Health Plan Overview for Group Medicare Retirees - 2019
CDPHP is pleased to offer Medicare Advantage plans, including the Group Medicare ChoiceRx (HMO) and Group Medicare Choice (HMO) for Medicare-primary NYSHIP retirees and their spouses. Medicare-primary NYSHIP retirees who are enrolled in the CDPHP HMO for active employees and reside in NYSHIP code numbers 063, 300, and 310 are required to enroll in a CDPHP Group Medicare plan. To qualify, you must be enrolled in Medicare Parts A and B and live in the service area.
CDPHP Medicare Advantage group plans make health care easy. Employees receive all the benefits of Medicare and more.
- No deductibles and easy paperless referrals
- A network of more than 10,000 practitioners and providers - use the Find-A-Doc search tool to find a participating doctor, specialist, laboratory, or pharmacy near you
- Worldwide coverage for urgent and emergency care when you travel
Summary Information for Medicare Eligibles - 2019
Group Medicare Prescription Drug Coverage
CDPHP offers a five-tier prescription drug plan for New York state Medicare-eligible retirees. For your convenience, covered prescriptions can be filled at any Caremark network pharmacy throughout the United States (includes virtually all chain stores and most independent pharmacies). Use the pharmacy search to find a participating pharmacy near you.
Prescription drug benefits are as follows:
- No deductible
- No coverage gap
- Tier 1: $2 copayment for preferred generic drugs
- Tier 2: $10 copayment for generic drugs
- Tier 3: $30 copayment for preferred brand drugs
- Tier 4: $50 copayment for non-preferred brand drugs
- Tier 5: $55 copayment for specialty drugs
- Once the total yearly Part D drug costs* reach $3,820:
- You pay the above-stated copayments for all generic drugs on Tiers 1 though 4. You pay the above-stated copayments for all brand-name drugs (as defined by CMS*) on Tiers 3, 4, and 5 until your Part D total out-of-pocket spending reaches $5,100.
- When your total Part D out-of-pocket spending reaches $5,100, catastrophic coverage begins:
- You pay the greater of 5% coinsurance or $3.40 for generic and multisource brand drugs on Tiers 1 through 4 and the greater of 5% coinsurance or $8.50 for all other brand drugs. For Tier 5 drugs, you pay the lesser of 5% coinsurance or the above-stated cost-share.
- Tier 5 drugs limited to a 30-day supply
- Mail order: 90-day supply available for two copayments for Tier 1, 2, 3, and 4 drugs
- Retail pharmacy: 90-day supply available for three copayments for Tier 1, 2, 3, and 4 drugs
- CDPHP Medicare Advantage Part D Formulary and Enhanced Formulary apply
Ask Us About Our Stars
CDPHP Medicare Advantage PPO plans and HMO plans were both rated 4.5 out of 5 stars for 2019 by CMS**.
Star ratings are based on quality and performance in several different categories, including detecting and preventing illness, patient ratings, and customer service.
For 2018 Medicare Documents, click here.
*The Medicare Coverage Discount Program provides manufacturer discounts on brand-name drugs to Part D enrollees who have reached the coverage gap and are not already receiving "Extra Help." A 50% discount on the negotiated price (excluding the dispensing fee and vaccine administration fee, if any) is available for brand-name drugs from manufacturers that have agreed to pay the discount. Although you pay the same copayments in the coverage gap as during the initial coverage stage, the 50% manufacturer discount still applies. Both the amount you pay and the 50% discounted by the manufacturer count toward your out-of-pocket costs as if you had paid them and moves you through the coverage gap.
**Every year, Medicare evaluates plans based on a 5-star rating system.