2019 EmblemHealth VIP Dual (HMO SNP)

  • EmblemHealth VIP Dual (HMO-SNP) – This is a special needs plan for people enrolled in both Medicare and New York State Medicaid. You may pay as little as $0 each month for this plan based on your Low Income Subsidy (LIS) level. You pay $0 for covered services in this plan. You will also get benefits Medicare does not cover, like comprehensive dental, hearing aids, vision, 48 acupuncture visits, 24 one-way transportation visits to approved health care locations, a SilverSneakers® membership and up to a $1,500 over-the-counter items Medicare card depending on where you live.

    MONTHLY PLAN PREMIUM
    (Amount you pay for your insurance every month)
    Suffolk

    Your level of Extra Help Premium
    0% (Full Premium) $39.30
    25% $29.50
    50% $19.60
    75% $9.80
    100% $0.00


    Plan Highlights

    Benefits

    What you pay

    Primary Care Doctor Visit $0
    Specialist Doctor Visit $0
    Preventive Care
    (Services that keep you healthy)
    $0
    Urgently Needed Services $0
    Emergency Room $0
    Inpatient Hospital Coverage $0
    Diagnostic Services/Labs/Imaging $0
    Foot Care $0
    Dental Services
    (No annual dollar limit)
    Comprehensive and Preventive
    Hearing Aid $1,500 every 3 years
    Routine Eyewear $0 per year
    ($200 plan limit every two years)
    24-Hour Nurse Hotline Yes
    SilverSneakers Yes
    Prescription Drug Yes

    Disclaimer

    HIP Health Plan of New York (HIP) is an HMO plan with a Medicare contract. Enrollment in HIP depends on contract renewal. HIP is an EmblemHealth company. This information is not a complete description of benefits. Call 877-344-7364/TTY: 711 for more information. 

    The SilverSneakers® fitness program is provided by Tivity Health, Inc., an independent company. © 2019. All rights reserved.


    To view the Portable Document Format (PDF) files, you need Adobe Acrobat Reader . If you do not already have this software, you can download a free copy from Adobe®Download the Adobe Reader® now . Follow Adobe's instructions for download and installation.

  • Find a Doctor


    Medical Provider Search

    Search
    VIP Prime Network

    Dental Provider Search

    Search
    Dentist

    Download Directories

    VIP Prime Network
    Bronx
    Kings
    Nassau
    New York
    Orange and Rockland
    Queens
    Richmond
    Suffolk
    Westchester
    Hudson Valley (Dutchess, Putnam, Sullivan and Ulster)

    Disclaimer

    HIP Health Plan of New York (HIP) is an HMO plan with a Medicare contract. Enrollment in HIP depends on contract renewal. HIP is an EmblemHealth company. This information is not a complete description of benefits. Call 877-344-7364/TTY: 711 for more information. 

    The SilverSneakers® fitness program is provided by Tivity Health, Inc., an independent company. © 2019. All rights reserved.


    To view the Portable Document Format (PDF) files, you need Adobe Acrobat Reader . If you do not already have this software, you can download a free copy from Adobe®Download the Adobe Reader® now . Follow Adobe's instructions for download and installation.

  • Prescription Drug Benefits — Coverage When You Need It

    As a member of this plan, you are automatically enrolled in Medicare Part D. Because of your eligibility for Medicaid and Medicare, you should receive Extra Help in paying for your prescription drug coverage.

    This means that you will receive help in paying for your monthly Medicare Part D premium(The amount you pay for your insurance every month), yearly deductible (amount you pay before your plan starts to pay)and prescription drug copays(the amount you pay for health services).

    Our plan groups each drug into one of five “tiers (levels).” You will need to use the formulary (list of covered drugs) to find what tier a drug is on.

    Below are the five drug tiers:

    Tier 1 Preferred Generic

    Tier 2 Generic

    Tier 3 Preferred Brand

    Tier 4 Non-Preferred Drug

    Tier 5 Specialty Tier


    Low Income Subsidy

    Based on a determination by the Social Security Administration (SSA), you may be eligible for additional Part D savings through the Low Income Subsidy (LIS). In this plan, depending on your eligibility level for Extra Help, you may pay up to an $85 yearly deductible and some small copays (the amount you pay for drugs) or coinsurances (the percentage you pay for drugs) when you fill your prescriptions at pharmacies that contract with EmblemHealth pharmacy.

    After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through home delivery pharmacy) reach $5,100, you pay the greater of: 5% of the costor you pay $3.40 for generic drugs (including brand drugs treated as generic). You pay $8.50 for all other drugs.

    For more information and an application for Low Income Subsidy (LIS), please call Social Security at 800-772-1213 (TTY:800-325_0778), Monday through Friday, 7 am to 7 pm. Or visit ssa.gov.

    Your LIS category will entitle you to one of the following:


    LIS Category (Subsidy Level) Out-of-pocket costs through the coverage gap Generic/Brand Catastrophic Level Drug Copay Over $5,100 Generic/Brand Premium (the amount you pay for your insurance every month)
    Category 0 Not eligible for low income subsidy; amounts listed in benefit summary The greater of $3.40/$8.50 or 5% of the cost $39.30
    Category 1 (100%) $3.40 / $8.50 $0 $0
    Category 2 (100%) $1.25 / $3.80 $0 $0
    Category 3 (100%) $0 (institutional) $0 $0
    Category 4 (100%) $85 deductible/15% of the cost $3.40 / $8.50 $0
    Category 4 (75%) $85 deductible/15% of the cost $3.40 / $8.50$9.80
    Category 4 (50%) $85 deductible/15% of the cost $3.40 / $8.50 $19.60
    Category 4 (25%) $85 deductible/15% of the cost $3.40 / $8.50 $29.50

    Find a Pharmacy
    There’s an EmblemHealth network pharmacy near you. Here’s how to find one.

    Set up Home Delivery and Refills for Prescription Drugs
    Have your prescriptions and refills delivered directly to your home through Express Scripts, Inc. (ESI), our home-delivery pharmacy.

    Rx Cost Calculator
    Look up the costs of each prescription drugs you take.

    Additional Pharmacy Information

    Learn more about what our over-the-counter debit card covers, how to get money back for a drug, our Medication Management Therapy program, how to get help paying for Part D drugs through the Extra Help program (as known as Low Income Subsidy) and much more.

    To view the Portable Document Format (PDF) files on this page, you need Adobe Acrobat Reader. If you do not already have this software, you can download a free copy from Adobe®. Download the Adobe Reader® now. Follow Adobe's instructions for download and installation. 



    Disclaimer

    HIP Health Plan of New York (HIP) is an HMO plan with a Medicare contract. Enrollment in HIP depends on contract renewal. HIP is an EmblemHealth company. This information is not a complete description of benefits. Call 877-344-7364/TTY: 711 for more information. 

    The SilverSneakers® fitness program is provided by Tivity Health, Inc., an independent company. © 2019. All rights reserved.


    To view the Portable Document Format (PDF) files, you need Adobe Acrobat Reader . If you do not already have this software, you can download a free copy from Adobe®Download the Adobe Reader® now . Follow Adobe's instructions for download and installation.

  • 2019 Plan Documents


    Your important plan documents below include coverage and costs for medical product and services and prescription drugs that will start on January 2019.


    Summary of Benefits

    Summary of Benefits Download (PDF)
    Summary of Benefits - VIP DUAL (HMO SNP)

    Evidence of Coverage

    EmblemHealth VIP Dual (HMO SNP) Download (PDF)
    EmblemHealth VIP Dual (HMO SNP)

    Nondiscrimination Policy


    2019 Annual Notice of Change

    EmblemHealth VIP Dual (HMO SNP) Download (PDF)
    Bronx, Kings, Queens and New York
    Suffolk
    Richmond, Nassau, Westchester, Orange and Rockland

    Nondiscrimination Policy


    Comprehensive and Preventive Dental Benefits


    Download Directories

    VIP Prime Network Download (PDF)
    Bronx
    Kings
    Nassau
    New York
    Orange and Rockland
    Queens
    Richmond
    Suffolk
    Westchester
    Hudson Valley (Dutchess, Putnam, Sullivan and Ulster)

    Pharmacy Directory

    Pharmacy Directory Download (PDF)
    HMO/PPO Pharmacy Directory

    Low-Income Subsidy and Plan Ratings

    Do you get extra help from Medicare to pay for your Medicare prescription drug plan costs? If so, your monthly plan premium will be lower than it would be if you did not get extra help from Medicare. The amount of help you get will determine your total monthly premium as a member of our plan.

    Documents Download (PDF)
    LIS Plan Summary
    EmblemHealth Medicare Plan Ratings Coming Soon

    Nondiscrimination Policy


    Disclaimer

    HIP Health Plan of New York (HIP) is an HMO plan with a Medicare contract. Enrollment in HIP depends on contract renewal. HIP is an EmblemHealth company. This information is not a complete description of benefits. Call 877-344-7364/TTY: 711 for more information. 

    The SilverSneakers® fitness program is provided by Tivity Health, Inc., an independent company. © 2019. All rights reserved.


    To view the Portable Document Format (PDF) files, you need Adobe Acrobat Reader . If you do not already have this software, you can download a free copy from Adobe®Download the Adobe Reader® now . Follow Adobe's instructions for download and installation.

  • Enroll in an EmblemHealth Medicare Advantage Plan

    You've looked at your options, and now you're ready to enroll. We want to make the process as easy as possible for you.

    There are four simple ways to enroll.


    Enroll Online

    Enrollment for 2019 Plans Begins on October 15th

    Enroll Now


    Medicare beneficiaries may also enroll in EmblemHealth Medicare Plan through the CMS Medicare Online Enrollment Center located at www.medicare.gov.


    Make an In-Home Appointment

    Call us at 800-447-9169 (TTY: 711), 8 am to 8 pm, seven days a week to:

    • Schedule an in-home appointment with an EmblemHealth Sales Representative who will answer your questions and help you complete the enrollment application.
    • Request an enrollment kit.

    Visit us at a Seminar

    Call us to make an appointment or for questions about a seminar near you at 800-447-9169 (TTY: 711), 8 am to 8 pm, seven days a week to:


    Call to Enroll

    You may enroll in an EmblemHealth Medicare Advantage Plan for 2019 over the phone beginning October 15th by calling us toll-free at 800-447-9169 (TTY:711), seven days a week, 8 am to 8 pm.

    Enroll by Mail

    We make it easy for you to become an EmblemHealth VIP Medicare Advantage plan member.

    • Fill in all the requested Medicare information on your enrollment form.
    • Sign and date your enrollment form.
    • Mail it to us at:
      EmblemHealth
      Attention: Medicare Marketing
      P.O. Box 2859
      New York, NY 10117-7894

    2019 EmblemHealth Medicare Enrollment Form

    2019 EmblemHealth Medicare Advantage Application for EmblemHealth VIP Dual (HMO SNP)


    Disclaimer

    HIP Health Plan of New York (HIP) is an HMO plan with a Medicare contract. Enrollment in HIP depends on contract renewal. HIP is an EmblemHealth company. This information is not a complete description of benefits. Call 877-344-7364/TTY: 711 for more information. 

    The SilverSneakers® fitness program is provided by Tivity Health, Inc., an independent company. © 2019. All rights reserved.


    To view the Portable Document Format (PDF) files, you need Adobe Acrobat Reader . If you do not already have this software, you can download a free copy from Adobe®Download the Adobe Reader® now . Follow Adobe's instructions for download and installation.