CDPHP Choice (HMO)
H3388 - 001 - 0
(4.5 / 5)
CDPHP Choice (HMO) is a Medicare Advantage Plan by CDPHP Medicare Advantage.
This page features plan details for 2024 CDPHP Choice (HMO) H3388 – 001 – 0 available in Greater Capital Region of New York State.
IMPORTANT: This page features the 2024 version of this plan. See the 2025 version using the link below:
Locations
CDPHP Choice (HMO) is offered in the following locations.
Plan Overview
CDPHP Choice (HMO) offers the following coverage and cost-sharing.
| Insurer: | CDPHP Medicare Advantage |
| Health Plan Deductible: | $0.00 |
| MOOP: | $6,100 In-network |
| Drugs Covered: | No |
Ready to sign up for CDPHP Choice (HMO) ?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
M-F: 8:00 am – 10:00 pm EST
Sat-Sun: 8:00 am – 9:00 pm EST
Premium Breakdown
CDPHP Choice (HMO) has a monthly premium of $39.90. This amount includes your Part C premium but does not include your Part B premium.| Part B | Part C | Part B Give Back | Total |
|---|---|---|---|
| $174.70 | $39.90 | $0.00 | $ |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
Additional Benefits
CDPHP Choice (HMO) also provides the following benefits.
| $0 |
| In-network | No |
| $6,100 In-network |
| No |
| In-network | No |
| $200 copay per visit (Authorization is required.) (Referral is required.) |
| Primary | $0 copay (Not applicable.) (Not applicable.) |
| Specialist | $0-25 copay per visit (Authorization is required.) (Referral is required.) |
| $0 copay (Authorization is required.) (Referral is not required.) |
| Emergency | $90 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| Urgent care | $45 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| Diagnostic tests and procedures | $0-25 copay (Authorization is required.) (Referral is required.) |
| Lab services | $0-5 copay (Authorization is required.) (Referral is required.) |
| Diagnostic radiology services (e.g., MRI) | $100 copay (Authorization is required.) (Referral is required.) |
| Outpatient x-rays | $25 copay (Authorization is required.) (Referral is required.) |
| Hearing exam | $25 copay (Authorization is not required.) (Referral is not required.) |
| Fitting/evaluation | $0 copay (There are no limits.) (Authorization is not required.) (Referral is not required.) |
| Hearing aids | $199-499 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Oral exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Cleaning | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Fluoride treatment | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Non-routine services | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Diagnostic services | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Restorative services | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Endodontics | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Periodontics | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Extractions | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Routine eye exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Contact lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Eyeglass frames | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Eyeglass lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Upgrades | Not covered (Not applicable.) (Not applicable.) |
| Occupational therapy visit | $25 copay (Authorization is not required.) (Referral is required.) |
| Physical therapy and speech and language therapy visit | $25 copay (Authorization is not required.) (Referral is required.) |
| $165 copay (Not applicable.) (Not applicable.) |
| $0 copay (There are no limits.) (Authorization is required.) (Referral is not required.) |
| Foot exams and treatment | $25 copay (Authorization is not required.) (Referral is required.) |
| Routine foot care | Not covered (Not applicable.) (Not applicable.) |
| Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
| Diabetes supplies | 0-20% coinsurance per item (Authorization is required.) (Not applicable.) |
| Covered (Authorization is not required.) (Referral is not required.) |
| Chemotherapy | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| Other Part B drugs | $35 copay or 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| Part B Insulin drugs | $35 copay (Authorization is required.) (Not applicable.) |
| $260 per day for days 1 through 6 $0 per day for days 7 through 90 (Authorization is required.) (Referral is required.) |
| Inpatient hospital – psychiatric | $260 per day for days 1 through 6 $0 per day for days 7 through 90 (Authorization is not required.) (Referral is required.) |
| Outpatient group therapy visit with a psychiatrist | $25 copay (Authorization is not required.) (Referral is required.) |
| Outpatient individual therapy visit with a psychiatrist | $25 copay (Authorization is not required.) (Referral is required.) |
| Outpatient group therapy visit | $25 copay (Authorization is not required.) (Referral is required.) |
| Outpatient individual therapy visit | $25 copay (Authorization is not required.) (Referral is required.) |
| $0 per day for days 1 through 20 $120 per day for days 21 through 100 (Authorization is required.) (Referral is required.) |
Ready to sign up for CDPHP Choice (HMO) ?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
M-F: 8:00 am – 10:00 pm EST
Sat-Sun: 8:00 am – 9:00 pm EST
Table of Contents
Need more information on CDPHP Choice (HMO)? See 2025 CDPHP Choice (HMO) at MedicareAdvantageRX.com.
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