2022 Herkimer County New York
Medicare Advantage Plans
There are 48 Medicare Advantage Plans available in Herkimer County NY from 8 different health insurance providers. 12 of these Medicare Advantage plans offer additional gap coverage. The plan with the lowest out of pocket expense is $3400 and the highest out of pocket is $7550. Herkimer County New York residents can also pick from 8 Medicare Special Needs Plans. The best Medicare Advantage plan in Herkimer County New York received a 5 overall star rating from CMS and the lowest rated plan is 3.5 stars.
(Click the Plan Name for More Details)
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Medicare Advantage Health Plans Without Drug Coverage
|Plan Name ⇅||Premium||Type||MOOP||Overall
|Aetna Medicare Eagle Plan (PPO)
|$0||Local PPO *||$7,550|
|CDPHP Choice (HMO)
|$39.90||Local HMO *||$5,000|
|CDPHP Flex (PPO)
|$0||Local PPO *||$5,500|
|Humana Honor (PPO)
|$0||Local PPO *||$4,500|
|Medicare BlueBasic (PPO)
|$0||Local PPO *||$4,500|
|MVP Medicare Preferred Gold without Part D (HMO-POS)
|$62.00||Local HMO *||$7,550|
|MVP SmartFund (MSA)
|UnitedHealthcare Medicare Advantage Patriot (Regional PPO
|$0||Regional PPO *||$6,700|
|Wellcare Advantage No Premium (PFFS)
|Wellcare Advantage Premium Enhanced (PFFS)
|Wellcare Fidelis Patriot No Premium (HMO-POS)
|$0||Local HMO *||$7,550|
2022 Medicare Special Needs Plans in Herkimer county New York
|Plan Name ⇅||Monthly
|Aetna Medicare Assure Plan (HMO D-SNP)||$23.80||$425.0||No Gap Coverage||Dual-Eligible|
|Humana Gold Plus SNP-DE H3533-002 (HMO D-SNP)||$30.10||$460.0||No Gap Coverage||Dual-Eligible|
|HumanaChoice SNP-DE H5970-020 (PPO D-SNP)||$19.40||$480.0||No Gap Coverage||Dual-Eligible|
|UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP)||$42.40||$480.0||No Gap Coverage||Dual-Eligible|
|UnitedHealthcare Dual Complete Plan 2 (HMO D-SNP)||$37.40||$480.0||No Gap Coverage||Dual-Eligible|
|UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)||$42.40||$480.0||No Gap Coverage||Institutional|
|Wellcare Dual Access Open (PPO D-SNP)||$37.30||$480.0||No Gap Coverage||Dual-Eligible|
|Wellcare Fidelis Dual Access (HMO D-SNP)||$20.00||$480.0||No Gap Coverage||Dual-Eligible|
Plan Type Is the type of organization offering the Medicare Plan.
- 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
- Many - Many Generics and Some Brands
- Some - Some Generics and Few Brands
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
Data as of September 1, 2021.
Plans are subject to change as contracts are finalized.
Includes 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded. For 2022, 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.