2022 Medicare Advantage With Prescription Drug Coverage (MAPD) In-Network with UVM/CVPH Clinton County, NY

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MAPD's: Preventive Services In-Network $0      
Chemotherapy & Medicare Part B Drugs 20%
Durable Medical Equipment/Oxygen 20%                          PLAN NAME 
Monthly Plan Premium Monthly Premium with (LIS) Extra Help Annual Drug Tier 3-5 Deductible $0 with Extra Help Copay & Coinsurance - Cost for IN-NETWORK Providers - Prior Authorization and Limits may apply General Information only
Doctor Primary/ Specialist Therapy
PT, OT & ST  
Lab Services Diagnostic Tests & Procedures Diagnostic Radiology (like MRI) Outpatient Therapy Mental Health Group / Individual Hospital Outpatient Hospital
Inpatient
Skilled
Nursing
Facility 
$0 days 1-20
Maximum Out of Pocket Spending Limit
Aetna Medicare Credit Plan (PPO) $0 $0 $350 $15/$45 $40 $10 $45 $450 $40/$40 $45-395 $395/day 1-5 $188/day 21-100 $7,550
Aetna Medicare Discover Value Plan (PPO) $25 $0 $300 $0/$30 $40 $0 $30 $225 $40/$40 $30-325 $325/day 1-6 $188/day 21-100 $7,550
Aetna Medicare Premier Plan (PPO) $0 $0 $250 $0/$35 $35 $0 $35 $200 $35/$35 $35-335 $335/day 1-6 $188/day 21-100 $7,550
Aetna Medicare Value Plan (HMO) $0 $0 $0 $0/$25 $30 $0 $25 $200 $30/$30 $25-325 $300/day 1-6 $188/day 21-100 $7,550
CDPHP $0 Medicare Rx (HMO) 5* $0 $0 $300 $0-40 $40 0-20% 20% $195 $40/$40 $365 $360/day 1-5 $184/day 21-100 $7,500
CDPHP Basic RX (HMO) 5* $31 $0 $0 $0-45 $40 $0-45 $45 $140 $40/$40 $330 $335/day 1-6 $150/day 21-100 $6,700
CDPHP Choice Rx (HMO) 5* $131 $88 $0 $0-30 $30 $0-30 $30 $100 $30/$30 $200 $260/day 1-6 $120/day 21-100 $5,000
CDPHP Flex Rx (PPO) 5* $42 $8 $0 $0-40 $40 $0-40 $40 $135 $40/$40 $325 $310/day 1-6 $145/day 21-100 $5,500
CDPHP Value Rx (HMO) 5* $60.80 $23.00 $0 $0-35 $35 $0-35 $35 $130 $35/$35 $300 $295/day 1-6 $140/day 21-100 $5,800
CDPHP Vital Rx (PPO) 5* $0 $0 $350 $0-50 $40 $0-20% 20% $220 $40/$40 $395 $460/day 1-4 $184.day 21-100 $7,500
Empire MediBlue Access (PPO) $90 $50.10 $310 $10/$50 $40 $0-20 $0-80 $50-150 $40/$40 20% $372/day 1-5 $188/day 21-100 $6,200
Empire MediBlue Plus (HMO) $42 $3.30 $325 $0/$40 $40 $0 $0-$60 $80-100 $40/$40 $0-300 $325/day 1-5 $188/day 21/100 $5,000
Excellus- Medicare BluePlus (PPO) $116 $73.60 $480 All Tiers $5/$50 $40 $20 $20 20% 20%/20% 20% $360/day 1-5 $188/day 21-100 $6,000
MVP Medicare Secure Plus with Part D (HMO-POS) $90 $48 $0 $0/$40 $20 $0 $10 $40-150 $40/$40 $300 $350/day 1-5 $188/day 21-100 $7,550
MVP Medicare WellSelect with Part D (PPO) $0 $0 $300 $0/$45 $30 $0 $20 $60-150 $40/$40 $350 $385/day 1-5 $188/day 21-100 $7,550
UVM Health Advantage Preferred (PPO) $130 $90.60 $0 $0/$25 $15 $0 $25 $20-125 $15/$25 $175 $350/day 1-2 $150/day 21-48 $5,000
UVM Health Advantage Secure (PPO) $50 $11.10 $150 $0/$30 $20 $0 $30 $25-125 $15/$25 $200 $400/day 1-2 $150/day 21-48 $5,000
UVM Health Advantage Select (PPO) $0 $0 $250 $0/$35 $20 $0 $35 $25-160 $15/$25 $285 $450/day 1-2 $188/day 21-55 $6,700 v
UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO) $16 $0 $300 $0/$40 $40 $0 $35 $175 $15/$25 $0-375 $375/day 1-5 $188/day 21-59 $7,200
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) $46 $11.80 $250 $0/$40 $40 $0 $35 $160 $15/$25 $0-340 $360/day 1-5 $188/day 21-57 $6,900
UnitedHealthcare Medicare Advantage Choice Plan 4 (Regional PPO) $84 $41.60 $150 $0/$30 $30 $0 $30 $175 $15/$25 $0-325 $315/day 1-5 $188/day 21-56 $6,700
Wellcare Fidelis Assist (HMO-POS) $17.10 $0 $480 $0/$30 $30 $0 $0-20 $0-390 $25/$25 $390 or 20% $390/day 1-5 $184/day 21-100 $7,550
Wellcare Fidelis No Premium (HMO) $0 $0 $0 $10/$45 $40 $0 $0-20 $0-403 $25/$25 $403 or 20% $403/day 1-5 $184/day 21-100 $7,550

This Product is funded in part by The Administration for Community Living, New York State and Clinton County Office for the Aging NY Connects.

General information only - See plan Summary of Benefits and Evidence of Coverage for more details