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Neighborhood Care

EmblemHealth VIP Dual (HMO D-SNP)

This is a special needs plan (HMO D-SNP) for people enrolled in Medicare and who have full 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 aid allowance, eyewear allowance, $0 for 10 additional acupuncture visits and a SilverSneakers® membership.

 

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

 

Provider Network: VIP Bold

 

Your level of Extra Help Premium
No Extra Help $24.70
Extra Help $0.00

Quick Links

Plan Highlights

If you have questions, please call 800-859-4880 (TTY: 711) 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: $300 every 3 years
Routine eyewear: $300 every 2 years
24-Hour Nurse Line: 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-$5,030 – 30-Day Supply 

You Pay		 COVERAGE GAP
Over $5,030

You Pay		 CATASTROPHIC
Over $8,000

You Pay
Annual Deductible

$0

 

$0

Tier 1 Preferred Generic

Tier 2 Generic

$0 or $1.55 or $4.50

Depends on your level of extra help

Tier 3 Preferred Brand

Tier 4 Non-Preferred Drugs

Tier 5 Specialty

Generics: $0 or $1.55 or $4.50

Brands: $0 or $4.60 or $11.20

Depends on your level of extra help

Tier 6 Select Care Drugs

 $0

$0 for most adult Part D vaccines, including shingles, tetanus and travel vaccines.

 

Set up Home Delivery and Refills for Prescription Drugs

Have your prescriptions and refills delivered directly to your home through Express Scripts, Inc. (ESI), our home-delivery pharmacy.

Additional Pharmacy Information

Learn more about how to get money back for a drug, our Medication Therapy Management program, how to get help paying for Part D drugs through the Extra Help program (as known as Low-Income Subsidy), and much more.

New York State Medicaid pharmacy coverage update for members enrolled in EmblemHealth VIP Dual (HMO D-SNP) and Enhanced Care or Enhanced Care Plus plan, or Integrated Benefits for Dually Eligible Enrollees (IB-Dual) Program.

The pharmacy benefits section of your member handbook was no longer valid after April 1, 2023. There was a change to your Medicaid pharmacy benefits starting April 1, 2023. Your Medicare Part D pharmacy coverage and pharmacy did not change. Learn more.

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 Provider & Pharmacy Directories

Health Insurance Plan of Greater New York (HIP) is an HMO D-SNP plan with a Medicare contract and a contract with the New York State Department of Health. Enrollment in HIP depends on contract renewal. HIP is an EmblemHealth company. For more information, contact the plan.

Because you qualify for extra help, you get reduced Part D cost-sharing benefits when you enroll.

Free language assistance services are available at 877-344-7364 (TTY: 711)

SilverSneakers and the SilverSneakers shoe logotype are registered trademarks of Tivity Health, Inc. © 2023 Tivity Health, Inc. All rights reserved. Teladoc and related marks are trademarks of Teladoc Health, Inc. and are used by EmblemHealth with permission.

You will need the Adobe® Acrobat Reader software to view files in the Portable Document Format (PDF). If you don’t already have it, you can download a copy from Adobe® here.

Last Update 3/4/2024

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2024 EmblemHealth VIP Dual (HMO SNP) | EmblemHealth