Capital District Physician’s Health Plan (CDCHP) Medicare Insurance Review & Complaints: Health Insurance (2024)
Capital District Physician's Health Plan Medicare plans are available only in New York with both HMO and PPO options. Capital District Physician's Health Plan rates are competitive with two $0 premium plans and several other affordable options. CDCHP Medicare Advantage plans are currently the only options, as there are no Capital District Physician’s Health Plan Medicare Supplement options.
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Shawn Laib
Insurance and Finance Writer
Since graduating from the University of WA with a B.A. in English Literature, Shawn has been professionally writing in the spheres of entertainment, insurance, business, marketing, and politics. He is passionate about using his writing skills and insurance knowledge to educate the general population on everyday issues surrounding these misunderstood topics. His work has been published on SUPERJ...
Insurance and Finance Writer
UPDATED: Nov 27, 2023
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Editorial Guidelines: We are a free online resource for anyone interested in learning more about insurance. Our goal is to be an objective, third-party resource for everything insurance related. We update our site regularly, and all content is reviewed by insurance experts.
UPDATED: Nov 27, 2023
It’s all about you. We want to help you make the right coverage choices.
Advertiser Disclosure: We strive to help you make confident insurance decisions. Comparison shopping should be easy. We are not affiliated with any one insurance provider and cannot guarantee quotes from any single provider.
Our insurance industry partnerships don’t influence our content. Our opinions are our own. To compare quotes from many different insurance companies please enter your ZIP code on this page to use the free quote tool. The more quotes you compare, the more chances to save.
On This Page
Capital District Physician’s Health Plan (CDPHP) is a small, local health insurance company providing coverage to residents of a portion of New York. Their products include individual and family HMO and PPO plans and Medicare options.
This Capital District Physician’s Health Plan Medicare review will look at the plan options that are available, how to get Capital District Physician’s Health plan quotes, and how the company rates compared to other providers.
Whether you’re just about ready to buy Capital District Physician’s Health Plan Medicare insurance or are just starting your search, it’s important to compare options. Enter your ZIP code to see multiple quotes from top companies before you make a decision.
About Capital District Physician’s Health
Named for the district of New York where it was founded, Capital District Physician’s Health Plan (CDPHP) was founded in 1984 by a group of doctors looking to create a better approach to patient care. Highly locally focused, the company serves more than 300,000 members in specific counties.
Capital offers group plans for employers as well as individual and family plans. They also write several government-sponsored plans including Medicare and Medicaid coverage. They promise quick access to customer service and local representatives. About half of the company’s board members are practicing physicians.
CDPHP offers both HMO and PPO plans for individuals and also has both options for their Medicare Advantage plans. Plans can be purchased online, over the phone, or through local agents. The company’s headquarters is in Albany, NY.
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CDPHP Medicare Plans
CDPHP offers four Medicare Advantage HMO plans and two PPO plans, all of which include prescription drug coverage, and one in each list that can be purchased without the Part D coverage. There are no Capital District Physician’s Health Plan Medicare Supplement plans.
Let’s take a look at the Capital District Physician’s Health Plan Medicare Advantage options.
HMO Plans
The $0 Plan is, as the name implies, a $0-premium plan that will cost you nothing more per month beyond the regular Original Medicare premiums. This plan has a $15 copay for office visits as well as a $50 specialist copay. Inpatient hospital visits have a copay of $450 a day for the first four days.
Dental, hearing, and vision are included, as is prescription coverage. There is a $300 deductible for prescriptions that applies to Tiers 3 and up. Tier 1 drugs start at $3.
Basic Rx has copays of $10 for primary care and $45 for specialist visits. Inpatient hospital visits have a copay of $360 a day for the first five days. Dental, vision, and hearing are included, and there is no prescription drug deductible. Tier 1 drugs again start at $3.
The Value Rx plan has a $15 copay for primary care office visits as well as a $35 copay for specialist visits. The inpatient hospital copay is $295 for the first six days. There is no deductible for prescriptions, which start at $2 for Tier 1, and dental, vision, and hearing are included.
The Choice plan is available either with or without prescription coverage. Primary care visits have a copay of $10 and specialists a copay of $30. Inpatient hospital stays have a copay of $260 a day for the first six days. The plan includes dental, vision, and hearing, and if you choose the Rx option, there is no deductible and prescriptions start at $0 for Tier 1.
PPO Plans
The two PPO plans are the Vital Rx and the Flex/Flex Rx.
Vital Rx is the $0 premium plan with no deductible and no copay for primary care visits. It includes both vision and basic dental. Flex can be purchased with or without the Rx addition. It also has no deductible and no co-pay for primary care and also has both dental and vision coverage.
Capital District Physician’s Health Plan Medicare Rates
CDPHP has reasonable rates, starting with the $0 premium plan and going up to the Choice Rx, which is the most expensive plan at $130.00. Their other plans offer rates in between those two, with every other plan under $100 a month. Both PPO plans are $0 premium unless you choose to add Part D to the Flex Plan.
These rates are not really comparable outside the small area where CDPHP provides their services but based on what we have seen around the country for Medicare Advantage plans, they are on the low side.
Since these are all HMO plans, we do expect the rates to be lower than a PPO due to the more limited provider network and lack of out of network coverage.
Capital District Physician’s Health Plan (CDCHP) Medicare Claims Process
Ease of Filing a Claim
Capital District Physician’s Health Plan (CDPHP) offers multiple convenient methods for filing a claim. Policyholders can submit claims online through the company’s website, over the phone by contacting their customer service, or even through mobile apps designed for this purpose. The variety of options ensures that policyholders can choose the method that suits them best.
Average Claim Processing Time
While specific claim processing times may vary depending on the nature and complexity of the claim, CDPHP is committed to a swift and efficient claims processing system. Policyholders can typically expect their claims to be processed in a reasonable amount of time, ensuring that they receive the benefits and coverage they are entitled to promptly.
Customer Feedback on Claim Resolutions and Payouts
Customer feedback is an essential aspect of evaluating an insurance provider’s claims process. CDPHP has received positive feedback from customers regarding the resolution of their claims and the timeliness of claim payouts. The company’s commitment to customer satisfaction is reflected in its track record of addressing policyholders’ needs effectively.
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Digital and Technological Features of Capital District Physician’s Health Plan (CDCHP) Medicare
Mobile App Features and Functionality
CDPHP offers a user-friendly mobile app that provides policyholders with convenient access to their insurance information. The app offers features such as viewing policy details, checking claim status, and even submitting claims directly through the mobile platform. This enhances the overall customer experience by allowing easy, on-the-go management of insurance matters.
Online Account Management Capabilities
Policyholders can take advantage of CDPHP’s robust online account management system. Through their secure online accounts, customers can access and manage their policies, review claim history, make premium payments, and update personal information. The online portal simplifies policy management, ensuring that customers have easy access to their insurance information.
Digital Tools and Resources
In addition to the mobile app and online account management, CDPHP provides a range of digital tools and resources to support its policyholders. These include educational resources, health and wellness tools, and access to a network of healthcare providers. These digital resources empower policyholders to make informed decisions about their healthcare and insurance coverage.
Capital District Physician’s Health Plan Medicare Ratings and Consumer Reviews
CDPHP has an A+ rating with the Better Business Bureau (BBB), and has only six complaints on file in the past three years. The BBB page does not currently have any reviews for CDPHP.
The National Committee for Quality Assurance rates CDPHP’s Medicare plans at a 4.5 out of 5 overall, with good marks in most areas of consumer satisfaction.
The company also has a 5 out of 5 for their official Medicare star rating for 2021 for PPO plans, and 4.5 out of 5 for HMO plans. That ranks them among the best in the state and nationwide as well.
There are 13 reviews of CDPHP on Yelp for an overall two-star rating. There are some positive reviews mixed with the negative, which mainly cite poor customer service and difficulty with coverage.
We were unable to find much else in the way of reviews, which leaves us with the impression of a company that has a solid reputation.
Capital District Physician’s Health Plan Medicare: The Bottom Line
If you live in the service area and do not mind the limitations of an HMO, CDPHP plans may be a good choice for you. The rates are reasonable even with low copays, and the plans come with plenty of benefits. CDPHP seems to have a great reputation and little in the way of complaints, which adds up to a good value.
Now that you’ve looked at affordable Capital District Physician’s Health Plan Medicare insurance options, see if there’s a better deal out there. Enter your ZIP code to compare rates today.
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Frequently Asked Questions
What is Capital District Physician’s Health Plan (CDPHP) Medicare Insurance?
Capital District Physician’s Health Plan (CDPHP) Medicare Insurance is a health insurance company that offers Medicare Advantage plans, Medicare Supplement plans, and prescription drug plans to eligible individuals in certain counties of New York.
What types of Medicare plans does CDPHP offer?
CDPHP offers several Medicare plans, including Medicare Advantage plans, Medicare Supplement plans, and standalone Medicare Part D prescription drug plans.
What are some of the benefits of CDPHP Medicare Advantage plans?
CDPHP Medicare Advantage plans offer comprehensive coverage for medical and prescription drug costs, as well as additional benefits like vision, dental, and hearing coverage. Some plans also offer fitness and wellness programs.
Can I enroll in a CDPHP Medicare plan if I live outside of New York?
No, CDPHP only offers Medicare plans to eligible individuals in certain counties of New York.
What are some common complaints about CDPHP Medicare Insurance?
Some common complaints about CDPHP Medicare Insurance include difficulty navigating the website and finding plan information, limited provider networks, and denial of claims.
How do I file a complaint with CDPHP Medicare Insurance?
If you have a complaint about your CDPHP Medicare plan, you can contact the company’s customer service department by phone or email. You can also file a complaint with the New York State Department of Financial Services.
Can I switch to a different Medicare plan if I am not satisfied with CDPHP?
Yes, you can switch to a different Medicare plan during the Annual Enrollment Period (AEP) or during a Special Enrollment Period (SEP) if you experience a qualifying life event. It is important to research and compare plans before making a switch to ensure you are choosing the best plan for your needs.
Are you looking for free insurance quotes?
Your one-stop online insurance guide. Get free quotes now!
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Shawn Laib
Insurance and Finance Writer
Since graduating from the University of WA with a B.A. in English Literature, Shawn has been professionally writing in the spheres of entertainment, insurance, business, marketing, and politics. He is passionate about using his writing skills and insurance knowledge to educate the general population on everyday issues surrounding these misunderstood topics. His work has been published on SUPERJ...
Insurance and Finance Writer
Editorial Guidelines: We are a free online resource for anyone interested in learning more about insurance. Our goal is to be an objective, third-party resource for everything insurance related. We update our site regularly, and all content is reviewed by insurance experts.