EmblemHealth Medicare Supplement Insurance Plans Details

  • Medicare Part A covers some hospital services, while Medicare Part B covers some medical services, but they don’t cover all costs. That’s why some people with Medicare choose to add a Medicare Supplement Insurance Plan offered by EmblemHealth.

    It “supplements” Medicare by covering the bills that are only partially covered by Medicare Parts A and B.

    At EmblemHealth, we offer six Medicare Supplement Insurance plans. You choose the plan with the benefit design that suits your needs. Benefits provided will depend upon the plan you select, and premiums may vary by plan and by region.

    All EmblemHealth Medicare Supplement plans cover the following Basic Benefits:

    • Hospitalization: EmblemHealth pays Part A coinsurance* plus coverage for 365 additional days in your lifetime after Medicare stops paying.
    • Medical Expenses: EmblemHealth pays Part B coinsurance* (20 percent of Medicare-approved expenses), Medicare pays 80 percent.
    • Blood: First three pints of blood each year.
    • Hospice care: EmblemHealth pays Part A coinsurance*.

    * Coinsurance is the percentage of the Medicare approved expenses that you pay.

    Benefits provided will depend upon the plan you select, and premiums may vary by plan and by region.

    Monthly Premium Rates
    Each rating region consists of the noted counties. Rates and benefits are subject to change. Please refer to your contract or contact EmblemHealth for additional information, including limitations and exclusions.

    We, Group Health Incorporated, an EmblemHealth company (hereafter referred to as “EmblemHealth”) can only raise your premium if we raise the premium for all policies like yours in this geographic region.

    EmblemHealth Medicare Supplement Insurance 2019 monthly premium rates (per individual):

    Region Plan A Plan B Plan C Plan F Plan F+

    Albany

    $185.48

    $242.45

    $288.56

    $508.59

    $71.46

    Buffalo

    $175.46

    $229.40

    $272.95

    $481.07

    $67.43

    Downstate

    $194.87

    $253.28

    $300.87

    $530.59

    $74.00

    Mid-Hudson

    $185.48

    $242.45

    $288.56

    $508.59

    $71.46

    Rochester

    $175.46

    $229.40

    $272.95

    $481.07

    $67.59

    Syracuse

    $181.39

    $237.12

    $282.08

    $497.18

    $69.86

    Utica/Watertown

    $175.46

    $229.40

    $272.95

    $481.07

    $67.59

    The following is a breakdown of counties in each region:


    Downstate: Bronx, Kings Nassau, New York, Queens, Richmond, Rockland, Suffolk and Westchester
    Mid-Hudson: Delaware, Dutchess, Orange, Putnam, Sullivan and Ulster
    Albany: Albany, Clinton, Columbia, Essex, Fulton, Greene, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Warren and Washington.
    Syracuse: Broome, Cayuga, Chemung, Cortland, Onondaga, Schuyler, Steuben, Tioga and Tompkins
    Buffalo: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming
    Utica/Watertown: Chenango, Franklin, Herkimer, Jefferson, Lewis, Madison, Oneida, Oswego, Otsego and St. Lawrence
    Rochester: Oneida, Oswego, Otsego and St. Lawrence

    Applicants must be from New York State to be eligible for coverage under one of these plans.

    When Coverage Begins

    Once you send in your completed application with the first payment, we will verify your eligibility and send you an identification card, a contract along with the schedule page, which will show you the effective date of your coverage.

    Helpful Resources

    2019 Medicare Supplement Brochure — Helpful information for beneficiaries.

    2019 Medicare Supplement Benefit Chart






    Last Updated 10/29/18
    HCR_MedSupp_Detail_200

  • What it Covers

    All EmblemHealth Medicare Supplemental plans cover the following basic benefits:

    • Hospitalization: EmblemHealth pays Part A coinsurance* plus coverage for 365 additional days in your lifetime after Medicare stops paying.
    • Medical Expenses: EmblemHealth pays Part B coinsurance* (20 percent of Medicare-approved expenses), Medicare pays 80 percent.
    • Blood: First three pints of blood each year.
    • Hospice care: EmblemHealth pays Part A coinsurance.*

    In addition to the Basic Benefits, Plan B also covers

    • Part A inpatient deductible** per benefit period: $1,364 in 2019.

    In addition to the Basic Benefits, Plan C also covers

    • Coinsurance* for skilled nursing facility care.
    • Part A inpatient deductible** per benefit period: $1,364 in 2019.
    • Part B annual deductible***: $185 in 2019.
    • Emergency care rendered during the first 60 days of foreign travel.

    In addition to the Basic Benefits, Plan F also covers

    • Coinsurance* for skilled nursing facility care.
    • Part A inpatient deductible** per benefit period: $1,364 in 2019.
    • Part B annual deductible***: $185 in 2019.
    • 100% of Part B costs above what Medicare will pay.
    • Emergency care rendered during the first 60 days of foreign travel.

    In addition to the Basic Benefits, Plan F+ also covers

    • Coinsurance* for skilled nursing facility care.
    • Part A inpatient deductible** per benefit period: $1,364 in 2019.
    • Part B annual deductible***: $185 in 2019.
    • 100% of Part B costs above what Medicare will pay.
    • Emergency care rendered during the first 60 days of foreign travel.
    • SilverSneakers® membership

    Plan F+ is a high deductible plan that pays the same benefits as Plan F after one has paid a calendar year deductible of $2,300 in 2019



    * Coinsurance is the percentage of the Medicare approved expenses that you pay.

    ** Part A inpatient deductible is the amount you pay for Medicare Part A hospitalization services, including semi-private room and board, general nursing and other services and supplies during the first 60 days of a hospital stay covered by Medicare.

    *** Part B annual deductible is the amount you pay for health care outside of the hospital before your plan starts to pay.






    Last Updated 10/29/18
    HCR_MedSupp_Benefits_300

  • Eligibilty

    Medicare Supplement Insurance is open for enrollment all year long. To apply for coverage under one of EmblemHealth’s Medicare Supplement Insurance Plans, you must:

    • Be eligible for Medicare
    • Reside in New York State
    • Not have coverage provided by Medicaid
    • Not have coverage by any other health insurance plan

    You may apply for an EmblemHealth Medicare Supplement Insurance Plan if your current coverage is ending and you want to change your plan. You can do this if you have EmblemHealth insurance or another insurance plan.

    How to Enroll

    We’ve made enrolling as easy as possible. To apply for an EmblemHealth Medicare Supplement plan, complete and return the enclosed application along with a check for the first payment to us.

    If you do not send payment with your application, we will send you an invoice after the application is processed, once your eligibility has been confirmed.

    We will send you an identification card along with your contract within 7-10 business days after all parts of the application and the premium has been paid, unless you request a later effective date.

    EmblemHealth Medicare Supplement Application Form


    Mail the form to:


    EmblemHealth
    PO Box 2820
    New York, NY 10016-2820






    Last Updated 10/29/18
    HCR_MedSupp_Enroll_400