2014 Medicare Prescription Plans in Herkimer county New York



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2014 Medicare Part-D Plans in Herkimer county New York



(Click the Plan Name for More Details)
Plan Name Type Monthly Premium Deductible Gap Full LIS Plan Rating
Return to Counties In New York
AARP MedicareRx Enhanced (PDP)
(S5921-213)
Enhanced $101.00 $0 Some Generics, Some Brands No
AARP MedicareRx Preferred (PDP)
(S5805-001)
Enhanced $44.30 $0 No Gap Coverage No
AARP MedicareRx Saver Plus (PDP)
(S5921-379)
Basic $23.40 $310.00 No Gap Coverage Yes
Aetna CVS/pharmacy Prescription Drug Plan (PDP)
(S5810-037)
Basic $61.40 $310.00 No Gap Coverage No
Aetna Medicare Rx Premier (PDP)
(S5810-239)
Enhanced $144.40 $0 Few Generics No
BlueCross BlueShield Rx PDP (PDP)
(S3521-001)
Basic $50.90 $310.00 No Gap Coverage No
Cigna Medicare Rx Secure (PDP)
(S5617-013)
Basic $36.80 $310.00 No Gap Coverage Yes
Cigna Medicare Rx Secure-Max (PDP)
(S5617-229)
Enhanced $105.70 $0 Many Generics, Some Brands No
Cigna Medicare Rx Secure-Xtra (PDP)
(S5617-248)
Enhanced $53.30 $0 No Gap Coverage No
Cigna-HealthSpring Rx -Reg 3 (PDP)
(S5932-004)
Basic $37.90 $310.00 No Gap Coverage Yes
EmblemHealth Medicare Prescription Drug Plan (PDP)
(S5966-001)
Basic $50.00 $310.00 No Gap Coverage No
EnvisionRxPlus Silver (PDP)
(S7694-003)
Basic $41.40 $310.00 No Gap Coverage No
Express Scripts Medicare - Choice (PDP)
(S5983-006)
Enhanced $49.50 $0 No Gap Coverage No
Express Scripts Medicare - Value (PDP)
(S5983-004)
Basic $36.40 $310.00 No Gap Coverage Yes
First Health Part D Essentials (PDP)
(S5569-007)
Basic $43.10 $310.00 No Gap Coverage No
First Health Part D Premier Plus (PDP)
(S0197-005)
Enhanced $105.90 $0 Some Generics, Some Brands No
First Health Part D Value Plus (PDP)
(S5569-006)
Enhanced $52.30 $0 No Gap Coverage No
First United American - Enhanced (PDP)
(S5580-003)
Enhanced $67.60 $120.00 No Gap Coverage No
First United American - Select (PDP)
(S5580-006)
Basic $40.10 $310.00 No Gap Coverage No
Humana Enhanced (PDP)
(S5552-003)
Enhanced $52.50 $0 Few Brands No
Humana Preferred Rx Plan (PDP)
(S5552-004)
Basic $25.80 $310.00 No Gap Coverage Yes
Humana Walmart Rx Plan (PDP)
(S5552-005)
Enhanced $12.60 $310.00 No Gap Coverage No
MedicareRx Rewards Standard (PDP)
(S5960-109)
Basic $54.60 $310.00 No Gap Coverage No
SmartSaver Rx PDP (PDP)
(S1140-001)
Basic $42.90 $310.00 No Gap Coverage NoToo New
WellCare Classic (PDP)
(S5967-140)
Basic $29.00 $0 No Gap Coverage Yes
WellCare Extra (PDP)
(S5967-175)
Enhanced $50.60 $0 No Gap Coverage No


Medicare Advantage Plans in Herkimer county New York

Plan Name Type Premium C+D Part D
Deductible
Drug Benefit Type Gap Max Out of Pocket Overall Rating
ActiveSaver MSA (MSA)
(H9788-003)
MSA * NA
BasiCare with Part D (PPO)
(H9615-008)
Local PPO $27.00 $310.00 Basic No Gap Coverage $4,000
CDPHP Choice (HMO)
(H3388-001)
Local HMO * $24.00 $2,500
CDPHP Choice Rx (HMO)
(H3388-002)
Local HMO $81.00 $0 Enhanced Some Generics, Few Brands $2,500
CDPHP Classic (PPO)
(H5042-004)
Local PPO * $110.00 $3,400
CDPHP Classic Rx (PPO)
(H5042-001)
Local PPO $182.00 $0 Enhanced Some Generics, Few Brands $3,400
CDPHP Core Rx (PPO)
(H5042-005)
Local PPO $126.00 $0 Enhanced No Gap Coverage $3,400
CDPHP Prime Rx (PPO)
(H5042-007)
Local PPO $256.00 $0 Enhanced Some Generics, Few Brands $3,400
CDPHP Value Rx (HMO)
(H3388-004)
Local HMO $32.00 $0 Enhanced No Gap Coverage $3,300
Fidelis Medicare $0 Premium (HMO)
(H3328-019)
Local HMO $0 $0 Basic No Gap Coverage $6,700
Fidelis Medicare Advantage Flex (HMO-POS)
(H3328-003)
Local HMO $37.20 $240.00 Basic No Gap Coverage $6,700
Fidelis Medicare Advantage without Rx (HMO-POS)
(H3328-001)
Local HMO * $0 $6,700
GoldAnywhere with Part D - Option 1 (PPO)
(H9615-002)
Local PPO $238.00 $0 Enhanced Few Generics $2,000
GoldAnywhere with Part D - Option 2 (PPO)
(H9615-007)
Local PPO $64.00 $0 Enhanced Few Generics $4,000
GoldValue with Part D (HMO-POS)
(H9859-013)
Local HMO $59.50 $0 Enhanced Few Generics $6,000
HumanaChoice H5970-002 (PPO)
(H5970-002)
Local PPO $31.00 $0 Enhanced Few Generics, Few Brands $6,700
HumanaChoice H5970-004 (PPO)
(H5970-004)
Local PPO $152.00 $200.00 Enhanced Few Generics, Few Brands $6,700
Medicare BlueBasic PPO (PPO)
(H3335-041)
Local PPO * $40.00 $4,800
Medicare BlueClassic PPO (PPO)
(H3335-051)
Local PPO $0 $0 Enhanced No Gap Coverage $5,000
Medicare BlueEnhanced PPO (PPO)
(H3335-006)
Local PPO $85.00 $0 Enhanced No Gap Coverage $4,000
Medicare BlueSecure PPO (PPO)
(H3335-005)
Local PPO $45.00 $0 Enhanced No Gap Coverage $4,500
Preferred Gold with Part D (HMO-POS)
(H9859-002)
Local HMO $117.00 $0 Enhanced Few Generics $4,500
Preferred Gold without Part D (HMO-POS)
(H9859-001)
Local HMO * $18.40 $4,500
Today's Options Premier 100 (PFFS)
(H2816-001)
PFFS * $40.00 N/A
Today's Options Premier 400 (PFFS)
(H2816-007)
PFFS * $0 $4,400
Today's Options Premier Plus 350A (PFFS)
(H2816-013)
PFFS $92.00 $0 Enhanced No Gap Coverage N/A
Today's Options Premier Plus 850B (PFFS)
(H2816-019)
PFFS $37.00 $0 Enhanced No Gap Coverage N/A
UnitedHealthcare MedicareComplete Choice (Regional PPO)
(R5342-001)
Regional PPO $0 $0 Enhanced No Gap Coverage $5,200
UnitedHealthcare MedicareComplete Choice Essential (Regiona
(R5342-002)
Regional PPO * $0 $5,200


Medicare Special Needs Plans in Herkimer county New York

Plan Name Type Consolidated Premium C+D Part D
Deductible
Gap Special Needs Type Overall Rating
Fidelis Dual Advantage (HMO SNP)
(H3328- 002)
Local HMO $37.20 $310.00 No Gap Coverage Dual-Eligible
Fidelis Dual Advantage Flex (HMO SNP)
(H3328- 017)
Local HMO $37.20 $310.00 Some Generics Dual-Eligible
Fidelis Long Term Care Advantage (HMO SNP)
(H3328- 018)
Local HMO $44.50 $310.00 No Gap Coverage Institutional


Source: CMS.

Plans as of September 3, 2013.

Plans are subject to change as contracts are finalized.

Includes 2014 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.



Plan Type Is the type of organization offering the Medicare Plans.

  • HMO - Health Maintenance Organization
  • PPO - Preferred Provider Organization
  • PDP - Prescrition Drug Plan
  • SNP - Special Needs Plan
  • POS - Point of Service
  • PFFS - Private Fee For Service

* Plan Type Indicates plan does not offer Part D drug coverage.

Monthly Consolidated Premium (Includes Part C + D) Your premium may be lower depending on your eligibility for medical assistance. Call your plan for details.

Part D Total Premium: The Part D Total Premium is the sum of the Basic and Supplemental Premiums. Note: the Part D Total Premium is net of any Part A/B rebates applied to "buy down" the drug premium for Medicare Advantage plans; for some plans the total premium may be lower than the sum of the basic and supplemental premiums due to negative basic or supplemental premiums.

Benefit Type

Enhanced Alternative plans may offer additional gap coverage which is calculated as the percentage of “generic” formulary products with coverage above standard "generic" coverage gap cost-sharing benefit and/or the percentage of “brand” formulary products covered in addition to the coverage gap discount for applicable drugs.

GAP

Coverage gap ("donut hole"). This means there's a temporary limit on what the drug plan will cover for drugs. (Unless you get the low-income subsidy) Once you reach the coverage gap in 2014, you will pay 47.5% of the plan's cost for covered brand-name prescription drugs. You get these savings if you buy your prescriptions at a pharmacy or order them through the mail.

Additional gap coverage levels are determined separately for formulary generic and brand products and are described as follows:

  • All: 100% of formulary drugs are covered through the gap
  • Many: 65% to 100% of formulary drugs are covered through the gap
  • Some: 10% to 65 % of formulary drugs are covered through the gap
  • Few: 0% to 10% of formulary drugs are covered through the gap (and must also be >15 "brand" products covered through the gap)
  • No Gap Coverage: 0% of formulary drugs are covered through the gap (or 15 "brand" products covered through the gap)
  • All Formulary Drugs: cover 100% of “generic” and 100% of “brand” products (either by covering all formulary drug products in the gap or by having no initial coverage limit)

Maximum Out-of-Pocket (MOOP) limit on enrollee spending that includes costs for all in-network Part A and Part B Services. NOT Part D - prescription drugs. N/A is defined as Not Applicable