Aetna Medicare Eagle Plan (PPO) - H5521-323-0
Benefits & Contact Info
|
Montgomery |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $7,000 |
|
|
|
|
CDPHP Flex (PPO) - H5042-012-0
Benefits & Contact Info
|
Montgomery |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,100 |
|
|
|
|
Freedom Valor (PPO) - H5526-024-0
Benefits & Contact Info
|
Montgomery |
$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 USAA Honor (PPO) - H5970-016-0
Benefits & Contact Info
|
Montgomery |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medicare BlueSalute (PPO) - H3335-044-0
Benefits & Contact Info
|
Montgomery |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
MediGold Cash Back No Premium MA Only (HMO) - H9827-003-0
Benefits & Contact Info
|
Montgomery |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,800 |
|
new |
|
|
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
Benefits & Contact Info
|
Montgomery |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
UHC Medicare Advantage Patriot No Rx NY-MA02 (Regional PPO) - R5342-002-0
Benefits & Contact Info
|
Montgomery |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Wellcare Advantage No Premium (PFFS) - H2816-038-0
Benefits & Contact Info
|
Montgomery |
$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 |
AARP Medicare Advantage from UHC NY-0024 (HMO-POS) - H3379-050-0
Benefits & Contact Info
|
Montgomery |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
|
AARP Medicare Advantage from UHC NY-0026 (PPO) - H3418-010-0
Benefits & Contact Info
|
Montgomery |
$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: 30%
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
|
Aetna Medicare Credit Plan (PPO) - H5521-313-0
Benefits & Contact Info
|
Montgomery |
$0.00 |
$250 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: 20% Non-Preferred Drug: 50% Specialty Tier: 29%
all covered insulin pay $35 or less | $8,500 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 |
Aetna Medicare Elite Plan (PPO) - H5521-119-0
Benefits & Contact Info
|
Montgomery |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 20% Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $8,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Premier Plus Plan (PPO) - H5521-382-0
Benefits & Contact Info
|
Montgomery |
$0.00 |
$250 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 20% Non-Preferred Drug: 40% Specialty Tier: 29%
all covered insulin pay $35 or less | $8,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Value Plan (HMO-POS) - H3312-062-0
Benefits & Contact Info
|
Montgomery |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 20% Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $8,500 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 |
CDPHP $0 Medicare Rx (HMO) - H3388-014-0
Benefits & Contact Info
|
Montgomery |
$0.00 |
$250 Tier 1 and 2 exempt |
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: 27%
all covered insulin pay $35 or less | $7,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
CDPHP Vital Rx (PPO) - H5042-009-0
Benefits & Contact Info
|
Montgomery |
$0.00 |
$300 Tier 1 and 2 exempt |
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: 26%
all covered insulin pay $35 or less | $7,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Freedom Basic (PPO) - H5526-022-0
Benefits & Contact Info
|
Montgomery |
$0.00 |
$350 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $42.00 Non-Preferred Drug: $94.00 Specialty Tier: 27%
all covered insulin pay $35 or less | $8,300 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 |
Freedom Nation (PPO) - H5526-021-0
Benefits & Contact Info
|
Montgomery |
$0.00 |
$125 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $42.00 Non-Preferred Drug: $94.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $6,750 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Freedom Value (HMO) - H3384-063-0
Benefits & Contact Info
|
Montgomery |
$0.00 |
$295 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: $94.00 Specialty Tier: 28%
all covered insulin pay $35 or less | $6,750 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Plus H3533-006 (HMO) - H3533-006-0
Benefits & Contact Info
|
Montgomery |
$0.00 |
$350 Tier 1, 2 and 3 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%
all covered insulin pay $35 or less | $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 |
HumanaChoice H5970-015 (PPO) - H5970-015-0
Benefits & Contact Info
|
Montgomery |
$0.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $5,300 Browse Formulary |
|
|
|
|
HumanaChoice H5970-018 (PPO) - H5970-018-0
Benefits & Contact Info
|
Montgomery |
$0.00 |
$310 Tier 1, 2 and 3 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%
all covered insulin pay $35 or less | $5,350 Browse Formulary |
|
|
|
|
MediGold Cash Back No Premium (HMO) - H9827-004-0
Benefits & Contact Info
|
Montgomery |
$0.00 |
$275 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: 29%
all covered insulin pay $35 or less | $7,300 Browse Formulary |
|
new |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
MediGold No Premium (HMO) - H9827-001-0
Benefits & Contact Info
|
Montgomery |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $6,200 Browse Formulary |
|
new |
|
|
MVP Medicare WellSelect with Part D (PPO) - H9615-008-0
Benefits & Contact Info
|
Montgomery |
$0.00 |
$250 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%
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
|
Wellcare Fidelis No Premium (HMO) - H5599-004-0
Benefits & Contact Info
|
Montgomery |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $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 Giveback Open (PPO) - H2775-111-0
Benefits & Contact Info
|
Montgomery |
$0.00 |
$500 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $8,300 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) - H2775-106-0
Benefits & Contact Info
|
Montgomery |
$0.00 |
$450 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 26% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) - H2775-113-0
Benefits & Contact Info
|
Montgomery |
$20.60 |
$510 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 46% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $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 |
UHC Nursing Home Plan NY-F001 (PPO I-SNP) - H2292-001-0
Benefits & Contact Info
|
Montgomery |
$23.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Aetna Medicare Discover Value Plan (PPO) - H5521-383-0
Benefits & Contact Info
|
Montgomery |
$25.00 |
$250 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 20% Non-Preferred Drug: 40% Specialty Tier: 29%
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Plus H3533-013 (HMO) - H3533-013-0
Benefits & Contact Info
|
Montgomery |
$25.00 |
$275 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $6,000 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
Benefits & Contact Info
|
Montgomery |
$27.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $4,950 Browse Formulary |
|
|
|
|
Wellcare Fidelis Assist (HMO-POS) - H5599-002-0
Benefits & Contact Info
|
Montgomery |
$27.50 |
$430 Tier 1, 2 and 6 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% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Premier Plan (PPO) - H5521-110-0
Benefits & Contact Info
|
Montgomery |
$29.00 |
$150 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: 30%
all covered insulin pay $35 or less | $8,500 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 |
MediGold Plus (HMO) - H9827-002-0
Benefits & Contact Info
|
Montgomery |
$29.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
new |
|
|
UHC Medicare Advantage NY-0020 (Regional PPO) - R5342-001-0
Benefits & Contact Info
|
Montgomery |
$29.00 |
$295 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%
all covered insulin pay $35 or less | $7,900 Browse Formulary |
|
|
|
|
CDPHP Basic RX (HMO) - H3388-013-0
Benefits & Contact Info
|
Montgomery |
$31.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Drug: $97.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $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 |
Anthem Medicare Advantage (HMO) - H8432-038-2
Benefits & Contact Info
|
Montgomery |
$33.00 |
$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: 28%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
CDPHP Flex Rx (PPO) - H5042-011-0
Benefits & Contact Info
|
Montgomery |
$34.80 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $44.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $6,100 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Longevity Plan (PPO I-SNP) - H5521-461-0
Benefits & Contact Info
|
Montgomery |
$38.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25%
all covered insulin pay $35 or less | 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 |
Aetna Medicare Assure Plan (HMO D-SNP) - H3312-070-0
Benefits & Contact Info
|
Montgomery |
$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
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
MVP Medicare Secure with Part D (HMO-POS) - H3305-032-0
Benefits & Contact Info
|
Montgomery |
$39.50 |
$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%
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
|
CDPHP Choice (HMO) - H3388-001-0
Benefits & Contact Info
|
Montgomery |
$39.90 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,100 |
|
|
|
|
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
Benefits & Contact Info
|
Montgomery |
$40.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a |
|
-- |
|
|
Humana Gold Plus SNP-DE H3533-002 (HMO D-SNP) - H3533-002-0
Benefits & Contact Info
|
Montgomery |
$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
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
HumanaChoice SNP-DE H5970-020 (PPO D-SNP) - H5970-020-0
Benefits & Contact Info
|
Montgomery |
$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
all covered insulin pay $35 or less | 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 |
Hamaspik Medicare Select (HMO D-SNP) - H0034-001-0
Benefits & Contact Info
|
Montgomery |
$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%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
MVP Medicare Patriot Plan with Part D (PPO) - H9615-018-0
Benefits & Contact Info
|
Montgomery |
$42.40 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Drug: 25% Specialty Tier: 27%
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
|
UHC Dual Complete NY-Q001 (HMO-POS D-SNP) - H3387-015-1
Benefits & Contact Info
|
Montgomery |
$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
all covered insulin pay $35 or less | 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 Fidelis Dual Access (HMO D-SNP) - H5599-001-0
Benefits & Contact Info
|
Montgomery |
$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
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Wellcare Premium Enhanced (PFFS) - H2816-019-0
Benefits & Contact Info
|
Montgomery |
$47.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Full Dual Advantage (HMO D-SNP) - H8432-039-2
Benefits & Contact Info
|
Montgomery |
$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 Tier 6: $0.00
all covered insulin pay $35 or less | 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 |
UHC Dual Complete NY-S001 (PPO D-SNP) - H0271-060-1
Benefits & Contact Info
|
Montgomery |
$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
all covered insulin pay $35 or less | n/a Browse Formulary |
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UHC Dual Complete NY-S002 (HMO-POS D-SNP) - H3387-014-1
Benefits & Contact Info
|
Montgomery |
$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
all covered insulin pay $35 or less | n/a Browse Formulary |
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Wellcare Dual Access Open (PPO D-SNP) - H2775-112-0
Benefits & Contact Info
|
Montgomery |
$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
all covered insulin pay $35 or less | 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 |
Wellcare Fidelis Dual Plus (HMO D-SNP) - H5599-008-0
Benefits & Contact Info
|
Montgomery |
$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
all covered insulin pay $35 or less | n/a Browse Formulary |
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Freedom Plus (HMO) - H3384-059-0
Benefits & Contact Info
|
Montgomery |
$53.00 |
$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%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
CDPHP Value Rx (HMO) - H3388-004-0
Benefits & Contact Info
|
Montgomery |
$53.80 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $42.00 Non-Preferred Drug: $93.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $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 |
UHC Medicare Advantage NY-0021 (Regional PPO) - R5342-005-0
Benefits & Contact Info
|
Montgomery |
$56.00 |
$195 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: 30%
all covered insulin pay $35 or less | $7,500 Browse Formulary |
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Anthem Medicare Advantage (PPO) - H3342-023-2
Benefits & Contact Info
|
Montgomery |
$83.00 |
$310 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $38.00 Non-Preferred Drug: $88.00 Specialty Tier: 28% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $6,200 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
UHC Medicare Advantage NY-0022 (Regional PPO) - R5342-006-0
Benefits & Contact Info
|
Montgomery |
$88.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $7,200 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 Secure Plus with Part D (HMO-POS) - H3305-022-0
Benefits & Contact Info
|
Montgomery |
$97.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Drug: 25% Specialty Tier: 33%
all covered insulin pay $35 or less | $7,550 Browse Formulary |
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Medicare BluePlus (PPO) - H3335-018-0
Benefits & Contact Info
|
Montgomery |
$109.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $14.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: 27% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,100 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Premium Ultra Open (PPO) - H2775-105-0
Benefits & Contact Info
|
Montgomery |
$110.00 |
$0 |
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: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $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 |
Senior Blue 652 (HMO) - H3384-013-0
Benefits & Contact Info
|
Montgomery |
$122.00 |
$0 |
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: 33%
all covered insulin pay $35 or less | $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
Benefits & Contact Info
|
Montgomery |
$122.40 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: 25% Specialty Tier: 33%
all covered insulin pay $35 or less | $6,500 Browse Formulary |
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CDPHP Choice Rx (HMO) - H3388-002-0
Benefits & Contact Info
|
Montgomery |
$124.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $40.00 Non-Preferred Drug: $90.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $6,100 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 |
Wellcare Premium Ultra (PFFS) - H2816-013-0
Benefits & Contact Info
|
Montgomery |
$136.00 |
$0 |
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: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
MVP Medicare Preferred Gold with Part D (HMO-POS) - H3305-021-0
Benefits & Contact Info
|
Montgomery |
$147.40 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: 25% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,800 Browse Formulary |
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Aetna Medicare Platinum Plan (PPO) - H5521-459-0
Benefits & Contact Info
|
Montgomery |
$150.00 |
$250 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: 20% Non-Preferred Drug: 50% Specialty Tier: 29%
all covered insulin pay $35 or less | $4,300 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 |
Forever Blue 770 (PPO) - H5526-018-0
Benefits & Contact Info
|
Montgomery |
$206.00 |
$0 |
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: 33%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|