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The 2019 Medicare Advantage Plans in Orange County NY.

2018 Medicare Advantage Plans in Orange County New York

There are 28 Medicare Advantage Plans available in Orange County NY from 9 different health insurance providers. 7 of these Medicare Advantage plans offer additional gap coverage. The plan with the lowest out of pocket expense is $4500 and the highest out of pocket is $6700. The highest rated plan available in Orange County received a 4.5 overall star rating from CMS and the lowest rated plan is 2.5 stars. Orange County New York residents can also pick from 10 Medicare Special Needs Plans.

(Click the Plan Name for More Details)

Name Premium
Part D
 Gap  MOOP Overall Rating Formulary Sign Up
Aetna Medicare Elite Plan (PPO)
$31.00 $150.00 Yes $6,700 FormularyEnroll
Aetna Medicare Premier Plan (PPO)
$66.00 $150.00 Yes $6,700 FormularyEnroll
Aetna Medicare Value Plan (HMO)
$26.00 $200.00 Yes $6,700 FormularyEnroll
Affinity Medicare Passport Essentials (HMO)
$0.00 $250.00 Yes $5,400 FormularyEnroll
BasiCare with Part D (PPO)
$0.00 $325.00 No $6,700 Formulary
EmblemHealth VIP Essential (HMO)
$59.00 $250.00 No $6,700 FormularyEnroll
EmblemHealth VIP Gold (HMO)
$237.00 $200.00 No $6,700 FormularyEnroll
EmblemHealth VIP Gold Plus (HMO)
$297.00 $200.00 No $6,700 Formulary
EmblemHealth VIP Value (HMO)
$0.00 $250.00 No $6,700 FormularyEnroll
Empire MediBlue Select (HMO)
$36.00 $325.00 No $6,700 Formulary
Fidelis Medicare $0 Premium (HMO)
$0.00 $0.00 No $6,700 Formulary
Fidelis Medicare Advantage without Rx (HMO-POS)
$0.00 $6,700
Gold PPO with Part D (PPO)
$133.00 $0.00 Yes $6,700 Formulary
GoldValue with Part D (HMO-POS)
$108.00 $0.00 Yes $6,700 FormularyEnroll
Preferred Gold with Part D (HMO-POS)
$172.20 $0.00 Yes $6,700 FormularyEnroll
Preferred Gold without Part D (HMO-POS)
$59.20 $6,700 Enroll
SmartFund (MSA)
Today's Options Advantage Plus 450A (PPO)
$106.00 $0.00 No $5,000 FormularyEnroll
Today's Options Advantage Plus 750B (PPO)
$56.00 $0.00 No $6,700 FormularyEnroll
WellCare Advance (HMO)
$0.00 $6,700 Enroll
WellCare Value (HMO)
$59.00 $0.00 No $5,000 Formulary
Return to 2018 Medicare Advantage Plans in New York

* Plan Type does not offer Medicare Part D drug coverage.

2018 Medicare Special Needs Plans in Orange county New York

Plan Name Monthly
Premium C+D
Part D
 Gap  Special Needs
Overall Rating
Affinity Medicare Solutions (HMO SNP)
(H5991- 002)
   $39.00 $405.00  No Dual-Eligible
Affinity Medicare Ultimate (HMO SNP)
(H5991- 001)
   $39.00 $405.00  No Dual-Eligible
ArchCare Advantage (HMO SNP)
(H1777- 007)
   $39.00 $405.00  No Institutional
EmblemHealth VIP Dual (HMO SNP)
(H3330- 037)
   $39.00 $405.00  No Dual-Eligible
Empire MediBlue Dual Advantage (HMO SNP)
(H8432- 007)
   $39.00 $405.00  Yes Dual-Eligible
Fidelis Dual Advantage Flex (HMO SNP)
(H3328- 017)
   $38.40 $405.00  No Dual-Eligible
WellCare Access (HMO SNP)
(H3361- 065)
   $25.80 $405.00  No Dual-Eligible
WellCare Liberty (HMO SNP)
(H3361- 043)
   $20.40 $405.00  No Dual-Eligible

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 provider 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; 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
  • (EA) Enhanced Alternative 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.
  • (DS) Defined Standard Benefit
  • (BA) Basic Alternative
  • (AE) Actuarially Equivalent Standard


In 2018 once you and your plan provider have spent $3750 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 35% of the plans cost for covered brand-name prescription drugs and 44% on generic drugs unless your plan offers additional coverage.

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

Source: CMS.

Data as of September 5, 2017.

Plans are subject to change as contracts are finalized.

Includes 2018 approved contracts. Employer sponsored 800 series and plans under sanction are excluded. For 2018, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.

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