AARP Medicare Advantage Patriot No Rx NY-MA01 (HMO-POS) - H3307-018-0
Benefits & Contact Info
|
Westchester |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Aetna Medicare Eagle Plan (PPO) - H5521-320-0
Benefits & Contact Info
|
Westchester |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $8,500 |
|
|
|
|
Anthem Veteran (HMO) - H8432-037-1
Benefits & Contact Info
|
Westchester |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $8,300 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Cigna True Choice Courage Medicare (PPO) - H7849-086-0
Benefits & Contact Info
|
Westchester |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Humana USAA Honor (PPO) - H5970-016-0
Benefits & Contact Info
|
Westchester |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
MVP Medicare Preferred Gold without Part D (HMO-POS) - H3305-020-0
Benefits & Contact Info
|
Westchester |
$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 |
UHC Medicare Advantage Patriot No Rx NY-MA02 (Regional PPO) - R5342-002-0
Benefits & Contact Info
|
Westchester |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Wellcare Patriot No Premium (HMO) - H4868-003-0
Benefits & Contact Info
|
Westchester |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
-- |
|
|
AARP Medicare Advantage from UHC NY-0002 (HMO-POS) - H3307-012-0
Benefits & Contact Info
|
Westchester |
$0.00 |
$395 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: 27%
all covered insulin pay $35 or less | $7,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
AARP Medicare Advantage from UHC NY-0013 (PPO) - H3418-002-0
Benefits & Contact Info
|
Westchester |
$0.00 |
$395 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: 27%
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
|
Aetna Medicare Elite Plan (PPO) - H5521-120-0
Benefits & Contact Info
|
Westchester |
$0.00 |
$300 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Value Select Plan (HMO) - H3312-074-0
Benefits & Contact Info
|
Westchester |
$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 |
Cigna True Choice Medicare (PPO) - H7849-083-0
Benefits & Contact Info
|
Westchester |
$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 | $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Elderplan Flex (HMO-POS) - H3347-016-0
Benefits & Contact Info
|
Westchester |
$0.00 |
$375 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
|
Elderplan Select (HMO-POS I-SNP) - H3347-018-0
Benefits & Contact Info
|
Westchester |
$0.00 |
$545 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: 25% Specialty Tier: 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 |
Healthfirst Signature (HMO) - H1722-002-0
Benefits & Contact Info
|
Westchester |
$0.00 |
$250 Tier 1, 2, 3 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Supplemental Drugs: $5.00
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
-- |
|
|
Healthfirst Signature (PPO) - H9678-001-0
Benefits & Contact Info
|
Westchester |
$0.00 |
$250 Tier 1, 2, 3 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Supplemental Drugs: $5.00
all covered insulin pay $35 or less | $5,000 Browse Formulary |
|
new |
new |
|
HumanaChoice Partnered H5970-027 (PPO) - H5970-027-0
Benefits & Contact Info
|
Westchester |
$0.00 |
$395 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: 27%
all covered insulin pay $35 or less | $7,850 Browse Formulary |
|
|
|
|
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 with Part D (PPO) - H9615-010-0
Benefits & Contact Info
|
Westchester |
$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 |
|
|
|
|
PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan) - H9869-001-0
Benefits & Contact Info
|
Westchester |
$0.00 |
$0 |
Yes, some additional gap coverage. | Tier 1: 0% Tier 2: 0% Tier 3: 0%
all covered insulin pay $35 or less | n/a Browse Formulary |
-- |
-- |
-- |
|
Wellcare Fidelis No Premium (HMO) - H5599-004-0
Benefits & Contact Info
|
Westchester |
$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
|
Westchester |
$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 (HMO) - H4868-019-0
Benefits & Contact Info
|
Westchester |
$0.00 |
$425 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 47% Specialty Tier: 26% 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
|
Westchester |
$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:
|
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) - H5521-384-0
Benefits & Contact Info
|
Westchester |
$18.00 |
$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:
|
Wellcare Assist Open (PPO) - H2775-113-0
Benefits & Contact Info
|
Westchester |
$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:
|
UHC Nursing Home Plan NY-F003 (HMO I-SNP) - H3379-002-0
Benefits & Contact Info
|
Westchester |
$22.20 |
$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 |
EmblemHealth VIP Dual (HMO D-SNP) - H5991-012-2
Benefits & Contact Info
|
Westchester |
$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: $5.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25% Select Care Drugs: $5.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
VNS Health EasyCare (HMO) - H5549-012-0
Benefits & Contact Info
|
Westchester |
$25.00 |
$145 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $15.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
Senior Whole Health of New York NHC (HMO D-SNP) - H5992-007-0
Benefits & Contact Info
|
Westchester |
$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 |
|
-- |
-- |
|
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-F002 (PPO I-SNP) - H2292-002-0
Benefits & Contact Info
|
Westchester |
$26.10 |
$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 |
|
-- |
|
|
Senior Whole Health Medicare Complete Care (HMO D-SNP) - H5992-009-1
Benefits & Contact Info
|
Westchester |
$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 |
|
-- |
-- |
|
Longevity Health Plan (HMO I-SNP) - H8457-001-0
Benefits & Contact Info
|
Westchester |
$26.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Wellcare Fidelis Assist (HMO-POS) - H5599-002-0
Benefits & Contact Info
|
Westchester |
$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:
|
UHC Medicare Advantage NY-0020 (Regional PPO) - R5342-001-0
Benefits & Contact Info
|
Westchester |
$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 |
|
|
|
|
Wellcare Dual Access (HMO D-SNP) - H4868-004-0
Benefits & Contact Info
|
Westchester |
$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 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Cigna True Choice Plus Medicare (PPO) - H7849-127-0
Benefits & Contact Info
|
Westchester |
$32.00 |
$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 | $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) - H3347-002-0
Benefits & Contact Info
|
Westchester |
$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 |
|
|
|
|
Elderplan Assist (HMO-POS I-SNP) - H3347-015-0
Benefits & Contact Info
|
Westchester |
$34.50 |
$545 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: 25% Specialty Tier: 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 |
MVP DualAccess Plus (HMO D-SNP) - H3305-035-0
Sanctioned Plan
|
Westchester |
$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
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Elderplan Extra Help (HMO-POS) - H3347-009-0
Benefits & Contact Info
|
Westchester |
$34.70 |
$545 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
|
UHC Care Advantage NY-E001 (PPO I-SNP) - H2292-003-0
Benefits & Contact Info
|
Westchester |
$35.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
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 |
MVP DualAccess Complete (HMO D-SNP) - H3305-034-0
Benefits & Contact Info
|
Westchester |
$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 DualAccess (HMO D-SNP) - H3305-033-0
Benefits & Contact Info
|
Westchester |
$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 |
|
|
|
|
Anthem Select (HMO) - H8432-016-0
Benefits & Contact Info
|
Westchester |
$38.00 |
$200 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice Partnered H5970-025 (PPO) - H5970-025-0
Benefits & Contact Info
|
Westchester |
$38.00 |
$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 | $6,700 Browse Formulary |
|
|
|
|
Aetna Medicare Value Plan (HMO) - H3312-018-0
Benefits & Contact Info
|
Westchester |
$39.00 |
$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:
|
Healthfirst Increased Benefits Plan (HMO) - H3359-019-0
Benefits & Contact Info
|
Westchester |
$39.20 |
$545 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: 50% Specialty Tier: 25% Supplemental Drugs: $5.00
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
MVP Medicare Secure with Part D (HMO-POS) - H3305-032-0
Benefits & Contact Info
|
Westchester |
$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 |
|
|
|
|
Humana Gold Plus SNP-DE H3533-002 (HMO D-SNP) - H3533-002-0
Benefits & Contact Info
|
Westchester |
$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
|
Westchester |
$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 Choice (HMO D-SNP) - H0034-002-0
Benefits & Contact Info
|
Westchester |
$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 |
|
-- |
|
|
Hamaspik Medicare Select (HMO D-SNP) - H0034-001-0
Benefits & Contact Info
|
Westchester |
$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
|
Westchester |
$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 |
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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-Q001 (HMO-POS D-SNP) - H3387-015-1
Benefits & Contact Info
|
Westchester |
$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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Healthfirst Life Improvement Plan (HMO D-SNP) - H3359-021-0
Benefits & Contact Info
|
Westchester |
$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: $5.00 Generic: $20.00 Preferred Brand: 16% Non-Preferred Drug: 50% Specialty Tier: 25% Supplemental Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Wellcare Fidelis Dual Access (HMO D-SNP) - H5599-001-0
Benefits & Contact Info
|
Westchester |
$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 |
Healthfirst CompleteCare (HMO D-SNP) - H3359-034-0
Benefits & Contact Info
|
Westchester |
$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: 19% Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) - H3347-003-0
Benefits & Contact Info
|
Westchester |
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Healthfirst Connection Plan (HMO D-SNP) - H3359-038-0
Benefits & Contact Info
|
Westchester |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 44% Specialty Tier: 25%
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 |
Aetna Medicare Assure Plan (HMO D-SNP) - H3312-069-0
Benefits & Contact Info
|
Westchester |
$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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Anthem Full Dual Advantage (HMO D-SNP) - H8432-007-0
Benefits & Contact Info
|
Westchester |
$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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Anthem Full Dual Advantage Select (HMO D-SNP) - H8432-028-0
Benefits & Contact Info
|
Westchester |
$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 |
Anthem HealthPlus Full Dual Advantage (HMO D-SNP) - H1732-003-0
Benefits & Contact Info
|
Westchester |
$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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-- |
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Anthem HealthPlus Full Dual Advantage LTSS (HMO D-SNP) - H1732-001-0
Benefits & Contact Info
|
Westchester |
$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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Centers Plan for Medicaid Advantage Plus (HMO D-SNP) - H6988-004-0
Benefits & Contact Info
|
Westchester |
$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 |
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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 |
Centers Plan for Nursing Home Care (HMO I-SNP) - H6988-003-0
Benefits & Contact Info
|
Westchester |
$48.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Elderplan Plus Long Term Care (HMO-POS D-SNP) - H3347-007-0
Benefits & Contact Info
|
Westchester |
$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 |
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RiverSpring MAP (HMO D-SNP) - H6776-002-0
Benefits & Contact Info
|
Westchester |
$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 |
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-- |
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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 |
RiverSpring Star (HMO I-SNP) - H6776-001-0
Benefits & Contact Info
|
Westchester |
$48.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
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UHC Dual Complete NY-S001 (PPO D-SNP) - H0271-060-1
Benefits & Contact Info
|
Westchester |
$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
|
Westchester |
$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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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
VillageCareMAX Medicare Health Advantage FLEX Plan (HMO D-SNP) - H2168-003-0
Benefits & Contact Info
|
Westchester |
$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: $5.00 Generic: $11.00 Preferred Brand: 19% Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) - H2168-001-0
Benefits & Contact Info
|
Westchester |
$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: $5.00 Generic: $11.00 Preferred Brand: 21% Non-Preferred Drug: 37% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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VillageCareMAX Medicare Select Advantage Plan (HMO) - H2168-004-0
Benefits & Contact Info
|
Westchester |
$48.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Generic: $11.00 Preferred Brand: 23% Non-Preferred Drug: 33% Specialty Tier: 25%
all covered insulin pay $35 or less | $8,300 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 |
VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) - H2168-002-0
Benefits & Contact Info
|
Westchester |
$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: $6.00 Generic: $12.00 Preferred Brand: 24% Non-Preferred Drug: 33% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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VNS Health EasyCare Plus (HMO D-SNP) - H5549-011-0
Benefits & Contact Info
|
Westchester |
$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 |
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VNS Health Total (HMO D-SNP) - H5549-003-0
Benefits & Contact Info
|
Westchester |
$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 Dual Access Open (PPO D-SNP) - H2775-112-0
Benefits & Contact Info
|
Westchester |
$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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Wellcare Fidelis Dual Plus (HMO D-SNP) - H5599-003-0
Benefits & Contact Info
|
Westchester |
$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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|
|
Aetna Medicare Premier Plan (PPO) - H5521-121-0
Benefits & Contact Info
|
Westchester |
$49.00 |
$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 |
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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 |
Anthem Medicare Advantage (HMO) - H8432-009-0
Benefits & Contact Info
|
Westchester |
$55.00 |
$325 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 28%
all covered insulin pay $35 or less | $6,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
UHC Medicare Advantage NY-0021 (Regional PPO) - R5342-005-0
Benefits & Contact Info
|
Westchester |
$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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|
|
AARP Medicare Advantage from UHC NY-0004 (HMO-POS) - H3307-023-0
Benefits & Contact Info
|
Westchester |
$73.00 |
$345 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 | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UHC Medicare Advantage NY-0022 (Regional PPO) - R5342-006-0
Benefits & Contact Info
|
Westchester |
$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 |
|
|
|
|
MVP Medicare Secure Plus with Part D (HMO-POS) - H3305-022-0
Benefits & Contact Info
|
Westchester |
$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 |
|
|
|
|
Wellcare Premium Ultra Open (PPO) - H2775-105-0
Benefits & Contact Info
|
Westchester |
$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 |
|
|
|
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 Preferred Gold with Part D (HMO-POS) - H3305-021-0
Benefits & Contact Info
|
Westchester |
$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 |
|
|
|
|
Aetna Medicare Platinum Plan (PPO) - H5521-460-0
Benefits & Contact Info
|
Westchester |
$171.00 |
$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 |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
EmblemHealth VIP Gold (HMO) - H3330-021-3
Benefits & Contact Info
|
Westchester |
$219.00 |
$200 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 29% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $8,850 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 VIP Gold Plus (HMO) - H3330-038-0
Benefits & Contact Info
|
Westchester |
$241.00 |
$200 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 29% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|