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Founder, CFP® Joel Ohman

UPDATED: Oct 29, 2021

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The Highlights

  • Medicare Advantage plans are available in Lakewood with both PPO and HMO networks
  • Options for Medicare Supplement in Lakewood, New York include Medigap Plan C and Medigap Plan F
  • Medicare Advantage plans may include Lakewood, New York prescription drug coverage, or you may need to buy Part D coverage separately

If you’re eligible for Medicare in Lakewood, New York, you have a lot of choices. Major health insurance companies provide Lakewood, New York Medicare Advantage plans with a variety of coverage options to choose from. You can choose a plan that includes Lakewood, NY Part D coverage, or buy prescription coverage as a standalone policy.

Lakewood, New York Medicare Supplement plans are available from a number of companies if you choose to stick with original Medicare. These plans can pay for the out-of-pocket costs that Lakewood original Medicare plans don’t cover, like coinsurance and deductibles.

Ready to buy Lakewood, New York Medicare coverage? Enter your ZIP code to compare Lakewood, NY Medicare options available to you right now.

Medicare Advantage Companies in Lakewood, New York

Medicare Advantage in Lakewood, New York is offered by some of the same local health insurance companies you may have been covered by before. Take a look at which companies in Lakewood, NY offer Medicare Advantage as well as which plans they offer to find the coverage and provider network that’s best for you.

Medicare Advantage Companies in Lakewood, New York

Plan Name Monthly Prem. (Parts C & D) Deductible Additional Gap Coverage Preferred Pharmacy Copay/ Coinsurance 30-Day Supply MOOP for Part A & B Benefits
Aetna Medicare Assure Plan (HMO D-SNP) – H3312-070-0 $0.00 for people who qualify for both Medicare and Medicaid. $0 for people who qualify for both Medicare and Medicaid. No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 29% N/A
Aetna Medicare Credit Plan (PPO) – H5521-313-0 $0.00 $250 . Tier 1 and 2 exempt Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 28% $7,550
Aetna Medicare Eagle Plan (PPO) – H5521-323-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $7,550
Aetna Medicare Elite Plan (PPO) – H5521-212-0 $16.00 $0 Yes, some additional gap coverage. Preferred Generic: $2.00, Generic: $5.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $7,550
Aetna Medicare Premier Plan (PPO) – H5521-215-0 $23.00 $100 . Tier 1 and 2 exempt Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 31% $7,550
Aetna Medicare Value Plan (HMO) – H3312-065-0 $0.00 $250 . Tier 1 and 2 exempt Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 28% $7,550
BlueCross BlueShield BlueSaver (HMO) – H3384-062-0 $0.00 $290 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $2.00, Generic: $12.00, Preferred Brand: $42.00, Non-Preferred Drug: $94.00, Specialty Tier: 27% $7,550
BlueCross BlueShield Forever Blue 751 (PPO) – H5526-004-0 $204.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $2.00, Generic: $8.00, Preferred Brand: $42.00, Non-Preferred Drug: $94.00, Specialty Tier: 33% $6,700
BlueCross BlueShield Forever Blue Value (PPO) – H5526-016-0 $145.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $4.00, Generic: $10.00, Preferred Brand: $42.00, Non-Preferred Drug: $94.00, Specialty Tier: 33% $6,700
BlueCross BlueShield Freedom Nation (PPO) – H5526-020-0 $25.00 $300 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $4.00, Generic: $12.00, Preferred Brand: $42.00, Non-Preferred Drug: $94.00, Specialty Tier: 27% $7,550
BlueCross BlueShield Senior Blue 601 (HMO) – H3384-022-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $6,700
BlueCross BlueShield Senior Blue 651 (HMO) – H3384-019-0 $120.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $2.00, Generic: $10.00, Preferred Brand: $42.00, Non-Preferred Drug: $94.00, Specialty Tier: 33% $6,700
BlueCross BlueShield Senior Blue Select (HMO) – H3384-058-0 $58.00 $190 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $2.00, Generic: $10.00, Preferred Brand: $42.00, Non-Preferred Drug: $94.00, Specialty Tier: 29% $6,700
Humana Honor (PPO) – H5970-016-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $4,500
HumanaChoice H5970-001 (PPO) – H5970-001-0 $16.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $2.00, Generic: $8.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $5,500
HumanaChoice H5970-015 (PPO) – H5970-015-0 $0.00 $250 . Tier 1, 2 and 3 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $2.00, Generic: $9.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 28% $6,500
HumanaChoice H5970-018 (PPO) – H5970-018-0 $0.00 $310 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $6.00, Generic: $16.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 27% $7,550
HumanaChoice SNP-DE H5970-020 (PPO D-SNP) – H5970-020-0 $0.00 for people who qualify for both Medicare and Medicaid. $0 for people who qualify for both Medicare and Medicaid. No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $19.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 25% N/A
Independent Health’s Encompass 65 (HMO) – H3362-016-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $7,550
Independent Health’s Encompass 65 Basic (HMO) – H3362-017-0 $125.00 $150 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $40.00, Non-Preferred Drug: 43%, Specialty Tier: 30% $7,550
Independent Health’s Encompass 65 Core (HMO) – H3362-033-0 $65.00 $225 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $15.00, Preferred Brand: $42.00, Non-Preferred Drug: 46%, Specialty Tier: 29% $7,550
Independent Health’s Encompass 65 Element (HMO) – H3362-038-0 $0.00 $375 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $4.00, Generic: $20.00, Preferred Brand: $47.00, Non-Preferred Drug: 41%, Specialty Tier: 26% $7,550
Independent Health’s Medicare Family Choice (HMO I-SNP) – H3362-020-0 $42.30 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $4.00, Generic: $15.00, Preferred Brand: 25%, Non-Preferred Drug: 25%, Specialty Tier: 33% N/A
Independent Health’s Medicare Passport Advantage (PPO) – H3344-005-0 $99.00 $100 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $20.00, Preferred Brand: $47.00, Non-Preferred Drug: 40%, Specialty Tier: 31% $7,550
Independent Health’s Medicare Passport Prime (PPO) – H3344-010-0 $215.00 $0 Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $45.00, Non-Preferred Drug: 40%, Specialty Tier: 33% $7,550
MVP Medicare Patriot Plan with Part D (PPO) – H9615-014-0 $36.00 $250 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $15.00, Preferred Brand: $40.00, Non-Preferred Drug: 27%, Specialty Tier: 27% $7,550
MVP Medicare Preferred Gold with Part D (HMO-POS) – H3305-021-0 $140.00 $0 Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $35.00, Non-Preferred Drug: 27%, Specialty Tier: 33% $5,800
MVP Medicare Preferred Gold without Part D (HMO-POS) – H3305-020-0 $62.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $7,550
MVP Medicare Secure Plus with Part D (HMO-POS) – H3305-022-0 $90.00 $0 Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $15.00, Preferred Brand: $45.00, Non-Preferred Drug: 27%, Specialty Tier: 33% $7,550
MVP Medicare Secure with Part D (HMO-POS) – H3305-032-0 $40.00 $150 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: 26%, Specialty Tier: 30% $7,550
MVP Medicare WellSelect Plus with Part D (PPO) – H9615-007-0 $116.00 $0 Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $35.00, Non-Preferred Drug: 27%, Specialty Tier: 33% $6,500
MVP Medicare WellSelect with Part D (PPO) – H9615-008-0 $0.00 $325 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: 25%, Specialty Tier: 27% $7,550
UnitedHealthcare Dual Complete (HMO D-SNP) – H3387-010-0 $0.00 for people who qualify for both Medicare and Medicaid. $0 for people who qualify for both Medicare and Medicaid. No additional gap coverage, only the Donut Hole Discount Tier 1: $0.00, Tier 2: $0.00, Tier 3: $0.00, Tier 4: $0.00, Tier 5: $0.00 N/A
UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO) – R5342-001-0 $16.00 $300 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 27% $6,700
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) – R5342-005-0 $46.00 $275 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 28% $6,700
UnitedHealthcare Medicare Advantage Choice Plan 4 (Regional PPO) – R5342-006-0 $84.00 $150 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 30% $6,700
UnitedHealthcare Medicare Advantage Patriot (Regional PPO) – R5342-002-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $6,700
UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP) – H3379-022-0 $36.00 $445 No additional gap coverage, only the Donut Hole Discount Tier 1: 25%, Tier 2: 25%, Tier 3: 25%, Tier 4: 25%, Tier 5: 25% N/A
Univera SeniorChoice Advanced (HMO-POS) – H3351-019-0 $33.00 $150 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $14.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 30% $7,200
Univera SeniorChoice Basic (HMO) – H3351-017-0 $0.00 $360 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $14.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 26% $7,550
Univera SeniorChoice Secure (HMO-POS) – H3351-002-0 $121.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $4,500
Univera SeniorChoice Select (HMO-POS) – H3351-001-0 $45.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $4,500
Univera SeniorChoice Value (HMO) – H3351-010-0 $69.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $6,700
Univera SeniorChoice Value Plus (HMO-POS) – H3351-012-0 $106.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $5,000
WellCare Absolute (PPO) – H2775-111-0 $0.00 $150 . Tier 1 and 2 exempt Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 30% $7,550
WellCare Imperial (PPO D-SNP) – H2775-112-0 $0.00 for people who qualify for both Medicare and Medicaid. $0 for people who qualify for both Medicare and Medicaid. No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $9.00, Preferred Brand: $45.00, Non-Preferred Drug: 49%, Specialty Tier: 25% N/A
WellCare Summit (PPO) – H2775-113-0 $5.10 $445 . Tier 1 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $20.00, Preferred Brand: $47.00, Non-Preferred Drug: 50%, Specialty Tier: 25% $6,700
WellCare Today’s Options Advantage 300 (PPO) – H2775-108-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $6,700
WellCare Today’s Options Advantage Plus 150A (PPO) – H2775-105-0 $121.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $35.00, Non-Preferred Drug: $75.00, Specialty Tier: 33% $3,400
WellCare Today’s Options Advantage Plus 550B (PPO) – H2775-106-0 $0.00 $0 Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $7.00, Preferred Brand: $37.00, Non-Preferred Drug: $90.00, Specialty Tier: 33% $6,700
WellCare Today’s Options Premier 200 (PFFS) – H2816-037-0 $71.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. N/A
WellCare Today’s Options Premier 300 (PFFS) – H2816-038-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. N/A

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Medicare Supplement Companies in Lakewood, New York

Original Medicare leaves you with some out-of-pocket costs such as deductibles and coinsurance. With Lakewood, New York Medicare Supplement plan, you can get coverage for some or all of those costs. Medicare Supplement plans in New York are standardized, but companies can choose which plans they will sell. Take a look at which companies sell Medicare Supplement (Medigap) insurance and which plans they offer.

Medicare Supplement Companies in Lakewood, New York

Company Plans
AARP – UnitedHealthcare Insurance Company of New York (Standard) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan L,
Medigap Plan N
BlueShield of Northeastern New York Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
EmblemHealth Services Company Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F
Empire BlueCross New York Medigap Plan A,
Medigap Plan B,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Globe Life Insurance Company of New York Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan L,
Medigap Plan N
Humana (Humana Insurance Company of New York) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan L,
Medigap Plan N
Mutual of Omaha Insurance Company Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan G
State Farm Mutual Automobile Insurance Company Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F

Lakewood, New York Standard Medicare Plan Coverage

Wondering what’s covered by each of the standard New York Medicare Supplement plans? Take a look at all of the Lakewood, New York Medicare Supplement plans with coverage details.

Lakewood, New York Standard Medicare Plan Coverage

Plan Name Monthly Cost Copays Coinsurance Deductibles Plan Benefits
Medigap Plan A Premiums range from $169-$350 depending on your age, sex, health status, and when you buy. $0 is generally your cost for approved Part B services. $1,484 Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: No
Part A deductible: No
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: No
Medigap Plan B Premiums range from $226-$510 depending on your age, sex, health status, and when you buy. $0 is generally your cost for approved Part B services. $0 Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: No
Part A deductible: Yes
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: No
Medigap Plan C Premiums range from $301-$511 depending on your age, sex, health status, and when you buy. $0 is generally your cost for approved Part B services. $0 Hospital (Part A) deductible,
$0 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: Yes
Part B excess charges: No
Foreign travel emergency: Yes
Medigap Plan D Premiums range from $391-$502 depending on your age, sex, health status, and when you buy. $0 is generally your cost for approved Part B services. $0 Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: Yes
Medigap Plan F Premiums range from $305-$514 depending on your age, sex, health status, and when you buy. $0 is generally your cost for approved Part B services. $0 Hospital (Part A) deductible,
$0 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: Yes
Part B excess charges: Yes
Foreign travel emergency: Yes
Medigap Plan F-high deductible Premiums range from $69-$91 depending on your age, sex, health status, and when you buy. $0 is generally your cost for approved Part B services after you pay $2,370 deductible. $2,370 total plan deductible.
After, you pay: $0 Hospital (Part A) deductible,
$0 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: Yes
Part B excess charges: Yes
Foreign travel emergency: Yes
Medigap Plan G Premiums range from $268-$476 depending on your age, sex, health status, and when you buy. $0 is generally your cost for approved Part B services. $0 Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: No
Part B excess charges: Yes
Foreign travel emergency: Yes
Medigap Plan G-high deductible Premiums range from $69-$91 depending on your age, sex, health status, and when you buy. $0 is generally your cost for approved Part B services after you pay $2,370 deductible. $2,370 total plan deductible.
After, you pay: $0 Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: No
Part B excess charges: Yes
Foreign travel emergency: Yes
Medigap Plan K Premiums range from $86-$207 depending on your age, sex, health status, and when you buy. 10% is generally your cost for approved Part B services up to $6,220. Then, you’ll pay $0 for the rest of the year. $742 (50% of Part A deductible) Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: No
Medigap Plan L Premiums range from $181-$297 depending on your age, sex, health status, and when you buy. 5% is generally your cost for approved Part B services up to $3,110. Then, you’ll pay $0 for the rest of the year. $371 (25% of Part A deductible) Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: No
Medigap Plan M Premiums range from $524-$524 depending on your age, sex, health status, and when you buy. $0 is generally your cost for approved Part B services. $742 (50% of Part A deductible) Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: Yes
Medigap Plan N Premiums range from $190-$282 depending on your age, sex, health status, and when you buy. $0 is generally your cost for approved Part B services with some $20 and $50 copays. $0 Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: Yes

Standalone Medicare Part D Plans in Lakewood, New York

Prescription drug coverage for Medicare in Lakewood, New York is covered by a Part D plan. You can purchase Part D coverage in Lakewood, New York as a standalone plan if it’s not included in your Medicare Advantage coverage. Take a look at the options for standalone Part D plans here.

Standalone Medicare Part D Plans in Lakewood, New York

Plan Details Tiers
SilverScript SmartRx (PDP)
S5601 – 178 – 0
by Aetna Medicare
Monthly Premium: $7.30
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $19.00
Tier 3: $46.00
Tier 4: 49%
Tier 5: 25%
Elixir RxPlus (PDP)
S7694 – 121 – 0
by Elixir Insurance
Monthly Premium: $15.60
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $6.00
Tier 3: $43.00
Tier 4: 45%
Tier 5: 25%
WellCare Wellness Rx (PDP)
S4802 – 172 – 0
by WellCare
Monthly Premium: $15.60
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $5.00
Tier 3: $40.00
Tier 4: 46%
Tier 5: 25%
Humana Walmart Value Rx Plan (PDP)
S5552 – 006 – 0
by Humana
Monthly Premium: $17.20
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $4.00
Tier 3: 16%
Tier 4: 35%
Tier 5: 25%
WellCare Value Script (PDP)
S4802 – 138 – 0
by WellCare
Monthly Premium: $17.70
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $6.00
Tier 3: $43.00
Tier 4: 47%
Tier 5: 25%
Express Scripts Medicare – Saver (PDP)
S5983 – 007 – 0
by Express Scripts Medicare
Monthly Premium: $23.60
Annual Deductible: $285
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $2.00
Tier 2: $7.00
Tier 3: $35.00
Tier 4: 50%
Tier 5: 28%
Cigna Secure-Essential Rx (PDP)
S5617 – 282 – 0
by Cigna
Monthly Premium: $24.00
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $2.00
Tier 3: 18%
Tier 4: 40%
Tier 5: 25%
Blue Rx Enhanced (PDP)
S3375 – 003 – 0
by BlueCross BlueShield: Empire, Excellus, WNY & NEN
Monthly Premium: $30.70
Annual Deductible: $325
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $0.00
Tier 2: $3.00
Tier 3: 20%
Tier 4: 39%
Tier 5: 27%
Express Scripts Medicare – Value (PDP)
S5983 – 004 – 0
by Express Scripts Medicare
Monthly Premium: $33.20
Annual Deductible: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $3.00
Tier 3: $20.00
Tier 4: 46%
Tier 5: 25%
WellCare Classic (PDP)
S4802 – 077 – 0
by WellCare
Monthly Premium: $34.80
Annual Deductible: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $4.00
Tier 3: $30.00
Tier 4: 33%
Tier 5: 25%
SilverScript Choice (PDP)
S5601 – 006 – 0
by Aetna Medicare
Monthly Premium: $35.00
Annual Deductible: $290
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $5.00
Tier 3: $35.00
Tier 4: 40%
Tier 5: 27%
Elixir RxSecure (PDP)
S7694 – 003 – 0
by Elixir Insurance
Monthly Premium: $35.80
Annual Deductible: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $7.00
Tier 3: 15%
Tier 4: 34%
Tier 5: 25%
WellCare Medicare Rx Saver (PDP)
S5810 – 037 – 0
by WellCare
Monthly Premium: $36.80
Annual Deductible: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $2.00
Tier 3: $42.00
Tier 4: 35%
Tier 5: 25%
Humana Basic Rx Plan (PDP)
S5552 – 004 – 0
by Humana
Monthly Premium: $37.10
Annual Deductible: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $1.00
Tier 3: 20%
Tier 4: 35%
Tier 5: 25%
Cigna Secure Rx (PDP)
S5617 – 013 – 0
by Cigna
Monthly Premium: $38.30
Annual Deductible: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $2.00
Tier 3: $25.00
Tier 4: 50%
Tier 5: 25%
WellCare Medicare Rx Select (PDP)
S5810 – 277 – 0
by WellCare
Monthly Premium: $40.20
Annual Deductible: $300
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $3.00
Tier 3: $47.00
Tier 4: 42%
Tier 5: 27%
AARP MedicareRx Walgreens (PDP)
S5921 – 382 – 0
by UnitedHealthcare
Monthly Premium: $40.90
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $6.00
Tier 3: $40.00
Tier 4: 40%
Tier 5: 25%
Blue Rx Standard (PDP)
S3375 – 001 – 0
by BlueCross BlueShield: Empire, Excellus, WNY & NEN
Monthly Premium: $49.10
Annual Deductible: $440
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $2.00
Tier 3: $34.00
Tier 4: 32%
Tier 5: 25%
EmblemHealth VIP Rx (PDP)
S5966 – 003 – 0
by EmblemHealth Medicare PDP
Monthly Premium: $49.30
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $2.00
Tier 2: $12.00
Tier 3: $40.00
Tier 4: 33%
Tier 5: 25%
Cigna Secure-Extra Rx (PDP)
S5617 – 248 – 0
by Cigna
Monthly Premium: $50.00
Annual Deductible: $100
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $4.00
Tier 2: $10.00
Tier 3: $42.00
Tier 4: 50%
Tier 5: 31%
AARP MedicareRx Saver Plus (PDP)
S5921 – 379 – 0
by UnitedHealthcare
Monthly Premium: $70.10
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $8.00
Tier 3: $31.00
Tier 4: 40%
Tier 5: 25%
Humana Premier Rx Plan (PDP)
S5552 – 005 – 0
by Humana
Monthly Premium: $72.30
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $4.00
Tier 3: $45.00
Tier 4: 39%
Tier 5: 25%
EmblemHealth VIP Rx Plus (PDP)
S5966 – 004 – 0
by EmblemHealth Medicare PDP
Monthly Premium: $72.50
Annual Deductible: $285
Zero Premium If Full LIS Benefits: No
ICL: $3,970
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $0.00
Tier 3: $35.00
Tier 4: $95.00
Tier 5: 28%
Blue Rx Plus (PDP)
S3375 – 002 – 0
by BlueCross BlueShield: Empire, Excellus, WNY & NEN
Monthly Premium: $72.70
Annual Deductible: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $3.00
Tier 3: $43.00
Tier 4: 45%
Tier 5: 33%
SilverScript Plus (PDP)
S5601 – 007 – 0
by Aetna Medicare
Monthly Premium: $76.60
Annual Deductible: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $0.00
Tier 2: $2.00
Tier 3: $47.00
Tier 4: 48%
Tier 5: 33%
WellCare Medicare Rx Value Plus (PDP)
S5768 – 200 – 0
by WellCare
Monthly Premium: $82.00
Annual Deductible: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $4.00
Tier 3: $47.00
Tier 4: 43%
Tier 5: 33%
Express Scripts Medicare – Choice (PDP)
S5983 – 006 – 0
by Express Scripts Medicare
Monthly Premium: $87.60
Annual Deductible: $100
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $2.00
Tier 2: $7.00
Tier 3: $42.00
Tier 4: 50%
Tier 5: 31%
AARP MedicareRx Preferred (PDP)
S5805 – 001 – 0
by UnitedHealthcare
Monthly Premium: $94.80
Annual Deductible: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $5.00
Tier 2: $10.00
Tier 3: $45.00
Tier 4: 40%
Tier 5: 33%

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