Capital District Physician’s Health Plan (CDCHP) Medicare Insurance Review & Complaints: Health Insurance

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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Eric Stauffer is a former insurance agent and banker turned consumer advocate. His priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best place to get it.

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Leslie Kasperowicz holds a BA in Social Sciences from the University of Winnipeg. She spent several years as a Farmers Insurance CSR, gaining a solid understanding of insurance products including home, life, auto, and commercial and working directly with insurance customers to understand their needs. She has since used that knowledge in her more than ten years as a writer, largely in the insuranc...

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Reviewed by Leslie Kasperowicz
Farmers CSR for 4 Years

UPDATED: Nov 2, 2020

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Capital District Physicians Health Plan

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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 Medicare Claims

As is common to health insurance companies, CDPHP handles claims directly with the provider. It is rare that an insured would be involved with the process of filing a claim, although in the event that a claim is denied they would be involved in the appeal process.

Though there really is not much in the way of claims information on the company’s website, this is standard for Medicare.

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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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