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Neighborhood Care

EmblemHealth VIP Gold Plus (HMO)

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

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

 

Available in the following counties: Bronx, Dutchess, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Sullivan, Ulster, and Westchester

 Provider Network: VIP Bold

 

Your level of Extra Help Premium
No Extra Help $223.00
Extra Help $154.80

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Plan Highlights

If you have questions, please call 800-859-4880 (TTY: 711). From Oct. 1 to March 31, you can call us from 8 a.m. to 8 p.m., seven days a week. From April 1 to Sept. 30, you can call us from 8 a.m. to 8 p.m., Monday through Friday. 

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: $110
Inpatient hospital coverage: $195 per day 1-10, $0 each additional day
Lab services: $0 or $15
X-rays:  $0 or 20% of the cost
Type of Care Copay
Foot care: $0
Dental services (no annual dollar limit): Comprehensive and preventive
Hearing aids: $3,000 every 3 years
Routine eyewear: $150 every year
24-Hour Nurse Line: Yes
Teladoc®: $0
SilverSneakers®: Yes
Prescription drugs: Yes

Drug Coverage

Having the prescription drugs 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 prescription drugs 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.

Initial Coverage Stage
$0-$2000
Tier Deductible
(The amount you pay before your plan starts to pay)		 Retail Cost Sharing Preferred Mail Order
Tier 1 Preferred Generic $0

Preferred Pharmacy 30-Day Supply: $2

Standard Pharmacy 30-Day Supply: $7

30-Day Supply: $0

90-Day Supply: $0
Tier 2 Generic $0

Preferred Pharmacy 30-Day Supply: $10

Standard Pharmacy 30-Day Supply: $20

30-Day Supply: $0

90-Day Supply: $0
Tier 3 Preferred Brand $200

Preferred Pharmacy 30-Day Supply: $40

Standard Pharmacy 30-Day Supply: $47

30-Day Supply: $40

90-Day Supply: $120
Tier 4 Non-Preferred Drugs $200

Preferred Pharmacy 30-Day Supply: $95

Standard Pharmacy 30-Day Supply: $100

30-Day Supply: $95

90-Day Supply: $285
Tier 5 Specialty $200

Preferred Pharmacy 30-Day Supply: 29%

Standard Pharmacy 30-Day Supply: 29%

30-Day Supply: 29%

90-Day Supply: Not available in a long-term supply
Tier 6 Select Care Drugs $0

Preferred Pharmacy 30-Day Supply: $0

Standard Pharmacy 30-Day Supply: $0

30-Day Supply: $0

90-Day Supply: $0

 

You pay no deductible and no more than $35 for a one-month supply of covered insulin and $0 for most adult Part D vaccines, including shingles, and some travel vaccines. 

You will pay the above cost-sharing when you use preferred pharmacies. You pay more when you use standard pharmacies. You may pay less if you get Extra Help. $0 Tier 1, 2, and 6 generics are available through preferred mail order.

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.

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 plan with a Medicare contract. Enrollment in HIP depends on contract renewal. HIP is an EmblemHealth company.  SilverSneakers is a registered trademark of Tivity Health, Inc. © 2024 Tivity Health, Inc. All rights reserved.

Teladoc and related marks are trademarks of Teladoc Health, Inc. and are used by EmblemHealth with permission. 

Last Update 10/01/2024

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VIP Gold Plus (HMO)