5

5 out of 5 stars* for plan year 2024

Plan ID: H3388-002

What You Need to Know:

  • CDPHP Choice Rx (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 $130, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is .
  • The plan includes an out-of-pocket maximum of $5,000 per year (in-network).
  • CDPHP Choice Rx (HMO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is .
  • This plan's Part D Initial Coverage Limit is $49.

* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.

$130

Monthly Premium

Medicare Plan Features
Monthly Premium: $130.00
Part C Premium: $44.80
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$130.00 $44.80 $49.00 $36.20 $85.20 $0 0.0
Gap Coverage: No
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local HMO
Similar Plan: H3388-004
Special Needs Type: NULL
Chronic Condition: NULL
Additional Gap Coverage: No additional gap coverage, only the Donut Hole Discount
Maximum Out-of-Pocket Limit for Parts A & B (Moop): $5,000
Annual Deductible: NULL
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Saratoga, New York: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
2,484 members 4.5 out of 5 Stars. 5 out of 5 Stars. 4 out of 5 Stars.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 3,350 drugs
Number of Members Enrolled in this Plan in Saratoga, 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
$44.80 $49.00 $36.20 $130.00
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
$87.70 $74.60 $119.40 $64.10 $108.90 $53.50 $98.30
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)
498 $0.00 901 $11.00 757 $40.00 505 $90.00 689 33%

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4
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MVP Medicare Patriot Plan with Part D (PPO) (2023)Local PPO$7,550$250
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UnitedHealthcare Medicare Advantage Choice Plan 1 (Region (2023)Regional PPO$6,700$300
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HumanaChoice H5970-015 (PPO) (2023)Local PPO$6,500$250
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Humana Honor (PPO) (2023)Local PPO *$4,500$-
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BlueShield Forever Blue 770 (PPO) (2023)Local PPO$6,700$0
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Aetna Medicare Premier Plan (PPO) (2023)Local PPO$7,550$200
5
BlueShield Freedom Nation (PPO) (2023)Local PPO$7,550$375
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Humana Gold Plus H3533-013 (HMO) (2023)Local HMO$6,700$275
4
BlueShield Freedom Plus (HMO) (2023)Local HMO$6,700$275
3
BlueShield Freedom Value (HMO) (2023)Local HMO$7,550$295
3
Aetna Medicare Elite Plan (PPO) (2023)Local PPO$7,550$100
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WellCare Patriot (HMO) (2023)Local HMO *$6,700$-
5
BlueShield Freedom Premier (HMO) (2023)Local HMO$6,700$100
3
HumanaChoice H5970-018 (PPO) (2023)Local PPO$7,550$310
4
BlueShield Freedom No Rx (HMO) (2023)Local HMO *$6,700$-
3
HumanaChoice H5970-019 (PPO) (2023)Local PPO$5,500$0
4
WellCare Value (HMO) (2023)Local HMO$6,700$0
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Aetna Medicare Credit Plan (PPO) (2023)Local PPO$7,550$250
5
CDPHP Choice (HMO) (2023)Local HMO *$5,000$-
5
Fidelis Medicare Advantage Flex (HMO-POS) (2023)Local HMO$7,550$445
New plan - not yet rated.
CDPHP Value Rx (HMO) (2023)Local HMO$5,800$0
5
CDPHP Vital Rx (PPO) (2023)Local PPO$7,500$350
5
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$395
2
MVP SmartFund (MSA) (2023)MSA *$-$-
4
CDPHP Flex Rx (PPO) (2023)Local PPO$5,500$0
5
MVP Medicare Secure Plus with Part D (HMO-POS) (2023)Local HMO$7,550$0
4
CDPHP Basic RX (HMO) (2023)Local HMO$6,700$0
5
WellCare Absolute (PPO) (2023)Local PPO$7,550$150
5
EmblemHealth VIP Part B Saver (HMO) (2023)Local HMO$7,550$445
2
Aetna Medicare Eagle Plan (PPO) (2023)Local PPO *$7,550$-
5
CDPHP Flex (PPO) (2023)Local PPO *$5,500$-
5
CDPHP $0 Medicare Rx (HMO) (2023)Local HMO$7,500$300
5
WellCare Today's Options Premier 300 (PFFS) (2023)PFFS *$-$-
5
EmblemHealth VIP Go (HMO-POS) (2023)Local HMO$7,550$250
2
MVP Medicare Secure with Part D (HMO-POS) (2023)Local HMO$7,550$150
4
Humana Gold Plus H3533-006 (HMO) (2023)Local HMO$7,200$300
4
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5
MVP Medicare Preferred Gold without Part D (HMO-POS) (2023)Local HMO *$7,550$-
4
Aetna Medicare Value Plan (HMO) (2023)Local HMO$7,550$250
5
WellCare Today's Options Advantage Plus 150A (PPO) (2023)Local PPO$3,400$0
5
BlueShield Senior Blue 652 (HMO) (2023)Local HMO$6,700$0
3
WellCare Today's Options Premier Plus 250A (PFFS) (2023)PFFS$-$0
5
WellCare Today's Options Premier Plus 650B (PFFS) (2023)PFFS$-$0
5
MVP Medicare Preferred Gold with Part D (HMO-POS) (2023)Local HMO$5,800$0
4
Empire MediBlue Access (PPO) (2023)Local PPO$6,200$310
Insufficient data to rate this plan.
WellCare Today's Options Premier 200 (PFFS) (2023)PFFS *$-$-
5
WellCare Today's Options Advantage Plus 550B (PPO) (2023)Local PPO$6,700$0
5
Medicare Advantage Plans by CDPHP Medicare Advantage
CDPHP Choice (HMO) (2023)Local HMO *$5,000$-
5
CDPHP Value Rx (HMO) (2023)Local HMO$5,800$0
5
CDPHP Vital Rx (PPO) (2023)Local PPO$7,500$350
5
CDPHP Flex Rx (PPO) (2023)Local PPO$5,500$0
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CDPHP Basic RX (HMO) (2023)Local HMO$6,700$0
5
CDPHP Flex (PPO) (2023)Local PPO *$5,500$-
5
CDPHP $0 Medicare Rx (HMO) (2023)Local HMO$7,500$300
5

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