Plan vs plan · Monroe County, NY · 2027 plan year
Wellcare Fidelis Simple (HMO-POS) vs Aetna Medicare Eagle Giveback (PPO)
Medicare.gov compares Medicare Advantage plans with each other. This page also shows Original Medicare, so you can see the full trade-off: premiums, copays, the yearly limit, extra benefits, and the rules about doctors and approvals.
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Wellcare Fidelis Simple (HMO-POS)
- Plan premium
- $0 a month
- Yearly limit, in network
- $9,850
- 2027 star rating
- 3 of 5
- Prior authorization needed for
- 20 services
Aetna Medicare Eagle Giveback (PPO)
- Plan premium
- $0 a month
- Yearly limit, in network
- $9,850
- 2027 star rating
- 4 of 5
- Prior authorization needed for
- 19 services
In New York, you can go back to Medigap later
New York requires Medigap companies to sell you a plan at any time of year, and your health does not change the price. So you can try Medicare Advantage and go back to Original Medicare with Medigap later.
Read about Medigap rights on Medicare.govYour yearly cost, side by side
Move the controls to match your year. Totals include premiums, the Part B premium, copays, and drug costs.
Want to check your exact drugs? Medicare.gov lets you enter each drug and shows what each plan charges for it. Enter your drugs on Medicare.gov
New York Department of Financial Services, community rated Medicare Supplement premiums (in effect as of October 1, 2026) lists $265 to $601 a month for a 65-year-old woman who does not use tobacco. We start at the lowest price. Health questions can raise the price after your first 6 months with Part B.
Original Medicare
With Medigap Plan G at $265 a month and Wellcare Value Script (PDP)
$8,606 a year
- Premiums
- $6,139
- Medical costs
- $292
- Drugs
- $2,175
Most you can pay in a bad year, before drugs: $6,431.
Wellcare Fidelis Simple (HMO-POS)
HMO-POS from Wellcare
$6,566 a year
- Premiums
- $2,514
- Medical costs
- $1,877
- Drugs
- $2,175
Most you can pay in a bad year, before drugs: $12,364.
Aetna Medicare Eagle Giveback (PPO)
PPO from Aetna Medicare
$9,431 a year
- Premiums
- $1,314
- Medical costs
- $1,085
- Drugs
- $7,032
Most you can pay in a bad year, before drugs: $11,164. This plan has no drug coverage, and its members cannot add a separate drug plan. We count drugs at full price. People often pick it when they get drugs from the VA, TRICARE, or an employer.
With these settings, Wellcare Fidelis Simple (HMO-POS) costs about $2,041 less a year than Original Medicare.
Tipping point for Wellcare Fidelis Simple (HMO-POS): with this drug use, if your medical copays and coinsurance in this plan pass $3,917 in a year, Original Medicare with Plan G costs less. The plan caps those costs at $9,850.
Tipping point for Aetna Medicare Eagle Giveback (PPO): with this drug use, if your medical copays and coinsurance in this plan pass $260 in a year, Original Medicare with Plan G costs less. The plan caps those costs at $9,850.
These are estimates, not quotes. Check every number with Medicare (Medicare.gov or 1-800-MEDICARE) and with the plan before you choose. What you pay depends on your doctors and hospitals, your drugs and pharmacy, and the care you use. Drug costs use typical prices for generic and brand-name drugs. Original Medicare amounts are 2027 projections from the 2026 Medicare Trustees Report. CMS sets the final amounts in November.
Text us about this comparisonWhat you pay each time you get care
In-network costs for one visit or one stay. The Original Medicare amounts follow your Medigap choice above: Plan G.
Primary doctor visit
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
Wellcare Fidelis Simple (HMO-POS)
$0
Aetna Medicare Eagle Giveback (PPO)
$0
Specialist visit
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
Wellcare Fidelis Simple (HMO-POS)
$50
Prior authorizationAetna Medicare Eagle Giveback (PPO)
$0-$35
Lab tests
Original Medicare + Medigap Plan G
$0
most Medicare-covered tests
Wellcare Fidelis Simple (HMO-POS)
$0-$50
Prior authorizationAetna Medicare Eagle Giveback (PPO)
$0
Prior authorization
MRI or CT scan
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
Wellcare Fidelis Simple (HMO-POS)
0%-30%
Prior authorizationAetna Medicare Eagle Giveback (PPO)
$0-$300
Prior authorization
Emergency room
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
Wellcare Fidelis Simple (HMO-POS)
$115
Aetna Medicare Eagle Giveback (PPO)
$115
Urgent care
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
Wellcare Fidelis Simple (HMO-POS)
$40
Aetna Medicare Eagle Giveback (PPO)
$40
Outpatient surgery
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
Wellcare Fidelis Simple (HMO-POS)
$475
Prior authorizationAetna Medicare Eagle Giveback (PPO)
$0-$300
Prior authorization
Ground ambulance
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
Wellcare Fidelis Simple (HMO-POS)
$320
Prior authorizationAetna Medicare Eagle Giveback (PPO)
$300
Prior authorization
Hospital stay, 5 days
Original Medicare + Medigap Plan G
$0
Plan G pays the $1,788 Part A deductible
Wellcare Fidelis Simple (HMO-POS)
$2,400
for a 5-day stay
Prior authorizationAetna Medicare Eagle Giveback (PPO)
$1,875
for a 5-day stay
Prior authorization
See every cost in one table
| What you pay in network | Original Medicare + Medigap Plan G | Wellcare Fidelis Simple (HMO-POS) | Aetna Medicare Eagle Giveback (PPO) |
|---|---|---|---|
| Monthly premium | Part B $209.50 + Medigap Plan G $265 + drug plan $37.30 | $0 + Part B $209.50 | $0 (pays back $100 a month of your Part B premium) + Part B $209.50 |
| Yearly limit on what you pay | You pay the $292 Part B deductible. Plan G pays the rest. | $9,850 in network | $9,850 in network; $14,800 in and out of network |
| Medical deductible | $292 Part B. Plan G pays the $1,788 Part A deductible. | $430 | $0 |
| Primary doctor visit | $0, after the $292 yearly Part B deductible | $0 copay | $0 copay |
| Specialist visit | $0, after the $292 yearly Part B deductible | $50 copayPrior authorization | $0-$35 copay |
| Lab tests | $0, most Medicare-covered tests | $0-$50 copayPrior authorization | $0 copayPrior authorization |
| MRI or CT scan | $0, after the $292 yearly Part B deductible | 0%-30% coinsurancePrior authorization | $0-$300 copayPrior authorization |
| X-rays | $0, after the $292 yearly Part B deductible | $50 copayPrior authorization | $35 copayPrior authorization |
| Emergency room | $0, after the $292 yearly Part B deductible | $115 copay | $115 copay |
| Urgent care | $0, after the $292 yearly Part B deductible | $40 copay | $40 copay |
| Outpatient hospital | $0, after the $292 yearly Part B deductible | 0%-30% coinsurancePrior authorization | $0-$350 copayPrior authorization |
| Surgery center | $0, after the $292 yearly Part B deductible | $475 copayPrior authorization | $0-$300 copayPrior authorization |
| Ground ambulance | $0, after the $292 yearly Part B deductible | $320 copayPrior authorization | $300 copayPrior authorization |
| Hospital stay | $0, Plan G pays the $1,788 Part A deductible | $600 per day for days 1-4; $0 per day for days 5-90Prior authorization | $375 per day for days 1-6; $0 per day for days 7-90Prior authorization |
| Skilled nursing facility | $0, Plan G pays days 21-100 | $0 per day for days 1-20; $221 per day for days 21-70; $0 per day for days 71-100Prior authorization | $0 per day for days 1-20; $218 per day for days 21-100Prior authorization |
| Mental health visit | $0, after the $292 yearly Part B deductible | $35 copayPrior authorization | $35 copayPrior authorization |
| Physical therapy | $0, after the $292 yearly Part B deductible | $35 copayPrior authorization | $25 copay |
| Home health care | $0, Medicare-covered home health | $0 copayPrior authorization | $0 copayPrior authorization |
| Medical equipment | $0, after the $292 yearly Part B deductible | 20% coinsurancePrior authorization | 20% coinsurancePrior authorization |
| Part B drugs | $0 after the $292 Part B deductible | 0%-20% coinsurancePrior authorization | 0%-20% coinsurancePrior authorization |
| Drug deductible (Part D) | $700 with Wellcare Value Script (PDP) | $700 | No drug coverage |
| Drug tiers (one month, retail) | Generic: $0 copayPreferred Brand: 25% coinsuranceNon-Preferred Drug: 39% coinsuranceInjectable Drugs: 15% coinsuranceSpecialty Tier: 25% coinsuranceSelect Care Drugs: $11 copay | Generic: $0 copayPreferred Brand: 25% coinsuranceNon-Preferred Drug: 37% coinsuranceInjectable Drugs: 1% coinsuranceSpecialty Tier: 25% coinsuranceSelect Care Drugs: $0 copay | No drug coverage |
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A higher drug plan premium is not, by itself, a reason to switch
With Original Medicare, you buy a separate drug plan. In New York, 9 drug plans are for sale for 2027, from $37.30 to $238.30 a month. Half of them cost $169.30 a month or less.
- Every 2027 drug plan limits what you pay for covered drugs to $2,400 a year. The drug coverage in Medicare Advantage plans has the same limit.
- The premium is one part of your yearly cost. The calculator above adds premiums, medical costs, and drug costs, so you can see the whole year.
- A Medicare Advantage plan can cost less in a light year. But you also take on its network and prior authorization rules.
- If your income is limited, Extra Help can pay most of your drug plan premium and drug costs. Check Extra Help at SSA.gov
Doctors, referrals, and prior authorization
Cost is one side. The other side is how you get care. These rules come from the CMS plan files. Prior authorization means the plan must approve a service before you get it.
Original Medicare
- Any doctor or hospital in the U.S. that takes Medicare
- No referrals
- Prior authorization only for a short list of services
Wellcare Fidelis Simple (HMO-POS)
HMO-POS
- You use the plan network. Some care outside the network is covered at a higher cost.
- You need a referral to see a specialist.
Prior authorization for 20 services
Specialist visits, Diagnostic tests, MRI or CT, Radiation therapy, Outpatient hospital, Surgery center, Ambulance, Mental health visits, Psychiatrist visits, Physical therapy, Occupational therapy, Home health, Partial hospitalization, Medical equipment, Prosthetics, Diabetic supplies, Substance use care, Hospital stay, Skilled nursing, Part B drugs
Aetna Medicare Eagle Giveback (PPO)
PPO
- The plan has a network. You can go outside it, but you pay more.
- No referral needed to see a specialist.
Prior authorization for 19 services
Diagnostic tests, MRI or CT, Radiation therapy, Outpatient hospital, Observation stay, Surgery center, Ambulance, Mental health visits, Psychiatrist visits, Home health, Partial hospitalization, Medical equipment, Prosthetics, Diabetic supplies, Dialysis, Substance use care, Hospital stay, Skilled nursing, Part B drugs
Extra benefits
| Extra benefit | Original Medicare | Wellcare Fidelis Simple (HMO-POS) | Aetna Medicare Eagle Giveback (PPO) |
|---|---|---|---|
| Dental | No | Preventive only | Comprehensive, up to $2,000 a year |
| Eye exam | No | Yes | Yes |
| Glasses or contacts | No | No | Yes, $375 allowance |
| Hearing aids | No | No | Yes, copays from $0 |
| Over-the-counter allowance | No | No | $240 a year |
| Fitness benefit | No | No | Yes |
| Rides to care | No | No | No |
| Meals after a hospital stay | No | No | Yes |
| Emergency care abroad | Plan G and Plan N pay 80% after a $250 deductible | Yes | Yes |
| Part B premium giveback | No | No | $100 a month |
What changed for 2027
Wellcare Fidelis Simple (HMO-POS)
Consolidated Renewal Plan · 2026 plan H4868-019-0
- In-network out-of-pocket maximum up from $9,250 to $9,850
- Medical deductible up from $150 to $430
- Drug deductible up from $615 to $700
- Specialist visit: $25 copay to $50 copay
- Outpatient hospital: $0 copay, 30% coinsurance to 0%-30% coinsurance
- Ground ambulance: $340 copay to $320 copay
- Skilled nursing facility: $0 per day for days 1-20; $218 per day for days 21-70; $0 per day for days 71-100 to $0 per day for days 1-20; $221 per day for days 21-70; $0 per day for days 71-100
- Eyewear removed
- Hearing aids removed
- Fitness benefit removed
Aetna Medicare Eagle Giveback (PPO)
Renewal Plan · 2026 plan H5521-323-0
- In-network out-of-pocket maximum up from $9,250 to $9,850
- Part B giveback up from $75 to $100
- Eyewear allowance up from $250 to $375
- Overall star rating down from 4.5 to 4
More 2027 plans in Monroe County
- Medicare Blue Choice Core (HMO), H3351-022
- Medicare Blue Choice Prime (HMO-POS), H3351-023
- Wellcare Fidelis Assist (HMO-POS), H5599-002 (page for Kings County, NY)
- VNS Health EasyCare (HMO), H5549-012 (page for Kings County, NY)
- MVP Medicare Preferred Gold with Part D (HMO-POS), H3305-015 (page for Erie County, NY)
- Aetna Medicare Elite (PPO), H5521-521
- Medicare Blue Choice Optimum (HMO-POS), H3351-006
- Medicare Blue Choice Freedom (HMO-POS), H3351-007
County guide: 2027 plans in Monroe CountyState guide: New York
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Sources and method
Plan data comes from the CMS 2027 Plan Benefit Package and landscape files. The data is from 2026-10-10. We checked a sample of plans field by field against Medicare.gov. Original Medicare amounts are the 2027 projections in the 2026 Medicare Trustees Report (Tables V.E1 and V.E2). CMS sets the final amounts in November. Medigap prices come from New York Department of Financial Services, community rated Medicare Supplement premiums (in effect as of October 1, 2026), pulled 2026-10-13. They are for the price area that includes ZIP 14420. Totals use typical Medicare-allowed amounts for each service and typical drug prices.
- Wellcare Fidelis Simple (HMO-POS) on Medicare.gov · plan website · drug list · doctor directory
- Aetna Medicare Eagle Giveback (PPO) on Medicare.gov · plan website · drug list · doctor directory
- Medigap prices: New York Department of Financial Services, community rated Medicare Supplement premiums (in effect as of October 1, 2026)
- CMS Plan Benefit Package files, 2027
- CMS 2027 landscape files (premiums and limits)
- CMS 2027 plan crosswalk
- CMS 2027 Star Ratings
- 2026 Medicare Trustees Report: projected 2027 Part A and Part B amounts (Tables V.E1 and V.E2)
- CMS 2026 Part A and Part B amounts
- Medicare.gov: Medigap guaranteed issue rights
These are estimates, not quotes, and they are for education only. Check every number with Medicare and with the plan before you choose. What you pay depends on your doctors and hospitals, your drugs and pharmacy, and the care you use. Plans can change their benefits, premiums, drug lists, and networks each year.
Pinnie is not an insurance agent or broker and does not sell Medicare plans. Pinnie is not connected with or endorsed by the U.S. government or the federal Medicare program. For all your options, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.