-014-1
Benefit Details
|
Broome |
$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
| 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 Nursing Home Plan (HMO-POS I-SNP) - H3379-022-0
Benefit Details
|
Broome |
$42.40 |
$480 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| n/a Browse Formulary |
|
|
|
|
UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP) - H2292-001-0
Benefit Details
|
Broome |
$42.40 |
$480 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| n/a Browse Formulary |
|
-- |
|
|
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) - R5342-005-0
Benefit Details
|
Broome |
$46.00 |
$250 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
select insulin coverage $35 or less | $6,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Premium Enhanced (PFFS) - H2816-019-0
Benefit Details
|
Broome |
$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: 48% Specialty Tier: 33% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
CDPHP Value Rx (HMO) - H3388-004-0
Benefit Details
|
Broome |
$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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MVP Medicare Preferred Gold without Part D (HMO-POS) - H3305-020-0
Benefit Details
|
Broome |
$62.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $7,550 |
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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 Advantage Premium Enhanced (PFFS) - H2816-037-0
Benefit Details
|
Broome |
$62.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a |
|
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UnitedHealthcare Medicare Advantage Choice Plan 4 (Regional PPO) - R5342-006-0
Benefit Details
|
Broome |
$84.00 |
$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%
select insulin coverage $35 or less | $6,700 Browse Formulary |
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MVP Medicare Secure Plus with Part D (HMO-POS) - H3305-022-0
Benefit Details
|
Broome |
$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 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medicare BlueSecure (PPO) - H3335-014-0
Benefit Details
|
Broome |
$92.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $30 copay | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Premium Ultra Open (PPO) - H2775-105-0
Benefit Details
|
Broome |
$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: 43% Specialty Tier: 33% Select Care Drugs: $0.00
| $3,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare BlueEnhanced (PPO) - H3335-015-0
Benefit Details
|
Broome |
$124.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $6.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $30 copay | $5,000 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 |
MVP Medicare WellSelect Plus with Part D (PPO) - H9615-007-0
Benefit Details
|
Broome |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: 26% Specialty Tier: 33%
| $6,500 Browse Formulary |
|
|
|
|
CDPHP Choice Rx (HMO) - H3388-002-0
Benefit Details
|
Broome |
$131.00 |
$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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MVP Medicare Preferred Gold with Part D (HMO-POS) - H3305-021-0
Benefit Details
|
Broome |
$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 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Premium Ultra (PFFS) - H2816-013-0
Benefit Details
|
Broome |
$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: 42% Specialty Tier: 33% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|