EmblemHealth for Medicare Beneficiaries

Medicare Exercise Couple

     


EmblemHealth VIP Essential (HMO) provides in-Network coverage from providers in our Medicare Essential Network, which includes leading primary and specialty care doctors and hospitals. For a $0 premium to a low premium this plan offers all of the benefits of Original Medicare with $10 copayments for primary care physicians (PCPs) and $35 copayments for specialists. You will also receive benefits such as comprehensive dental, hearing aids, vision and access to SilverSneakers® membership plus Part D prescription drug coverage.

EmblemHealth VIP Gold (HMO) is a Medicare Advantage plan, coordinated by doctors in our extensive VIP Prime Network. It offers all of the benefits of Original Medicare with $0 copayments for primary care physician (PCPs) and $25 copayments for specialists. You will also receive benefits such as comprehensive dental, hearing aids, vision and access to SilverSneakers® membership plus Part D prescription drug coverage.

EmblemHealth VIP Gold Plus (HMO) provides in-Network coverage from providers in our extensive VIP Prime Network, which includes leading primary and specialty care doctors and hospitals. This plan offers all of the benefits of Original Medicare with $0 copayments for some medical benefits such as primary care physicians (PCPs), specialists, and urgent care services. You will also receive benefits such as comprehensive dental, hearing aids, vision and access to SilverSneakers® membership plus Part D prescription drug coverage.

EmblemHealth VIP Dual (HMO SNP) is a special needs plan for beneficiaries who are enrolled in New York State Medicaid. This plan is coordinated by doctors in our extensive VIP Prime Network. Our special needs plan covers all the benefits of Original Medicare and includes Part D prescription drug coverage. You will have $0 copayments for covered services and a $0 premium based on your Low Income Subsidy (LIS) level. Under this plan, you will receive benefits such as comprehensive dental, hearing aids, vision and additional benefits such as 48 acupuncture visits and a $720 over-the-counter items debit card.

Eligible 1199SEIU retirees in New York City, Nassau, Suffolk and Westchester 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

Moving from a Marketplace or SHOP Plan to a Medicare Plan

Learn More

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

Learn More

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.


Enroll Now

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 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 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. 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.


This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare part B premium. Our Medicare Special Needs Plan is for people with both Medicare and Medicaid. Your eligibility to enroll in this plan may depend on your Medicaid status. Premium, copays, coinsurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

ATTENTION: If you speak other languages, language assistance services, free of charge, are available to you. Call 1-877-344-7364 (HMO Customer Service) (TTY/TDD: 711). ATENCIÓN: Si usted habla otros idiomas, tiene a su disposición, gratis, servicios de ayuda para idiomas. Llame al 1-877-344-7364 (HMO Servicios de atención al cliente) (TTY/TDD: 711).

Healthways and SilverSneakers are registered trademarks of Healthways, Inc. and/or its subsidiaries. © 2016 Healthways, Inc. All rights reserved.

  
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