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CDPHP was founded in 1984 by a group of doctors in the Capital District area of New York, as the name implies. The plan was founded with the goal of creating a better model of patient care. Today, the plan covers a list of counties in New York, providing local care to over 300,000 members.
CDPHP offers plans for employers as well as plans that can be purchased directly for individuals and families. They also offer specialty plans such as child health, and government sponsored Medicaid and Medicare. The company has made efforts to enhance the member experience with many online tools such as the Personal Health Assessment.
Plans can be purchased directly through the company, or through affiliated brokers and independent agents. The headquarters are located in Albany, NY, but the company serves a large portion of the state.
CDPHP offers a selection of Medicare Advantage plans. These are all HMO plans, and coverage varies from county to county. For the purpose of this review, we selected the county in which the company headquarters is located. This gave us results that include three plans with Part D coverage and one plan that does not include Part D. All of the plans have a $0 deductible.
The base plan is the CDPHP Basic Rx. Co pays under this plan are $15 for an office visit and $50 for a specialist visit. Inpatient hospital is covered with a $360 per day co pay for the first five days of each admission. Prescription drug co pays are $3 for Tier 1, $15 for Tier 2 and $47 for Tier 3. Tier 4 has a $100 co pay and tier 5 has a coinsurance amount of 33%. There is no deductible for prescription coverage.
The Value Rx Plan has a higher co pay for office visits at $25, and a lower co pay for specialists at $40. Inpatient hospital also has a lower co pay of $255 per day, although this payment is required for the first six days rather than the first five. Prescription drug co pays are slightly lower: Tier 1 is $2, Tier 2 $13, and Tier 3 is $45. Tier 4 has a $97 co pay and the same 33% coinsurance applies.
The most expensive plan, the Choice Rx plan, has a $20 co pay for office visits and a $35 co pay for specialist visits. The inpatient hospital per-day cost is $225 for the first six days. Prescription drugs are a bit lower still, with a $0 co pay for Tier 1. Tier 2 drugs are $11, Tier 3 $42, and Tier 4 $90, with Tier 5 at the same cost as the other two plans. Since this plan is much more expensive than the others, it’s surprising that the co pays are not lower.
The Choice plan is also available without Part D coverage. All of the co pays and benefits are the same, but at a lower premium due to the lack of prescription drug coverage.
All of the plans include limited dental, vision, and hearing benefits. However, co pays vary from plan to plan, with the highest being the Basic plan and lowest on the Choice plan.
As noted, all of the plans are HMOs, which means a more limited network of providers than a PPO or even an HMO-POS. This generally means lower premiums as well. If you have an existing relationship with a doctor, you will need to verify whether or not you will be able to continue seeing that doctor under an HMO plan. CDPHP offers a provider search to assist you.
Since this company covers only a small region, it is not possible to provide a price comparison. However, the CDPHP website does make it simple to obtain rates, which will assist local shoppers in making their choice.
There is no $0 premium plan offered by this company, which is unusual, particularly for an HMO plan. The lowest priced plan is the Basic, which is quoted at $36 per month. The Value plan is $60 per month, and the Choice Rx plan $124. The Choice plan without the Rx coverage is considerably cheaper at $45 per month.
Overall, these rates are affordable given the relatively low co pays, particularly for prescription drugs. We do find the office visit co pays to be a little higher that we would expect for an HMO, but without a direct comparison to other local insurers on the same level, it’s difficult to say.
Ratings and Reviews
The Better Business Bureau gives Capital District an A+ rating. There have been a total of five complaints against the company in the past three years, and two of those were closed in the past 12 months.
CDPHP Medicare Health plans have received a 4.5 star rating across the board from the Centers for Medicare and Medicaid, the official rating system for Advantage plans.
The National Committee for Quality Assurance has rated the company at a full five stars, and they appear to be rated highly for most factors, notably in the customer experience categories. This is worth mentioning since many insurers manage a good rating from this service even with poor customer services ratings, due to good performance in other areas.
There are ten reviews of the health plan and its services on Yelp. These are a mix of negative and positive, with most negative complaints referring to difficulty in finding a provider and coverage issues.
Overall, the ratings and reviews of CDPHP paint a fairly positive picture.
The Bottom Line
CDPHP has affordable Medicare plans available to those within their service area. They are likely to appeal to those who prefer a small, local insurer, and don’t have a problem with the provider limitations of an HMO. The company has a good reputation and its Medicare plans are highly rated, making them well worth considering when shopping for Advantage coverage.
For a list of companies that we recommend, visit our Best Insurance Companies page.