EmblemHealth VIP Dual (HMO D-SNP)

This is a special needs plan (HMO 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, $0 for 10 additional acupuncture visits, a SilverSneakers® membership, and $50 for over-the-counter (OTC) items monthly, depending on where you live.

 

Available in the following counties: Suffolk

 

Provider Network: VIP Bold

 

Your level of Extra Help Premium
0% $42.30
25% $31.70
50% $21.20
75% $10.60
100% $0.00

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

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 Aids: $1,500 every 3 years
Routine eyewear: $500 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-$4,130

You Pay

COVERAGE GAP 

Over $4,130

You Pay

CATASTROPHIC 

Over $6,550

You Pay

$0

Generics: $0/$1.30/$3.70

Brands: $0/$4.00/$9.20

Depending on your level of Extra Help

Generics: $0/$1.30/$3.70

Brands: $0/$4.00/$9.20

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 & Pharmacy Directories

Health Insurance Plan of Greater New York (HIP) is an HMO/HMO-POS/HMO D-SNP plan with a Medicare contract and a Coordination of Benefits Agreement with the New York State Department of Health. Enrollment in HIP depends on contract renewal. HIP is an EmblemHealth company.

SilverSneakers® is a registered trademark of Tivity Health, Inc. © 2020 Tivity Health, Inc. All rights reserved.

 

© 2020 Teladoc Health, Inc. All rights reserved. Teladoc is a registered trademark of Teladoc Health, Inc. and may not be used without written permission.

 

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Last Update 10/01/2020

Y0026_ 200570  Accepted 9/29/20