at a glance
- CDPHP offers Medicare Advantage plans to residents of 26 counties in New York.
- CDPHP offers both HMO and PPO plans.
- Most CDPHP plans include Part D prescription drug coverage.
- CDPHP was founded by physicians in 1984 and has a 5-star rating from Medicare for 2021.
Capital District Physicians’ Health Plan Inc. (CDPHP) is a health insurance company based in Albany, New York. CDPHP was founded in 1984 and is dedicated to providing affordable health plans to New York residents.
CDPHP’s Medicare Advantage plans include both Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs).
Some plans come with no monthly premium payment. This makes CDPHP an affordable option for New York Medicare beneficiaries shopping for coverage.
Let’s take a closer look at what CDPHP plans offer and how much they may cost.
CHPHP offers two different types of Medicare Advantage plans in 2021. You can select an HMO or a PPO. Both plan types are offered in all counties that CDPHP covers.
CDPHP HMO plans
An HMO is a very common type of health insurance plan. With an HMO, like the ones offered by CDPHP, your care is covered when you use your providers in your plan’s network. You may be required to have a primary care provider (PCP).
The network will include any locations where you might receive healthcare services, such as:
- doctors’ offices
- pharmacies
- hospitals
- urgent care centers
- skilled nursing facilities
You’ll need to stay inside your plan’s network for your services to be covered. If you see a provider out of network, it won’t be covered.
Exceptions are made for emergency care. This is always covered, even if you use an out-of-network provider.
CDPHP PPO plans
A PPO is very similar to an HMO. You’ll still have a network of providers, but you’ll be able to go outside your network for most services if you pay a higher out-of-pocket cost.
For example, you might have a $15 copayment to see an in-network PCP, but a $40 copayment if you choose to see an out-of-network doctor instead.
Most HMO and PPO Medicare Advantage plans from CDPHP also include Medicare Part D (prescription drug) coverage.
Medicare Advantage plans that combine the coverage of an Advantage plan with Medicare Part D. For many people, these plans are a convenient way to have all their healthcare costs covered by a single plan.
CDPHP doesn’t have separate Medicare Part D plans. However, the Medicare Advantage plans from CDPHP include Part D coverage.
You can use the Medicare plan finder tool to search for separate Part D plans in New York, if you’d like.
CDPHP Medicare Advantage plans are offered 26 counties in New York. As of 2021, CDPHP services the following counties:
- Albany
- Broome
- Chenango
- Clinton
- Columbia
- Delaware
- Dutchess
- Essex
- Franklin
- Fulton
- Greene
- Hamilton
- Herkimer
- Madison
- Montgomery
- Oneida
- Orange
- Otsego
- Rensselaer
- Saratoga
- Schenectady
- Schoharie
- Tioga
- Ulster
- Warren
- Washington
Medicare Advantage plan offerings vary by location, so enter the ZIP code where you live when searching for plans.
CDPHP Medicare Advantage plans cover a broad range of healthcare services for members.
Like all Medicare Advantage plans, CDPHP plans cover all services covered by Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) combined. Together, parts A and B are often referred to as original Medicare.
In addition to all the services that are covered by original Medicare, CDPHP covers many extra services, including:
- Part D prescription drug coverage
- routine dental coverage
- routine vision coverage
- hearing services
- a hearing aid allowance
- preventive care, including vaccines and screenings
- SilverSneakers membership
- access to several health, nutrition, and fitness programs
In 2021, there are also some new perks and programs available to members, including:
- up to 14 meals delivered to your home following an inpatient hospital stay
- $0 telemedicine doctor’s visits
- $50 per quarter to spend on over-the-counter medical supplies (at certain pharmacies with select plans)
- $0 prescriptions through mail-order for hundreds of covered medications
CDPHP offers various Medicare Advantage plan options at different price points. Check out some of the plan prices in different locations in the table below.
| City, plan | Monthly premium | Health deductible, drug deductible | PCP visit copay | Specialist visit copay | Out-of-pocket max |
|---|---|---|---|---|---|
| Albany, NY: CDPHP Basic RX (HMO) | $31 | $0, $0 | $0 | $45 | $6,700 (in network) |
| Clifton, Park, NY: CDPHP Choice Rx (HMO) | $130 | $0, $0 | $0 | $30 | $5,000 |
| Oneonta, NY: CDPHP Vital Rx (PPO) | $0 | $0, $350 | $0 | $50 | $7,500 (in network), $11,300 (out of network), $11,300 (in and out of network) |
| Owego, NY: CDPHP Flex Rx (PPO) | $41.80 | $0, $0 | $0 | $40 | $5,500 (in network), $10,000 (out of network), $10,000 (in and out of network) |
Medicare Advantage (Part C) plans are insurance plans from private insurance companies, like CDPHP, that contract with Medicare to provide coverage.
To offer coverage to Medicare beneficiaries, Part C plans are required to cover all services covered by original Medicare. These include:
- PCP visits
- specialist visits
- preventive care
- speech, occupational, and physical therapy visits
- emergency room visits
- urgent care visits
- hospital stays
- emergency ambulance transportation
- skilled nursing facility stays (limited coverage)
- home healthcare (limited coverage)
- durable medical equipment
Many plans also offer coverage for things original Medicare doesn’t cover, like dental and vision care. Plans are available from local companies, like CDPHP, as well as large national ones.
No matter what company you choose, the Medicare Advantage plans available to you will depend on where you live. Plans are generally only offered in select states, counties, or even cities.
It’s important to note that the price of your Medicare Advantage plan premium is paid in addition to your monthly Part B premium.
- CDPHP Medicare Advantage plans offer various coverage options for New York residents.
- With CDPHP, you can choose between HMO or PPO plans.
- There are plans available without a monthly premium and with low copayments for many services.
- CDPHP plans include additional coverage for dental, vision, and hearing care, as well as extras like SilverSneakers and other health-based incentive programs.