Summary of 2019 Medicare Benefit and Plan Design Changes

Date Issued: 9/24/2018

For Medicare coverage effective January 1, 2019, the annual enrollment period begins October 15, 2018 and ends December 7, 2018. Any health plan changes must be made during this open enrollment period.

Please talk to your patients to be sure their health care coverage meets their needs and any associated costs and coinsurance are within their budget.

Here is a summary of benefit plan changes for 2019:

  • Service Area Expansion: All existing and new Medicare plans will be offered in Dutchess, Sullivan, Ulster, and Putnam counties.
  • Provider Network: VIP Essential and VIP Value will transition from the Medicare Essential Network to the VIP Prime Network of providers.
  • Benefit Enhancements: VIP Essential members will have their primary care doctor (PCP) copay reduced to $0, and added acupuncture benefit. VIP Value members will have their PCP copay reduced to $15 and optional dental and fitness benefit riders. VIP Dual members in Bronx, Kings, New York, and Queens counties will have their over-the-counter, allowable benefit increased to $125/month.
  • Three New Plans: VIP Rx Saver will be available to members in Bronx and Westchester counties with $5 PCP copays and comprehensive dental and fitness benefits with no maximums. VIP Part B Saver offers no deductible on primary care and specialist visits and optional dental and fitness benefit riders at low cost. VIP Go provides out-of-network coverage with no PCP/referrals required.
  • Discontinued Plan: Medicare Cost Plan will terminate as of December 31, 2018, as required by the Centers for Medicare & Medicaid Services.

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

Please be sure to refer your Medicare patients to other EmblemHealth Medicare providers. To locate participating providers, please use the “Find a Doctor” directory and create all your referrals on our secure provider website. To identify Medicare members, look for the Medicare network name, VIP Prime, on the front of the member ID card. Or, sign in to our secure provider website to view the member’s eligibility. There you can also see your network participation and review/edit your practice information.