Plan ID: H1732-004

What You Need to Know:

  • Empire MediBlue HealthPlus (HMO) is a Medicare Advantage Health Maintenance Organization Local HMO plan.
  • It must provide all of the same hospital and medical benefits as Medicare Part A and Part B, however, costs may be different.
  • It has additional benefits not included in Medicare Part A and Part B, including prescription drug coverage.
  • The plan's monthly premium is $0, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is $350 (Tier 1 and 2 excluded from the Deductible.).
  • The plan includes an out-of-pocket maximum of $6,900 per year (in-network).
  • Empire MediBlue HealthPlus (HMO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is $350 (Tier 1 and 2 excluded from the Deductible.).
  • This plan's Part D Initial Coverage Limit is $0.

$0

Monthly Premium

Medicare Plan Features
Monthly Premium: $0
Part C Premium: $0
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$0 $0 $0 $0 $0 $350.0 1.0
Gap Coverage: Yes
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local HMO
Similar Plan: H1732-005
Special Needs Type: NULL
Chronic Condition: NULL
Additional Gap Coverage: Yes, some additional gap coverage.
Maximum Out-of-Pocket Limit for Parts A & B (Moop): $6,900
Annual Deductible: $350 (Tier 1 and 2 excluded from the Deductible.)
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Bronx, New York: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
1,079 members New plan - No summary rating as of yet. New plan - not yet rated. New plan - not yet rated.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 3,708 drugs
Number of Members Enrolled in this Plan in Bronx, New York: NULL
Number of Drugs Per Tier: NULL
Preferred Pharmacy Cost Sharing During Initial Coverage Phase: NULL
Special Needs Plan SNP Eligibility Requirement: NULL
Monthly Premium Split as Follows:
Part C Premium Part D Base Premium Part D Supplemental Premium Total Premium
$0.00 $0.00 $0.00 $0.00
Monthly Premium with Extra Help Low Income Subsidy:
LIS100 Subsidy Total Monthly Premium with LIS Parts CD LIS25 Subsidy Monthly PartD Premium with LIS LIS25 Subsidy Total Monthly Premium with LIS Parts CD LIS50 Monthly PartD Premium with LIS LIS50 Subsidy Total Monthly Premium with LIS Parts CD LIS75 Monthly PartD Premium with LIS LIS75 Subsidy Total Monthly Premium with LIS Parts CD
$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Formulary Drug Details:
Tier 1 # of Drugs per Tier Tier 1 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 2 # of Drugs per Tier Tier 2 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 3 # of Drugs per Tier Tier 3 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 4 # of Drugs per Tier Tier 4 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 5 # of Drugs per Tier Tier 6 Preferred Pharmacy Cost Sharing (initial coverage phase)
306 $3.00 609 $15.00 942 $42.00 1061 $94.00 700 26%

Other Medicare Advantage Plans in Bronx, New York

Plan Name Type Premium MOOP Rx Deduct. Rating
Empire MediBlue Core Select (HMO) (2023)Local HMO *$6,700$-
4
Empire MediBlue Core (HMO) (2023)Local HMO *$7,550$-
4
UnitedHealthcare Medicare Advantage Patriot (Regional PPO (2023)Regional PPO *$6,700$-
5
UnitedHealthcare Medicare Advantage Choice Plan 3 (Region (2023)Regional PPO$6,700$275
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UnitedHealthcare Medicare Advantage Choice Plan 4 (Region (2023)Regional PPO$6,700$150
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UnitedHealthcare Medicare Advantage Choice Plan 1 (Region (2023)Regional PPO$6,700$300
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Humana Honor (PPO) (2023)Local PPO *$4,500$-
4
Humana Gold Plus H3533-027 (HMO) (2023)Local HMO$7,550$400
4
Humana Gold Plus H3533-032 (HMO) (2023)Local HMO$6,500$200
4
Aetna Medicare Elite Plan (PPO) (2023)Local PPO$7,550$250
5
Aetna Medicare Premier Plan (PPO) (2023)Local PPO$7,550$250
5
Aetna Medicare Elite Plan 2 (PPO) (2023)Local PPO$7,550$300
5
WellCare Preferred (HMO) (2023)Local HMO$6,700$0
5
WellCare Compass (HMO) (2023)Local HMO$6,700$445
5
Healthfirst Signature (HMO) (2023)Local HMO$7,550$350
Insufficient data to rate this plan.
HumanaChoice H5970-024 (PPO) (2023)Local PPO$7,200$350
4
Elderplan Extra Help (HMO) (2023)Local HMO$7,550$445
5
WellCare Choice (HMO) (2023)Local HMO$6,700$0
5
EmblemHealth VIP Passport NYC (HMO) (2023)Local HMO$7,550$295
3
WellCare Element (HMO) (2023)Local HMO$6,700$0
5
EmblemHealth VIP Reserve (HMO) (2023)Local HMO$7,550$295
3
AgeWell New York LiveWell (HMO) (2023)Local HMO$7,550$350
4
Fidelis Medicare Advantage Flex (HMO-POS) (2023)Local HMO$7,550$445
New plan - not yet rated.
Centers Plan for Medicare Advantage Care (HMO) (2023)Local HMO$7,550$395
3
EmblemHealth VIP Gold Plus (HMO) (2023)Local HMO$7,550$200
2
Fidelis Medicare $0 Premium (HMO) (2023)Local HMO$7,550$0
New plan - not yet rated.
EmblemHealth VIP Rx Saver (HMO) (2023)Local HMO$7,550$395
2
Montefiore + Oscar Easy Care (HMO) (2023)Local HMO$6,700$0
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Montefiore + Oscar Extra Benefits (HMO) (2023)Local HMO$6,700$445
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Empire MediBlue Plus (HMO) (2023)Local HMO$7,550$350
4
Aetna Medicare Eagle Plan (PPO) (2023)Local PPO *$7,550$-
5
Empire MediBlue Select (HMO) (2023)Local HMO$7,550$350
4
Empire MediBlue Extra Select (HMO) (2023)Local HMO$5,900$445
4
WellCare Absolute (PPO) (2023)Local PPO$7,550$150
5
EmblemHealth VIP Part B Saver (HMO) (2023)Local HMO$7,550$445
2
EmblemHealth VIP Go (HMO-POS) (2023)Local HMO$7,550$250
2
Healthfirst 65 Plus Plan (HMO) (2023)Local HMO$7,550$350
5
MetroPlus Platinum Plan (HMO) (2023)Local HMO$7,550$445
4
Healthfirst Increased Benefits Plan (HMO) (2023)Local HMO$7,550$445
5
Healthfirst Coordinated Benefits Plan (HMO) (2023)Local HMO *$7,550$-
5
AARP Medicare Advantage Plan 1 (HMO) (2023)Local HMO$6,700$395
5
AARP Medicare Advantage Patriot (HMO) (2023)Local HMO *$6,700$-
5
Aetna Medicare Value Plan (HMO) (2023)Local HMO$7,550$250
5
WellCare Summit (PPO) (2023)Local PPO$6,700$445
5
AARP Medicare Advantage Plan 2 (HMO) (2023)Local HMO$6,700$395
5
EmblemHealth VIP Gold (HMO) (2023)Local HMO$7,550$200
2
EmblemHealth VIP Essential (HMO) (2023)Local HMO$7,550$295
2
WellCare Today's Options Advantage Plus 550B (PPO) (2023)Local PPO$6,700$0
5
Medicare Advantage Plans by Empire BlueCross BlueShield
Empire MediBlue Core Select (HMO) (2023)Local HMO *$6,700$-
4
Empire MediBlue Core (HMO) (2023)Local HMO *$7,550$-
4
Empire MediBlue Plus (HMO) (2023)Local HMO$7,550$350
4
Empire MediBlue Select (HMO) (2023)Local HMO$7,550$350
4
Empire MediBlue Extra Select (HMO) (2023)Local HMO$5,900$445
4

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