2026 Medicare plan code

H5042-802-000

CDPHP Group Medicare Rx (PPO) · CDPHP Medicare Advantage · Greater Capital Region of New York State

Compact plan code: H5042802000

2026

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2026 plan record

CDPHP Group Medicare Rx (PPO)

H5042-802-000 Greater Capital Region of New York State Local PPO Employer-only
Open in quick lookup
01

In-network

Inpatient hospital

inpatient coinsurance is selected but its percentage is missing

02

Emergency transport

Ambulance

Ground · in-network20% coinsurance
Air · in-network20% coinsurance
03

Emergency services

Emergency room

20% coinsurance

Waived if admitted

04

Medical maximum

Maximum out-of-pocket

In-network$6,700
Combined in + out$10,000
05

Skilled care at home

Home health

In-network0% coinsurance
Out-of-network0% coinsurance
06

Monthly cost

Premium & giveback

Part C premiumNot reported
Consolidated C + DNot reported

Source trail

Official CMS, Contract Year 2026

Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release. Quick-reference values should be confirmed in current official plan documents.

About this code

What H5042-802-000 identifies

H5042-802-000 is a Contract Year 2026 Medicare plan segment code. The compact form H5042802000 refers to the same normalized contract, plan, and segment shown on this page.

Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.