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Founder, CFP® Joel Ohman

UPDATED: Oct 29, 2021

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The Highlights

  • Medicare Advantage plans in Tioga County, New York may include dental, vision, and hearing coverage
  • Medicare Supplement plans in Tioga County are designed to cover out-of-pocket costs not paid for by original Medicare
  • Tioga County residents can buy Medicare Advantage or choose original Medicare

Tioga County, New York Medicare plans are widely available, and Medicare-eligible residents can compare options that include Medicare Advantage, standalone Medicare Part D, and Medicare Supplement plans to fill the gaps in original Medicare.

Whether you are just looking for Medigap coverage in Tioga County to avoid out-of-pocket costs not covered by your Medicare Part A and B or want to sign up for Medicare Advantage instead, comparing your options is the best way to find affordable Tioga County, NY Medicare coverage that suits your needs.

Ready to find cheap Medicare rates in Tioga County, NY? Enter your ZIP code to compare Tioga County, New York Medicare plans today.

Medicare Advantage Companies in Tioga County, New York

A Medicare Advantage plan in Tioga County, NY can provide additional coverage above and beyond original Medicare, and allows you to choose your plan, coverage, and network. Take a look at the companies that offer Medicare Advantage plans in Tioga County, New York

Medicare Advantage Companies in Tioga County, 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 Premier Plan (PPO) – H5521-077-0 $0.00 $200. 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: 29% $7,550
Aetna Medicare Value Plan (HMO) – H3312-048-0 $0.00 $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
CDPHP $0 Medicare Rx (HMO) – H3388-014-0 $0.00 $300. Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $17.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 27% $7,500
CDPHP Basic RX (HMO) – H3388-013-0 $31.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $15.00, Preferred Brand: $45.00, Non-Preferred Drug: $97.00, Specialty Tier: 33% $6,700
CDPHP Choice (HMO) – H3388-001-0 $39.90 No Rx Coverage No Rx Coverage This Plan does NOT include prescription drug coverage. $5,000
CDPHP Choice Rx (HMO) – H3388-002-0 $130.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $11.00, Preferred Brand: $40.00, Non-Preferred Drug: $90.00, Specialty Tier: 33% $5,000
CDPHP Flex (PPO) – H5042-012-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include prescription drug coverage. $5,500
CDPHP Flex Rx (PPO) – H5042-011-0 $41.80 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $2.00, Generic: $14.00, Preferred Brand: $44.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $5,500
CDPHP Value Rx (HMO) – H3388-004-0 $60.80 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $2.00, Generic: $13.00, Preferred Brand: $42.00, Non-Preferred Drug: $93.00, Specialty Tier: 33% $5,800
CDPHP Vital Rx (PPO) – H5042-009-0 $0.00 $350. Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $17.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 26% $7,500
Fidelis Dual Advantage (HMO D-SNP) – H5599-006-0 $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: $20.00, Preferred Brand: $47.00, Non-Preferred Drug: 47%, Specialty Tier: 25% N/A
Fidelis Dual Advantage Flex (HMO D-SNP) – H5599-001-0 $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: $10.00, Preferred Brand: 24%, Non-Preferred Drug: 39%, Specialty Tier: 25% N/A
Fidelis Medicare $0 Premium (HMO) – H5599-004-0 $0.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $5.00, Generic: $20.00, Preferred Brand: $47.00, Non-Preferred Drug: 50%, Specialty Tier: 33% $7,550
Fidelis Medicare Advantage Flex (HMO-POS) – H5599-002-0 $7.40 $445. Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $15.00, Preferred Brand: 24%, Non-Preferred Drug: 41%, Specialty Tier: 25% $7,550
Fidelis Medicare Advantage without Rx (HMO-POS) – H5599-005-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include prescription drug coverage. $7,550
Humana Gold Plus H3533-001 (HMO) – H3533-001-0 $0.00 $350. 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: 26% $7,200
Humana Gold Plus SNP-DE H3533-002 (HMO D-SNP) – H3533-002-0 $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: $2.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 25% N/A
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
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
MVP SmartFund (MSA) – H5613-002-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include prescription drug coverage. N/A
Medicare BlueBasic (PPO) – H3335-043-0 $45.00 No Rx Coverage No Rx Coverage This Plan does NOT include prescription drug coverage. $4,500
Medicare BlueClassic (PPO) – H3335-038-0 $38.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $8.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $7,200
Medicare BlueEnhanced (PPO) – H3335-015-0 $138.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $6.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $5,000
Medicare BlueEssential (PPO) – H3335-053-0 $0.00 $150. Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 30% $7,550
Medicare BlueSecure (PPO) – H3335-014-0 $101.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $8.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $6,700
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
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 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
WellCare Today’s Options Premier Plus 250A (PFFS) – H2816-013-0 $156.00 $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% N/A
WellCare Today’s Options Premier Plus 650B (PFFS) – H2816-019-0 $55.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $1.00, Generic: $7.00, Preferred Brand: $37.00, Non-Preferred Drug: $90.00, Specialty Tier: 33% N/A

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Medicare Supplement Companies in Tioga County, New York

If you choose original Medicare in Tioga County, NY, you can get coverage for out-of-pocket costs like deductibles, co-pays, and coinsurance with Tioga County Medicare Supplement plan. Take a look at which companies offer Medicare Supplement plans in Tioga County, NY and which plans are available.

Medicare Supplement Companies in Tioga County, 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

Tioga County, New York Medicare Supplement Coverage by Plan

Not sure which Tioga County Medicare Supplement plan is right for you? Take a look at the details of each of the standard New York Medicare Supplement plans to find out what’s covered.

Tioga County, New York Medicare Supplement Coverage by Plan

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 Tioga County, New York

If you’re looking to buy a standalone Tioga County, NY Medicare Part D plan for prescription drug coverage, you have several options. Review the companies that offer Part D as a standalone policy and what sort of Medicare prescription coverage is available in Tioga County, New York.

Standalone Medicare Part D plans in Tioga County, 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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