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Medicare Advantage: Insurance Coverage and More | EmblemHealth

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Medicare Advantage

CHOOSE THE RIGHT PLAN

At EmblemHealth, we know choice matters. Our Medicare Advantage plans are designed to provide you with personalized health care at prices you can afford.

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Plan availability varies by location. Please enter your ZIP Code to see plans available in your area.

2020

2020 EmblemHealth Medicare Advantage Plans

EmblemHealth VIP Value (HMO)

You will pay $0 each month for the plan — a “$0 premium.” With EmblemHealth VIP Value you will pay $15 to see your primary care doctor, and $50 to see specialists. You will also get benefits Medicare does not cover like up to $450 yearly in routine eyewear.

This plan offers Optional Supplemental benefits - where you have the option to add a SilverSneakers^® membership and/or comprehensive dental benefits at a low cost.

Primary Care Physician: $15 Specialist: $50

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EmblemHealth VIP Essential (HMO)

Depending on where you live, you will pay either $0 each month or a low set amount each month (a premium). You will pay $0 to see your primary care doctor and $45 to see specialists. You will also get benefits Medicare does not cover, like comprehensive dental, hearing aids, vision, a SilverSneakers® membership, and acupuncture.

Primary Care Physician: $0 Specialist: $45

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EmblemHealth VIP Part B Saver (HMO)

You will pay $0 each month for the plan — a “$0 premium.” With EmblemHealth VIP Part B Saver (HMO), you will pay $25 to see your primary care doctor and $50 to see specialists. You can also get up to $500 annual savings toward your Part B premium. This plan offers Optional Supplemental Riders – where you have the option to add SilverSneakers® fitness and/or comprehensive dental benefits at a low cost.

Primary Care Physician: $25 Specialist: $50

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EmblemHealth VIP Rx Saver (HMO)

You will pay $5 to see your primary care doctor and $35 to see specialists. This plan does not have an annual deductible on Tier 1, Tier 2, and Tier 3 drug. In addition, you will get benefits Medicare does not cover, like comprehensive dental, hearing aids, vision, and a SilverSneakers® membership.

Primary Care Physician: $5 Specialist: $35

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EmblemHealth VIP Go (HMO-POS)

This plan provides in-network and out-of-network coverage for select services and does not require referrals. You will pay $10 to see your primary care doctor and $45 to see specialists in-network.

You will also get benefits Original Medicare does not cover, like comprehensive dental, hearing aids, vision and a SilverSneakers^®membership.

Primary Care Physician: $10/$30 Specialist: $45/$65 In and out of network

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EmblemHealth VIP Gold (HMO)

You will pay $0 to see your primary care doctor and $25 to see specialists. You will also get benefits Medicare does not cover, like comprehensive dental, hearing aids, vision, and a SilverSneakers® membership.

Primary Care Physician: $0 Specialist: $25

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EmblemHealth VIP Gold Plus (HMO)

You will pay $0 for many medical services, such as when you see your primary care doctor, specialists, or get urgently needed services.

You will also get benefits Medicare does not cover, like comprehensive dental, hearing aids, vision, and a SilverSneakers® membership.

Primary Care Physician: $0 Specialist: $0

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EmblemHealth VIP Dual (HMO D-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 level of Extra Help. You pay $0 for covered services in this plan.

You will also get benefits Medicare does not cover, like preventive and comprehensive dental, hearing aids, vision, 48 acupuncture visits, a SilverSneakers® membership and up to a $1,500 over-the-counter items Medicare card depending on where you live.

Primary Care Physician: $0 Specialist: $0

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EmblemHealth VIP Passport (HMO)

This plan does not require referrals. You will pay $32 each month for the plan. With this plan, you will pay $5 to see your primary care doctor and $35 to see specialists in-network.

You will also get benefits Medicare does not cover, like preventive dental, hearing aids, vision, a SilverSneakers^® membership, and 20 acupunture visits.

Primary Care Physician: $5 Specialist: $35

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EmblemHealth VIP Passport NYC (HMO)

This plan does not require referrals. You will pay $32 each month for the plan. With this plan, you will pay $10 to see your primary care doctor and $40 to see specialists’ in-network. You will also get benefits Medicare does not cover, like preventive dental, hearing aids, vision, a SilverSneakers® membership, and 20 acupuncture visits..

Primary Care Physician: $10 Specialist: $40

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EmblemHealth VIP Dual Select (HMO D-SNP)

This plan does not require referrals. This is a special needs plan for people enrolled in both Medicare and New York State Medicaid. You pay $0 for covered services in this plan.

You will also get benefits Original Medicare does not cover, like a comprehensive dental, hearing aids, vision, and up to a $600 over-the-counter items Medicare card.

Primary Care Physician: $0 Specialist: $0

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EmblemHealth VIP Solutions (HMO D-SNP)

This plan does not require referrals. This is a special needs plan for people enrolled in both Medicare and who have partial and/or full New York State Medicaid. You may pay $0-$36.60 each month for this plan based on your level of Extra Help. You may pay $0 or low copays depending on your level of Medicaid for covered services in this plan.

You will also get benefits Medicare does not cover, like preventive dental, hearing aids, and vision.

Primary Care Physician: $0 Specialist: $0 or $45

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EmblemHealth VIP Essential (HMO)

Primary Care Physician: $0 Specialist: $45

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EmblemHealth VIP Essential (HMO)

Primary Care Physician: $0 Specialist: $45

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EmblemHealth VIP Rx Saver (HMO)

Primary Care Physician: $5 Specialist: $35

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EmblemHealth VIP Go (HMO-POS)

You will also get benefits Original Medicare does not cover, like comprehensive dental, hearing aids, vision and a SilverSneakers^®membership.

Primary Care Physician: $10/$30 Specialist: $45/$65 In and out of network

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EmblemHealth VIP Gold (HMO)

You will pay $0 to see your primary care doctor and $25 to see specialists.

You will also get benefits Original Medicare does not cover, like comprehensive dental, hearing aids, vision and a SilverSneakers^®membership.

Primary Care Physician: $0 Specialist: $25

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EmblemHealth VIP Gold (HMO)

You will pay $0 to see your primary care doctor and $25 to see specialists.

You will also get benefits Original Medicare does not cover, like comprehensive dental, hearing aids, vision and a SilverSneakers^®membership.

Primary Care Physician: $0 Specialist: $25

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EmblemHealth VIP Gold (HMO)

You will pay $0 to see your primary care doctor and $25 to see specialists.

You will also get benefits Original Medicare does not cover, like comprehensive dental, hearing aids, vision and a SilverSneakers^®membership.

Primary Care Physician: $0 Specialist: $25

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EmblemHealth VIP Dual (HMO D-SNP)

You will also get benefits Medicare does not cover, like preventive and comprehensive dental, hearing aids, vision, 48 acupuncture visits, a SilverSneakers^® membership and up to a $1,500 over-the-counter items Medicare card.

Primary Care Physician: $0 Specialist: $0

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EmblemHealth VIP Dual (HMO D-SNP)

Primary Care Physician: $0 Specialist: $0

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EmblemHealth VIP Essential

Primary Care Physician: $0 Specialist: $45

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EmblemHealth VIP Rx (PDP)

With VIP Rx, you get $0 preferred generic drugs at preferred pharmacies nation-wide. You pay small a premium of $41 per month.

$0 preferred Generics at preferred pharmacies nation-wide

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EmblemHealth VIP Rx Plus (PDP)

With VIP Rx Plus, you get $0 preferred generic drugs at preferred pharmacies nation-wide and only $20 for 90-day generic drugs on Tier 2 when you use our mail order pharmacy. Deductible does not apply to drugs on Tiers 1, 2 and 3, so you save on the medicines you need.

$0 preferred Generics at preferred pharmacies nation-wide

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EmblemHealth VIP Essential (HMO)

Primary Care Physician: $0 Specialist: $45

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additional medicare resources

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Medicare Pharmacy: Additional Information

Learn more about what our over-the-counter debit card covers, how to get money back for a drug, and more.

Medicare Enrollment Periods

Find out about specific enrollment periods and guidelines.

Medicare Grievances and Appeals

Learn how to file a complaint or appeal using the necessary forms.

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Find the Right Plan

We want you to feel comfortable and secure with your Medicare decisions; that’s why EmblemHealth offers many low-cost Medicare plans - some even at $0 - with a wide range of benefits to meet your needs.

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Health Insurance Plan of Greater New York (HIP) is an HMO/HMO-POS/HMO D-SNP plan with a Medicare contract. HIP has a contract with the New York Medicaid Program for HMO D-SNP. Group Health Incorporated (GHI) is a PPO plan and a standalone PDP with a Medicare contract. Enrollment in HIP and GHI depends on contract renewal. HIP and GHI are EmblemHealth companies. Out-of-network/non-contracted providers are under no obligation to treat EmblemHealth members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

SilverSneakers and the SilverSneakers shoe logotype are registered trademarks of Tivity Health, Inc. © 2020 Tivity Health, Inc. All rights reserved. © 2019 Teladoc Health, Inc. All rights reserved. Teladoc and the Teladoc logo are registered trademarks of Teladoc Health, Inc. and may not be used without written permission.

Last Updated: 10/1/19

Y0026_ 127364 Accepted 10/1/19

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Any information provided on this Website is for informational purposes only. It is not medical advice and should not be substituted for regular consultation with your health care provider. If you have any concerns about your health, please contact your health care provider's office.

Also, this information is not intended to imply that services or treatments described in the information are covered benefits under your plan. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage.