AARP MedicareComplete Essential (HMO) - H3307-018-0
Benefit Details
|
Queens |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,200 |
|
|
|
|
AARP MedicareComplete Mosaic (HMO) - H3307-015-0
Benefit Details
|
Queens |
$0.00 |
$245 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $43.00 Non-Preferred Brand: $93.00 Specialty Tier: 27%
| $4,900 Browse Formulary |
|
|
|
|
AARP MedicareComplete Plan 2 (HMO) - H3379-001-0
Benefit Details
|
Queens |
$0.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Advantage Health NYC - SNP (HMO SNP) - H2773-017-0
Benefit Details
|
Queens |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $25.00 Non-Preferred Brand: 25% Specialty Tier: 33%
| n/a Browse Formulary |
-- |
-- |
|
|
Advantage Silver - NY City (HMO) - H2773-020-0
Benefit Details
|
Queens |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $30.00 Non-Preferred Brand: 25% Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
-- |
|
|
Aetna Better Health FIDA Plan (Medicare-Medicaid Plan) - H8056-001-0
Benefit Details
|
Queens |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx/OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Aetna Medicare Value Plan (HMO) - H3312-060-0
Benefit Details
|
Queens |
$0.00 |
$160 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Affinity Medicare Passport Essentials NYC (HMO) - H5991-006-0
Benefit Details
|
Queens |
$0.00 |
$150 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
|
AgeWell New York FIDA Plan (Medicare-Medicaid Plan) - H6308-001-0
Benefit Details
|
Queens |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx/OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
AgeWell New York LiveWell (HMO) - H4922-001-0
Benefit Details
|
Queens |
$0.00 |
$275 |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
new |
new |
new |
|
AlphaCare Renew (HMO) - H9122-001-0
Benefit Details
|
Queens |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $40.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
-- |
-- |
|
|
AlphaCare Signature FIDA Plan (Medicare-Medicaid Plan) - H6974-001-0
Benefit Details
|
Queens |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic Drugs: $0.00 Generic Drugs: $0.00 Preferred Brand Drugs: $0.00 Non-Preferred Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Amida Care True Life Plus (HMO) - H6745-001-0
Benefit Details
|
Queens |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Generic: $0.00 Preferred Brand: $33.00 Non-Preferred Brand: $45.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
-- |
-- |
|
CenterLight Healthcare FIDA Plan (Medicare-Medicaid Plan) - H8420-001-0
Benefit Details
|
Queens |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
Centers Plan for FIDA Care Complete (Medicare-Medicaid Plan) - H3018-001-0
Benefit Details
|
Queens |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Centers Plan for Medicare Advantage Care (HMO) - H6988-001-0
Benefit Details
|
Queens |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Generic: $2.00 Preferred Brand: $35.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
-- |
-- |
-- |
|
Easy Choice Diamond Rewards (HMO SNP) - H9285-003-0
Benefit Details
|
Queens |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
-- |
|
|
Easy Choice Rewards (HMO) - H9285-001-0
Benefit Details
|
Queens |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $3,400 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 Diabetes Care (HMO SNP) - H3347-012-0
Benefit Details
|
Queens |
$0.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
|
Elderplan FIDA Total Care (Medicare-Medicaid Plan) - H8029-001-0
Benefit Details
|
Queens |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx/OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
Empire BlueCross BlueShield HealthPlus FIDA Plan (Medicare-Medicaid Plan) - H8417-001-0
Benefit Details
|
Queens |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Empire MediBlue Core (HMO) - H3370-033-0
Benefit Details
|
Queens |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Empire MediBlue Plus (HMO) - H3370-029-2
Benefit Details
|
Queens |
$0.00 |
$245 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Fidelis Fully Integrated Dual Advantage Plan (Medicare-Medicaid Plan) - H1916-001-0
Benefit Details
|
Queens |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Fidelis Medicare $0 Premium (HMO) - H3328-019-0
Benefit Details
|
Queens |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Fidelis Medicare Advantage without Rx (HMO-POS) - H3328-001-0
Benefit Details
|
Queens |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
GuildNet Gold Plus FIDA Plan (Medicare-Medicaid Plan) - H0811-001-0
Benefit Details
|
Queens |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthfirst 65 Plus Plan (HMO) - H3359-001-0
Benefit Details
|
Queens |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Healthfirst AbsoluteCare FIDA Plan (Medicare-Medicaid Plan) - H5441-001-0
Benefit Details
|
Queens |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx/OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
Healthfirst Coordinated Benefits Plan (HMO) - H3359-027-0
Benefit Details
|
Queens |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Plus H3533-005 (HMO) - H3533-005-0
Benefit Details
|
Queens |
$0.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $8.00 Generic: $18.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
-- |
|
|
ICS Community Care Plus FIDA MMP (Medicare-Medicaid Plan) - H4465-001-0
Benefit Details
|
Queens |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
Liberty Health Advantage Preferred Choice (HMO) - H3337-001-0
Benefit Details
|
Queens |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $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 |
MetroPlus FIDA (Medicare-Medicaid Plan) - H9115-001-0
Benefit Details
|
Queens |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx/OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
North Shore-LIJ FIDA LiveWell (Medicare-Medicaid Plan) - H3129-001-0
Benefit Details
|
Queens |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx/OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
PHP Care Complete FIDA (Medicare-Medicaid Plan) - H9869-001-0
Benefit Details
|
Queens |
$0.00 |
$0 |
Yes, some additional gap coverage. | Tier 1: 0% Tier 2: 0% Tier 3: 0%
| 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 |
RiverSpring FIDA Plan (Medicare-Medicaid Plan) - H6435-001-0
Benefit Details
|
Queens |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx/OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
SWH Whole Health FIDA (Medicare-Medicaid Plan) - H8851-001-0
Benefit Details
|
Queens |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
Touchstone Health Medicare Power (HMO) - H3327-001-0
Benefit Details
|
Queens |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare MedicareComplete Choice Essential (Regional PPO) - R5342-002-0
Benefit Details
|
Queens |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
UnitedHealthcare MedicareComplete Choice Plan 1 (Regional PPO) - R5342-001-0
Benefit Details
|
Queens |
$0.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 26%
| $6,700 Browse Formulary |
|
|
|
|
VillageCareMAX Full Advantage FIDA (Medicare-Medicaid Plan) - H9345-001-0
Benefit Details
|
Queens |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
VNSNY CHOICE FIDA Complete (Medicare-Medicaid Plan) - H8490-001-0
Benefit Details
|
Queens |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
VNSNY CHOICE Medicare Enhanced (HMO) - H5549-004-0
Benefit Details
|
Queens |
$0.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
WellCare Advocate Complete FIDA (Medicare-Medicaid Plan) - H2751-002-0
Benefit Details
|
Queens |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx/OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Choice (HMO-POS) - H3361-106-0
Benefit Details
|
Queens |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: 48% Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Access Medicare Gold (HMO) - H4866-003-0
Benefit Details
|
Queens |
$10.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $8.00 Preferred Brand: $35.00 Non-Preferred Brand: $75.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
WellCare Rx (HMO) - H3361-130-0
Benefit Details
|
Queens |
$19.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $7.00 Preferred Brand: $36.00 Non-Preferred Brand: 50% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Plus H3533-021 (HMO) - H3533-021-0
Benefit Details
|
Queens |
$24.10 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $9.00 Generic: $19.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
-- |
|
|
AARP MedicareComplete Plan 1 (HMO) - H3307-002-0
Benefit Details
|
Queens |
$29.00 |
$230 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 27%
| $5,200 Browse Formulary |
|
|
|
|
Healthfirst AssuredCare (HMO SNP) - H3359-035-0
Benefit Details
|
Queens |
$30.80 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd
| 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 Essential (HMO) - H3330-032-2
Benefit Details
|
Queens |
$32.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
Humana Gold Plus SNP-DE H3533-004 (HMO SNP) - H3533-004-0
Benefit Details
|
Queens |
$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: $19.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 29%
| n/a Browse Formulary |
|
-- |
|
|
WellCare Access (HMO SNP) - H3361-109-0
Benefit Details
|
Queens |
$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 Brand: 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 |
Healthfirst Increased Benefits Plan (HMO) - H3359-019-0
Benefit Details
|
Queens |
$35.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd
| $6,700 Browse Formulary |
|
|
|
|
UnitedHealthcare Dual Complete (HMO SNP) - H3387-010-0
Benefit Details
|
Queens |
$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 |
|
-- |
|
|
MetroPlus Advantage Plan (HMO SNP) - H0423-001-0
Benefit Details
|
Queens |
$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 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthfirst CompleteCare (HMO SNP) - H3359-034-0
Benefit Details
|
Queens |
$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 |
|
|
|
|
Healthfirst Life Improvement Plan (HMO SNP) - H3359-021-0
Benefit Details
|
Queens |
$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 |
|
|
|
|
UnitedHealthcare MedicareComplete Choice Plan 3 (Regional PPO) - R5342-005-0
Benefit Details
|
Queens |
$39.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 29%
| $5,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Nursing Home Plan (HMO SNP) - H3379-002-0
Benefit Details
|
Queens |
$39.30 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd
| n/a Browse Formulary |
|
|
|
|
Access Medicare Pearl (HMO SNP) - H4866-005-0
Benefit Details
|
Queens |
$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 |
|
|
|
|
Access Medicare Pearl Advantage (HMO SNP) - H4866-008-0
Benefit Details
|
Queens |
$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 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Access Medicare Platinum (HMO) - H4866-002-0
Benefit Details
|
Queens |
$39.70 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd
| $6,700 Browse Formulary |
|
|
|
|
Access Medicare Platinum Advantage (HMO) - H4866-007-0
Benefit Details
|
Queens |
$39.70 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd
| $6,700 Browse Formulary |
|
|
|
|
Advantage Value One NY - Dual (HMO SNP) - H2773-018-0
Benefit Details
|
Queens |
$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: $10.00 Preferred Brand: $30.00 Non-Preferred Brand: 25% Specialty Tier: 33%
| n/a Browse Formulary |
-- |
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Affinity Medicare Solutions (HMO SNP) - H5991-002-0
Benefit Details
|
Queens |
$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: $11.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
|
Affinity Medicare Ultimate (HMO SNP) - H5991-001-0
Benefit Details
|
Queens |
$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: $47.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
|
AgeWell New York BeWell (HMO SNP) - H4922-002-0
Benefit Details
|
Queens |
$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 |
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 |
AgeWell New York CareWell (HMO SNP) - H4922-004-0
Benefit Details
|
Queens |
$39.70 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd
| n/a Browse Formulary |
new |
new |
new |
|
AgeWell New York FeelWell (HMO SNP) - H4922-003-0
Benefit Details
|
Queens |
$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 |
new |
new |
new |
|
AlphaCare Resilience (HMO SNP) - H9122-002-0
Benefit Details
|
Queens |
$39.70 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd
| 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 |
AlphaCare Total (HMO SNP) - H9122-003-0
Benefit Details
|
Queens |
$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 |
-- |
-- |
|
|
Amida Care Live Life Advantage (HMO SNP) - H6745-003-0
Benefit Details
|
Queens |
$39.70 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25%
| n/a Browse Formulary |
-- |
-- |
-- |
|
Amida Care True Life Advantage (HMO SNP) - H6745-002-0
Benefit Details
|
Queens |
$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 |
-- |
-- |
-- |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
ArchCare Advantage (HMO SNP) - H1777-007-0
Benefit Details
|
Queens |
$39.70 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd
| n/a Browse Formulary |
|
-- |
|
|
CenterLight Healthcare Direct Complete Plan (HMO SNP) - H5989-002-0
Benefit Details
|
Queens |
$39.70 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Generic: $9.50 Brand: 25%
| n/a Browse Formulary |
|
-- |
|
|
Centers Plan for Dual Coverage Care (HMO SNP) - H6988-002-0
Benefit Details
|
Queens |
$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 |
-- |
-- |
-- |
|
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 Nursing Home Care (HMO SNP) - H6988-003-0
Benefit Details
|
Queens |
$39.70 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd
| n/a Browse Formulary |
-- |
-- |
-- |
|
Elderplan Advantage For Nursing Home Residents (HMO SNP) - H3347-003-0
Benefit Details
|
Queens |
$39.70 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd
| n/a Browse Formulary |
|
|
|
|
Elderplan Extra Help (HMO) - H3347-009-0
Benefit Details
|
Queens |
$39.70 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Elderplan For Medicaid Beneficiaries (HMO SNP) - H3347-002-0
Benefit Details
|
Queens |
$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 |
|
|
|
|
Elderplan Plus Long Term Care (HMO SNP) - H3347-007-0
Benefit Details
|
Queens |
$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 |
|
|
|
|
EmblemHealth Dual Eligible (HMO SNP) - H3330-029-0
Benefit Details
|
Queens |
$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: $9.00 Preferred Brand: 25% Non-Preferred Brand: 30% 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 |
EmblemHealth Dual Eligible (PPO SNP) - H5528-018-0
Benefit Details
|
Queens |
$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: $9.00 Preferred Brand: 25% Non-Preferred Brand: 30% Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
|
Empire MediBlue Dual Advantage (HMO SNP) - H3370-028-0
Benefit Details
|
Queens |
$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: $4.00 Preferred Brand: $45.00 Non-Preferred Brand: $94.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Fidelis Dual Advantage (HMO SNP) - H3328-002-0
Benefit Details
|
Queens |
$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 Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Fidelis Dual Advantage Flex (HMO SNP) - H3328-017-0
Benefit Details
|
Queens |
$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 Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
|
Fidelis Medicaid Advantage Plus (HMO SNP) - H3328-016-0
Benefit Details
|
Queens |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
|
Fidelis Medicare Advantage Flex (HMO-POS) - H3328-003-0
Benefit Details
|
Queens |
$39.70 |
$250 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $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 |
GuildNet Gold (HMO SNP) - H6864-001-0
Benefit Details
|
Queens |
$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: $1.00 Generic: $10.00 Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25%
| n/a Browse Formulary |
-- |
|
|
|
Liberty Health Advantage Dual Power (HMO SNP) - H3337-003-0
Benefit Details
|
Queens |
$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 |
|
|
|
|
RiverSpring Star (HMO SNP) - H6776-001-0
Benefit Details
|
Queens |
$39.70 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd
| 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 |
Senior Whole Health of New York NHC (HMO SNP) - H5992-007-0
Benefit Details
|
Queens |
$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 |
-- |
-- |
-- |
|
Touchstone Health Medicare Grand (HMO SNP) - H3327-043-0
Benefit Details
|
Queens |
$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 |
|
|
|
|
Touchstone Health Medicare Prestige (HMO SNP) - H3327-026-0
Benefit Details
|
Queens |
$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 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Touchstone Health Medicare Total (HMO) - H3327-002-0
Benefit Details
|
Queens |
$39.70 |
$0 |
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: 33%
| $3,400 Browse Formulary |
|
|
|
|
VNSNY CHOICE Medicare Classic (HMO) - H5549-008-0
Benefit Details
|
Queens |
$39.70 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd
| $6,700 Browse Formulary |
|
|
|
|
VNSNY CHOICE Medicare Preferred (HMO SNP) - H5549-002-0
Benefit Details
|
Queens |
$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 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
VNSNY CHOICE Total (HMO SNP) - H5549-003-0
Benefit Details
|
Queens |
$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 |
|
|
|
|
Affinity Medicare Passport Select (HMO) - H5991-004-0
Benefit Details
|
Queens |
$41.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $5,400 Browse Formulary |
|
|
|
|
EmblemHealth PPO I (PPO) - H5528-001-0
Benefit Details
|
Queens |
$50.00 |
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 |
AARP MedicareComplete Plan 3 (HMO) - H3307-024-0
Benefit Details
|
Queens |
$69.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $2,800 Browse Formulary |
|
|
|
|
UnitedHealthcare MedicareComplete Choice Plan 4 (Regional PPO) - R5342-006-0
Benefit Details
|
Queens |
$69.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $4,900 Browse Formulary |
|
|
|
|
Advantage Platinum Plus NY (HMO) - H2773-015-0
Benefit Details
|
Queens |
$85.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $20.00 Non-Preferred Brand: 25% Specialty Tier: 33%
| $3,400 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 Standard Plan (PPO) - H5521-040-0
Benefit Details
|
Queens |
$96.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: 50% Specialty Tier: 29%
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
VNSNY CHOICE Medicare Ultra (HMO-POS) - H5549-009-0
Benefit Details
|
Queens |
$96.40 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
EmblemHealth VIP (HMO) - H3330-021-2
Benefit Details
|
Queens |
$103.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
VNSNY CHOICE Medicare Maximum (HMO SNP) - H5549-006-0
Benefit Details
|
Queens |
$76.10 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 |
|
|
|
|
MetroPlus Platinum (HMO) - H0423-004-0
Benefit Details
|
Queens |
$184.30 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd
| $6,700 Browse Formulary |
|
|
|
|
Aetna Medicare Connect Plus (PPO) - H5521-052-0
Benefit Details
|
Queens |
$188.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,500 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 |
EmblemHealth Advantage (PPO) - H5528-025-0
Benefit Details
|
Queens |
$223.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
EmblemHealth VIP High Option (HMO) - H3330-033-2
Benefit Details
|
Queens |
$306.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|