EmblemHealth for Medicare Beneficiaries

     

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EmblemHealth Essential (HMO) is a Medicare Advantage plan, coordinated by in-network doctors. The EmblemHealth Essential plan offers all the benefits of Original Medicare with $0 copayments for primary care physicians (PCPs) and $25 copayments for specialists, plus Part D prescription drug coverage. If you join this plan, you must choose a PCP from the Essential provider network, which is part of our larger HMO network. Your specialist can be from the Essential provider network or from our larger HMO provider network.

The EmblemHealth VIP (HMO) is a Medicare Advantage plan, coordinated by in-network doctors. It offers all the benefits of Original Medicare with low copayments for primary care physicians (PCPs), specialists, inpatient hospital stays, plus Part D prescription drug coverage. You have access to any of the providers within our extensive HMO provider network.

The EmblemHealth VIP High Option (HMO) is a Medicare Advantage plan, coordinated by in-network doctors. For a set monthly premium, EmblemHealth VIP High Option offers all the benefits of Original Medicare with $0 copayments for most medical benefits, plus Part D prescription drug coverage. If you join this plan, you must choose a PCP from the Essential provider network, which is part of our larger HMO network. Your specialist can be from the Essential provider network or from our larger HMO provider network.

EmblemHealth Essential (HMO) is a Medicare Advantage plan, coordinated by in-network doctors. The EmblemHealth Essential plan offers all the benefits of Original Medicare with $0 copayments for primary care physicians (PCPs) and $10 copayments for specialists, plus Part D prescription drug coverage. If you join this plan, you must choose a PCP from the Essential provider network, which is part of our larger HMO network. Your specialist can be from the Essential provider network or from our larger HMO provider network.

The EmblemHealth VIP (HMO) is a Medicare Advantage plan, coordinated by in-network doctors. It offers all the benefits of Original Medicare with low copayments for primary care physicians (PCPs), specialists, inpatient hospital stays, plus Part D prescription drug coverage. You have access to any of the providers within our extensive HMO provider network.

The EmblemHealth VIP High Option (HMO) is a Medicare Advantage plan, coordinated by in-network doctors. For a set monthly premium, EmblemHealth VIP High Option offers all the benefits of Original Medicare with $0 copayments for most medical benefits, plus Part D prescription drug coverage. If you join this plan, you must choose a PCP from the Essential provider network, which is part of our larger HMO network. Your specialist can be from the Essential provider network or from our larger HMO provider network.

EmblemHealth PPO I is a Medicare Advantage plan, designed with in and out-of-network flexibility. No referral is needed. EmblemHealth PPO I offers all the benefits of Original Medicare, plus $5 in-network copayments for primary care physicians (PCPs) and $20 in-network copayments for specialists. This plan does not include Part D prescription drug coverage. EmblemHealth PPO I may be ideal for someone who already has creditable Part D coverage such as VA benefits or group drug coverage.

EmblemHealth Advantage (PPO) is a Medicare Advantage plan, designed with in and out-of-network flexibility. No referral is needed. EmblemHealth Advantage (PPO) offers all the benefits of Original Medicare, plus $5 in-network copayments for primary care physicians (PCPs) and $40 in-network copayments for specialists plus Part D prescription drug coverage.

EmblemHealth PPO I is a Medicare Advantage plan, designed with in and out-of-network flexibility. No referral is needed. EmblemHealth PPO I offers all the benefits of Original Medicare, plus $0 in-network copayments for primary care physicians (PCPs) and $15 in-network copayments for specialists. This plan does not include Part D prescription drug coverage. EmblemHealth PPO I may be ideal for someone who already has creditable Part D coverage such as VA benefits or group drug coverage.

EmblemHealth PPO II is a Medicare Advantage plan, designed with in and out-of-network flexibility. No referral is needed. EmblemHealth PPO II offers all the benefits of Original Medicare, plus $0 in-network copayments for primary care physicians (PCPs) and $35 in-network copayments for specialists plus Part D prescription drug coverage.

EmblemHealth PPO III is a Medicare Advantage plan, designed with in and out-of-network flexibility. No referral is needed. EmblemHealth PPO III offers all the benefits of Original Medicare, plus $0 in-network copayments for primary care physicians (PCPs) and $15 in-network copayments for specialists, plus Part D prescription drug coverage. Pay only $2 copayment for Preferred Generic drugs and $10 copayment for Non-Preferred Generic drugs through the Coverage Gap.

The EmblemHealth Dual Eligible Special Needs plan is for people who have both Medicare and some level of Medicaid, or are in a Medicare Savings Program.


The EmblemHealth Dual Eligible Special Needs plan is for people who have both Medicare and some level of Medicaid, or are in a Medicare Savings Program. As a EmblemHealth Dual Eligible (HMO SNP) plan member, you have $0 copayments for covered services (based on level of Medicaid) and have a reduced premium and drug cost based on your LIS level. EmblemHealth Dual Eligible (HMO SNP) plan covers all the benefits of Original Medicare and include Part D prescription drug coverage, dental, hearing, vision, and a $480 medications debit card for over-the-counter drugs.

The EmblemHealth Dual Eligible (PPO SNP) is a Special Needs plan available to people who have both Medicare and some level of Medicaid, or are in a Medicare Savings Program and like the flexibility to go in and out-of network. As a EmblemHealth Dual Eligible (PPO SNP) plan member, you may have $0 copayments for covered services(based on level of Medicaid) and reduced premium and prescription drug costs based on your Low Income Subsidy (LIS) level. A EmblemHealth Dual Eligible (PPO SNP) plan covers all the benefits of Original Medicare and includes Part D prescription drug coverage, dental, hearing, vision and a $240 medications debit card for over-the-counter drugs.

The EmblemHealth Dual Eligible Special Needs plan is for people who have both Medicare and some level of Medicaid, or are in a Medicare Savings Program.

The EmblemHealth Dual Eligible Special Needs plan is for people who have both Medicare and some level of Medicaid, or are in a Medicare Savings Program. As a EmblemHealth Dual Eligible (HMO SNP) plan member, you have $0 copayments for covered services and have a reduced premium and drug cost based on your LIS level. EmblemHealth Dual Eligible (HMO SNP) plan covers all the benefits of Original Medicare and include Part D prescription drug coverage, dental, hearing, vision, and a $540 medications debit card for over-the-counter drugs.

The EmblemHealth Dual Eligible (PPO SNP) is a Special Needs plan available to people who have both Medicare and some level of Medicaid, or are in a Medicare Savings Program and like the flexibility to go in and out-of network. As a EmblemHealth Dual Eligible (PPO SNP) plan member, you may have $0 copayments for covered services(based on level of Medicaid) and reduced premium and prescription drug costs based on your Low Income Subsidy (LIS) level. A EmblemHealth Dual Eligible (PPO SNP) plan covers all the benefits of Original Medicare and includes Part D prescription drug coverage, dental, hearing, vision and a $300 medications debit card for over-the-counter drugs.

EmblemHealth offers a Part D prescription drug program to help you cover needs.

EmblemHealth MLTC plans are about helping you live independently and safely in your home. With our MLTC plans, you only have to make one call to coordinate all of your care.

EmblemHealth MLTC Plus (HMO SNP) provides you with managed long-term care services at no additional cost when you enroll in our EmblemHealth Medicare Advantage plan, based on your meeting the eligibility requirements for these additional benefits. Our plan includes: $0 copay for primary care providers (PCPs) and specialists, $0 copay for hospital stays, and prescription drug coverage. You also receive a $480 medications debit card for purchasing over-the-counter drugs.

EmblemHealth MLTC plans are about helping you live independently and safely in your home. With our MLTC plans, you only have to make one call to coordinate all of your care.

EmblemHealth MLTC Plus provides you with managed long-term care services at no additional cost when you enroll in our Medicare EmblemHealth Dual Eligible (HMO SNP) plan, based on your meeting the eligibility requirements for these additional benefits. Our EmblemHealth Dual Eligible (HMO SNP) plan includes: $0 copay for primary care providers (PCPs) and specialists, $0 copay for hospital stays, and prescription drug coverage. You also receive a $540 medications debit card for purchasing over-the-counter drugs.

Eligible 1199SEIU retirees in New York City, Nassau and Suffolk County can now get comprehensive health benefits through EmblemHealth's 1199SEIU VIP Premier (HMO) Medicare Plan.

Choose from two different benefit options:

  • Select Network Plan
    Lower your copayments and increase your benefits by choosing a Select Network primary care physician and using Select Network providers.
  • Fee-for-Service Benefit Plan
    Get access to a wider network of providers by paying slightly higher out-of-pocket costs.

Eligible 1199SEIU retirees in New York City, Nassau and Suffolk County can now get comprehensive health benefits through EmblemHealth's 1199SEIU VIP Premier (HMO) Medicare Plan.

Choose from two different benefit options:

  • Select Network Plan.
    Lower your copayments and increase your benefits by choosing a Select Network primary care physician and using Select Network providers.
  • Fee-for-Service Benefit Plan.
    Get access to a wider network of providers by paying slightly higher out-of-pocket costs.


EmblemHealth offers a variety of Supplement Plans if you choose not to select a Medicare Advantage plan.

EmblemHealth offers a variety of Supplement Plans if you choose not to select a Medicare Advantage plan.

Understanding Medicare Insurance

This section gives you easy-to-understand information on Medicare coverage. And if you have questions, call us. We're here for you.  

What is Medicare Insurance?

Why Medicare Advantage?

Frequently Asked Questions


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The EmblemHealth Difference in Medicare Coverage

We’re New Yorkers too. In fact, we have been bringing quality health care coverage to the New York community for over 75 years. We live here and work here just like you do, so we understand how complex health care can be –that’s why we’re here to help. Learn more about what makes us unique to New York and start getting the Medicare insurance benefits you deserve.

Network Information

Care for the Family Caregiver

Health and Wellness

Neighborhood Care

Small Steps

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Enroll In a Medicare Plan

You've looked at your health insurance options, and now you’re ready to enroll. We want to make the process as easy as possible for you. This section outlines your three EmblemHealth Medicare Advantage Plan enrollment options.


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Who to Contact if You Have Questions or Concerns

If you have any questions or concerns, you should contact:

  • EmblemHealth Medicare HMO Customer Service at 1-877-344-7364
    (TTY/TDD: 711), Monday through Sunday, from 8 am to 8 pm.
  • EmblemHealth Medicare PPO Customer Service at 1-866-557-7300
    (TTY/TDD: 711), Monday through Sunday, from 8 am to 8 pm.
  • EmblemHealth Medicare PDP Customer Service at 1-877-444-7241
    (TTY/TDD: 711), Monday through Sunday, from 8 am to 8 pm.
  • EmblemHealth Medicare Supplement Insurance Plans Sales at 1-866-287-7151
    (TTY/TDD: 711), Monday through Sunday, from 8 am to 8 pm.

There are also other ways to contact us. You can also contact Medicare directly about your health plan or prescription drug plan. Before you contact Medicare directly, we encourage you to call EmblemHealth Customer Service at the numbers listed above. EmblemHealth is responsible for resolving all of your issues related to your health plan and prescription drug plan coverage.



Disclaimers

HIP Health Plan of New York (HIP) is a HMO plan with a Medicare contract. Group Health Incorporated (GHI) is a PPO plan and a standalone  PDP with a Medicare contract. Enrollment in HIP and GHI depends on contract renewal. HIP and GHI are EmblemHealth companies.

All Medicare Advantage Plans and Medicare Prescription Drug Plans agree to stay in the program for a full calendar year at a time. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1 of each year. Each year, plans can decide whether to continue to participate with Medicare Advantage or Medicare Prescription Drug Plans. A plan may continue in their entire service area (geographic area where the plan accepts members) or choose to continue only in certain areas. Also, Medicare may decide to end a contract with a plan. Even if your Medicare Advantage Plan or Prescription Drug Plan leaves the program, you will not lose Medicare coverage. If a plan decides not to continue for an additional calendar year, it must send you a letter at least 90 days before your coverage will end. The letter will explain your options for Medicare coverage in your area.


The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on January 1 of each year.

EmblemHealth Dual Eligible (HMO SNP) and EmblemHealth Dual Eligible (PPO SNP) plans are available to anyone who has both Medical Assistance from the State and Medicare. Premiums, copays, coinsurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.


 

 
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