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.

This plan provides benefits Original Medicare does not cover, like comprehensive dental, hearing aids, vision, and a SilverSneakers® membership.


Available in the following counties: Bronx, Kings, New York, Queens


Provider Network: VIP Bold


Your level of Extra Help
All levels $0.00

Plan Highlights

If you have questions, please call: 800-859-4880 daily from
8 am to 8 pm.

Benefit Summary

Type of Care Copay
Primary care doctor visit:  $0
Specialist doctor visit: $45
Preventive care (Services that keep you healthy): $0
Urgently needed services: $50
Emergency room: $90
Inpatient hospital coverage: $492 per day 1-4, $0 each additional day
Lab Services: $0 or $15


Type of Care Copay
X-rays: $40
Foot care:  $40
Dental services (no annual dollar limit): Comprehensive and preventive.
Hearing Aids: $1800 every 3 years
Routine eyewear: $240 every year
24-Hour nurse hotline: Yes
Teladoc: $45

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 s 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.




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

You Pay



You Pay


Over $3,980

You Pay


Over $6,550

You Pay

Tier 1 Preferred Generic Drugs No Deductible $2 25% of the cost $3.70 or 5% of the cost
Tier 2 Generic Drugs No Deductible $15 25% of the cost $3.70 or 5% of the cost
Tier 3 Preferred Brand Drugs $295 $42 25% of the cost $9.20 or 5% of the cost 
Tier 4 Non-Preferred Drugs $295 $95 25% of the cost $3.70, $9.20 or 5% of the cost 
Tier 5 Specialty Drugs $295 27% of the cost 25% of the cost The greater of 5% or $3.70 for generic or $9.20 for brand 

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.


Plan Documents

Medicare HMO and HMO-POS Provider & Pharmacy Directories

EmblemHeath Plan Inc. 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 EmblemHealth depends on contract renewal. EmblemHealth Plan Inc. 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