Summary of 2017 Medicare Benefit and Plan Changes

For coverage effective January 1, 2017, the Medicare annual enrollment period begins October 15, 2016, and ends December 7, 2016. Please speak with your patients and encourage them to make sure their health coverage meets their needs and that they check to ensure any associated costs and coinsurance requirements are within their budget. Any health plan changes must be made during this open enrollment period.

EmblemHealth offers a suite of Medicare Advantage HMO plans and networks in New York City and Nassau, Suffolk and Westchester counties. Below is a summary of Medicare benefit plan changes for 2017:

  • Discontinued Plans: Individual PPO plans including EmblemHealth PPO I, EmblemHealth Advantage PPO and EmblemHealth Dual Eligible (PPO SNP) will sunset.
  • New Plan: EmblemHealth VIP Value (HMO) provides in-network coverage from providers in our Medicare Essential Network, and benefits with $30 copay for PCPs and $50 copay for specialists, plus Part D prescription drug coverage.
  • New Plan Names: All HMO plans will have new names.
  • Provider Network: EmblemHealth VIP Gold Plus (HMO), formerly EmblemHealth VIP High Option (HMO) will transition from the Medicare Essential Network to the VIP Prime Network of providers.
  • New Vendors: Dental services will transition to DentaQuest and vision services will transition to EyeMed.
  • Preferred Pharmacy Network: Part D prescription drug deductibles will apply to medications on formulary Tier 3, Tier 4 and Tier 5. A subset of “preferred pharmacies” within the Medicare pharmacy network will offer lower cost-sharing with $0 copay for preferred generic drugs.
  • Fitness Benefit: Access to membership in SilverSneakers®, an exercise program designed for older adults, are included in some HMO plans.
  • Plan Enhancements: EmblemHealth VIP Dual (HMO SNP), formerly EmblemHealth Dual Eligible (HMO SNP), will have additional benefits such as acupuncture visits and increased limits on over-the-counter (OTC) items debit card.
  • ID Cards: Urgent Care copay will display on member ID cards.

2017 Medicare Benefit Plans and Networks

2016 Plan Name 2017 Plan Name 2017 Provider Network 2017 Plan Highlights
EmblemHealth VIP (HMO) EmblemHealth VIP Gold (HMO) VIP Prime Network SilverSneakers Fitness, Comprehensive and Preventive Dental Services, $0 copay for preferred generic drugs, $0 copay for PCP visits
EmblemHealth VIP High Option (HMO) EmblemHealth VIP Gold Plus (HMO) VIP Prime Network SilverSneakers Fitness, Comprehensive and Preventive Dental Services, $0 copay for preferred generic drugs, $0 copay for PCP visits
New Plan for 2017 EmblemHealth VIP Value (HMO) Medicare Essential Network Preventive Dental Services, $0 copay for preferred generic drugs, offered in 6 counties (Manhattan, Queens, Richmond, Nassau, Suffolk and Westchester)
EmblemHealth Dual Eligible (HMO SNP) EmblemHealth VIP Dual (HMO SNP) VIP Prime Network 48 acupuncture visits per year, $720 annual over-the-counter (OTC) debit card, $0 copay for covered services, $0 copay for preferred generic drugs, Comprehensive and Preventive Dental Services

Note: Members can access a full list of services and any benefit limitations by referencing their Evidence of Coverage (EOC).

To identify Medicare members, look for the Medicare network names - Medicare Essential or VIP Prime - on the front of the member ID card, or sign in to our secure provider website to view the member’s eligibility. You can also see your network participation and review/edit your practice information on our provider website.

Please be sure to refer your Medicare patients to other Medicare providers. To locate participating providers, please use the “Find a Doctor” directory and create all your referrals using our secure provider website.