Bright Advantage Plus plan details in New York, NY

Selecting a Bright Advantage Plus plan in in New York, NY gives our members more coverage through our unique Care Partner model with Mount Sinai, lower copayments, and a lower out-of-pocket maximum. View the extra benefits included with this plan below, including dental coverage and an over-the-counter (OTC) card allowance.

Bright Advantage Plus (HMO)

Monthly Plan Premium


Please enter your zip to enroll

Plan Details

Monthly Premium


Annual Medical Deductible


Annual Prescription Drug Deductible


Primary Care Visit

$0 copay

Specialist Visit

$20 copay

Preventive Care

$0 copay

Annual Physical

$0 copay

Annual Max Out-Of-Pocket


Combined Annual Max Out-of-Pocket


Emergency Care

$90 copay

Urgent Care

$25 copay

Outpatient Surgery (Ambulatory Surgery Center)

$150 copay

Diagnostic Radiology Services

$50 copay for ultrasound; 20% coinsurance for other services copay

Lab Services

$0 copay

Outpatient X-rays

$10 copay


$250/day for days 1-5

$0/day for days 6-90

$0/day for days 90+

Outpatient Surgery (Outpatient Hospital Facility)

$250 copay

Prescription Drug Coverage Details

Annual Prescription Drug Deductible


Costs For Initial Coverage Period


Retail pricing (30-day supply)

Mail order pricing (90-day supply)

Tier 1: Preferred Generic

Retail pricing (30 or 90 day supply)


Mail order pricing (90 day supply)


Tier 2: Generic

Retail pricing (30 or 90 day supply)


Mail order pricing (90 day supply)


Tier 3: Preferred Brand

Retail pricing (30 or 90 day supply)


Mail order pricing (90 day supply)


Tier 4: Non-Preferred Drug

Retail pricing (30 or 90 day supply)


Mail order pricing (90 day supply)


Tier 5: Specialty Tier

Retail pricing (30 or 90 day supply)


Mail order pricing (90 day supply)


Coverage Gap

After your total yearly drug cost (including what our plan has paid and what you have paid) reaches $3,820, you will enter the coverage gap (also called the "donut hole"). This means that there's a temporary change in what you will pay for your drugs. Not everyone will enter the coverage gap. If you enter the coverage gap, you'll pay 25% of the plan's cost for covered brand name drugs and 37% of the plan's cost for covered generic drugs until your costs total $5,100, which is the end of the coverage gap.

Catastrophic Coverage

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $5,100, you will pay the greater of:

  • 5% of the cost, or
  • a $3.40 copay for a generic drug or a drug that’s treated like a generic and a $8.50 copay for all other drugs

Bright Extra Benefits

Preventive and Enhanced Dental

Copay for X-rays


Copay for oral exam


Copay for cleaning


Copay for fluoride treatment


Comprehensive Dental

Copay varies based on the services you receive

Hearing Services

Routine Hearing Exam & Hearing Aid Fitting/Evaluation


Hearing Aid Allowance

$3,000 every three years

Preventive and Enhanced Vision Coverage

Routine Eye Exam


Materials Allowance

$130 every two years

Included Extra Benefits

Over-the-counter (OTC) drugs and supplies

Additional Plan Resources

Summary of Benefits

Evidence of Coverage (EOC)

LIS Premium Summary Chart

*If you qualify for Extra Help, you may be eligible for discounted monthly premiums. Learn more about Bright Health plans with Extra Help

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† Savings with a Bright Health Medicare Advantage plan compared to Original Medicare or a Medicare Supplement plan.

Last Updated: Tues Oct 1 2019


Bright Health plans are HMOs and PPOs with a Medicare contract. Bright Health’s New York D-SNP plan is an HMO with a Medicare contract and a Coordination of Benefits Agreement with New York State Department of Health. Our plans are issued through Bright Health Insurance Company or one of its affiliates. Bright Health Insurance Company is a Colorado Life and Health company that issues indemnity products, including EPOs offered through Medicare Advantage. An EPO is an exclusive provider organization plan that may be written on an HMO license in some states and on a Life and Health license in some states, including Colorado. Enrollment in our plans depends on contract renewal.

This information is not a complete description of benefits. Call 844-667-5502 | TTY:711 for more information.

The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

You must continue to pay your Medicare Part B premium.

Every year, Medicare evaluates plans based on a 5-star rating system.

Medicare beneficiaries may also enroll in Bright Health Medicare Advantage plans through the CMS Medicare Online Enrollment Center located at 

Bright Health Medicare Advantage plans are plans with a network of doctors, hospitals, pharmacies, and other providers. Out-of-network/noncontracted providers are under no obligation to treat Bright Health members, except in emergency situations.

Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. You must generally use network pharmacies to fill your prescriptions for covered Part D drugs.

Other providers are available in our network. Most network providers participate through our Care Partner.

Bright Advantage Special Care (HMO SNP) has been approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) through 2021 based on a review of Bright Advantage Special Care (HMO SNP) Model of Care.

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