2015 Medicare Advantage Plans in Suffolk County New York


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2015 Medicare Advantage Plans in Suffolk County New York

There are 25 Medicare Advantage Plans available in Suffolk County NY from 13 health insurance providers and 23 Special Needs Plans available. 7 Advantage plans offer additional gap coverage. The plan with the lowest out of pocket expense is $3400 and the highest out of pocket is $6700. The highest rated plan available in Suffolk County received a 3.5 overall star rating from CMS and the lowest rated plan is 2.5 stars.

(Click the Plan Name for More Details)

Plan Name Type Premium
C+D
Part D
Deductible
 Gap  Max Out of
Pocket
Overall Rating Formulary
Return to Counties In New York
ActiveSaver MSA (MSA)
(H9788-004)
MSA * N/A NA
Advantage Platinum Plus NY (HMO)
(H2773-015)
Local HMO $49.00 $0.00 Yes $3,400 NABrowse
Formulary
Advantage Silver - NY (HMO)
(H2773-019)
Local HMO $0.00 $0.00 No $3,400 NABrowse
Formulary
Affinity Medicare Passport Elite (HMO)
(H5991-005)
Local HMO $126.00 $0.00 Yes $3,400 Browse
Formulary
Affinity Medicare Passport Essentials (HMO)
(H5991-003)
Local HMO $0.00 $0.00 Yes $5,800 Browse
Formulary
Affinity Medicare Passport Select (HMO)
(H5991-004)
Local HMO $46.00 $0.00 Yes $5,000 Browse
Formulary
Elderplan Classic: Zero Premium (HMO)
(H3347-005)
Local HMO $0.00 $320.00 No $6,700 Browse
Formulary
Elderplan Extra Help (HMO)
(H3347-009)
Local HMO $36.90 $320.00 No $6,700 Browse
Formulary
EmblemHealth Advantage (PPO)
(H5528-026)
Local PPO $199.00 $0.00 No $6,700 Browse
Formulary
EmblemHealth Essential (HMO)
(H3330-032)
Local HMO $122.00 $0.00 No $6,700 Browse
Formulary
EmblemHealth PPO I (PPO)
(H5528-009)
Local PPO * $87.00 $6,700
EmblemHealth VIP (HMO)
(H3330-021)
Local HMO $173.00 $0.00 No $6,700 Browse
Formulary
EmblemHealth VIP High Option (HMO)
(H3330-033)
Local HMO $328.00 $0.00 No $6,700 Browse
Formulary
Empire MediBlue Freedom I (PPO)
(H3342-019)
Local PPO $71.00 $304.00 No $4,500 Browse
Formulary
Empire MediBlue Plus (HMO)
(H3370-032)
Local HMO $80.00 $315.00 No $5,200 Browse
Formulary
Fidelis Medicare Advantage Flex (HMO-POS)
(H3328-003)
Local HMO $36.90 $240.00 No $6,700 Browse
Formulary
Fidelis Medicare Advantage without Rx (HMO-POS)
(H3328-001)
Local HMO * $0.00 $6,700
Humana Gold Plus H3533-010 (HMO)
(H3533-010)
Local HMO $33.00 $320.00 Yes $6,700 NABrowse
Formulary
Humana Gold Plus H3533-019 (HMO)
(H3533-019)
Local HMO $163.00 $320.00 Yes $3,400 NABrowse
Formulary
LiveWell (HMO)
(H4922-001)
Local HMO $32.90 $250.00 Yes $6,700 Too NewBrowse
Formulary
UnitedHealthcare MedicareComplete Choice (Regional PPO)
(R5342-001)
Regional PPO $0.00 $225.00 No $6,700 Browse
Formulary
UnitedHealthcare MedicareComplete Choice Essential (Regio
(R5342-002)
Regional PPO * $0.00 $6,700
VNSNY CHOICE Medicare Classic (HMO)
(H5549-008)
Local HMO $34.10 $320.00 No $6,700 Browse
Formulary
VNSNY CHOICE Medicare Enhanced (HMO)
(H5549-004)
Local HMO $0.00 $0.00 No $6,700 Browse
Formulary
WellCare Choice (HMO)
(H3361-132)
Local HMO $0.00 $0.00 No $6,700 Browse
Formulary

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



Medicare Special Needs Plans in Suffolk county New York

Plan Name Consolidated
Premium C+D
Part D
Deductible
 Gap  Special Needs
Type
Overall Rating Formulary
Advantage Health NY - SNP (HMO SNP)
(H2773- 003)
   $0.00 $0.00  No Chronic or Disabling ConditionNABrowse
Formulary
Advantage Value One NY - Dual (HMO SNP)
(H2773- 018)
   $36.90 $0.00  Yes Dual-EligibleNABrowse
Formulary
Affinity Medicare Solutions (HMO SNP)
(H5991- 002)
   $36.90 $320.00  No Dual-EligibleBrowse
Formulary
Affinity Medicare Ultimate (HMO SNP)
(H5991- 001)
   $36.90 $320.00  No Dual-EligibleBrowse
Formulary
BeWell (HMO SNP)
(H4922- 002)
   $36.90 $320.00  No Dual-EligibleToo NewBrowse
Formulary
CareWell (HMO SNP)
(H4922- 004)
   $36.90 $320.00  No InstitutionalToo NewBrowse
Formulary
CenterLight Healthcare Direct Complete Plan (HMO SNP)
(H5989- 002)
   $36.90 $320.00  No InstitutionalNABrowse
Formulary
Elderplan Advantage For Nursing Home Residents (HMO SNP)
(H3347- 003)
   $36.90 $320.00  No InstitutionalBrowse
Formulary
Elderplan Diabetes Care (HMO SNP)
(H3347- 012)
   $0.00 $320.00  No Chronic or Disabling ConditionBrowse
Formulary
Elderplan For Medicaid Beneficiaries (HMO SNP)
(H3347- 002)
   $36.90 $320.00  No Dual-EligibleBrowse
Formulary
Elderplan Plus Long Term Care (HMO SNP)
(H3347- 007)
   $36.90 $320.00  No Dual-EligibleBrowse
Formulary
EmblemHealth Dual Eligible (HMO SNP)
(H3330- 029)
   $36.90 $320.00  No Dual-EligibleBrowse
Formulary
EmblemHealth Dual Eligible (PPO SNP)
(H5528- 018)
   $36.90 $320.00  No Dual-EligibleBrowse
Formulary
EmblemHealth MLTC PLUS (HMO SNP)
(H3330- 035)
   $36.90 $320.00  No Dual-EligibleBrowse
Formulary
FeelWell (HMO SNP)
(H4922- 003)
   $36.90 $320.00  No Dual-EligibleToo NewBrowse
Formulary
Fidelis Dual Advantage Flex (HMO SNP)
(H3328- 017)
   $35.40 $320.00  Yes Dual-EligibleBrowse
Formulary
Fidelis Long Term Care Advantage (HMO SNP)
(H3328- 018)
   $3.00 $320.00  No InstitutionalBrowse
Formulary
GuildNet Gold (HMO-POS SNP)
(H6864- 001)
   $36.90 $320.00  No Dual-EligibleNABrowse
Formulary
UnitedHealthcare Nursing Home Plan (HMO SNP)
(H3379- 002)
   $30.30 $320.00  No InstitutionalBrowse
Formulary
VNSNY CHOICE Medicare Maximum (HMO SNP)
(H5549- 006)
   $36.90 $320.00  No Dual-EligibleBrowse
Formulary
VNSNY CHOICE Medicare Preferred (HMO SNP)
(H5549- 002)
   $36.30 $320.00  No Dual-EligibleBrowse
Formulary
VNSNY CHOICE Total (HMO SNP)
(H5549- 003)
   $36.90 $320.00  No Dual-EligibleBrowse
Formulary
WellCare Access (HMO SNP)
(H3361- 109)
   $36.90 $320.00  No Dual-EligibleBrowse
Formulary


Source: CMS.

Plans as of September 2, 2014.

Plans are subject to change as contracts are finalized.

Includes 2015 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded. For 2015, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.



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

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

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

In 2015 once you and your plan provider have spent $2,960 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") Once you reach the coverage gap you will pay 45% of the plan's cost for covered brand-name prescription drugs unless your plan offers additional coverage. You will still receive a 55% discount on brand-name drugs and a 35% discount on generic drugs.

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

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