EmblemHealth VIP Dual (HMO D-SNP)

This is a special needs plan (D-SNP) 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, a SilverSneakers® membership, and OTC Medicare card for up to $1,500 in over-the-counter items, depending on where you live.

 

Available in the following counties: Suffolk

 

Your level of extra help Premium
0% $36.60
25% $27.50
50% $18.30
75% $9.20
100% $0.00

Add Plan Highlights

If you have questions, please call: 800-447-9169 daily from 8am to 8pm

Benefit Summary

Type of Care Copay
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
Lab Services: $0
X-Rays: $0
Type of Care Copay
Foot care: $0
Dental services (no annual dollar limit): Comprehensive and preventive
Hearing aid: $1,500 every 3 years
Routine eyewear: $300 every 2 years
24-Hour nurse hotline: Yes
SilverSneakers®: Yes
Prescription drug: Yes

Drug Coverage

Having the medicines you need is an important part of staying healthy, which is why we take our pharmacy offerings very seriously. We strive to help you make sure you can afford the medicines you take. Our formulary gives you access to thousands of them, and our pharmacy network is large enough to provide the choices you need—close to home.

DEDUCTIBLE

(The amount you pay before your plan starts to pay)

You Pay

INITIAL COVERAGE

$0-$4,020

You Pay

COVERAGE GAP 

Over $4,020

You Pay

CATASTROPHIC 

Over $6,350

You Pay

$0

Generics: $0/$1.30/$3.60

Brands: $0/$3.90/$8.95

Depending on your level of Extra Help

Generics: $0/$1.30/$3.60

Brands: $0/$3.90/$8.95

Depending on your level of Extra Help

$0

Drug Cost Calculator

Use our Cost Calculator tool to estimate your prescription drug costs. Enter the prescription drugs you take and we'll show you your monthly drug costs.


Medicare HMO and HMO-POS Provider Directories

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. 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.

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Last Updated: 10/1/19

Y0026_ 127364 Accepted 10/1/19