You will pay $0 to see your primary care doctor and $25 to see specialists. You will also get benefits Medicare does not cover, like preventive and comprehensive dental, hearing aid allowance, eyewear allowance, and a SilverSneakers® membership.
Available in the following counties: Suffolk and Westchester
Provider Network: VIP Bold
| Your level of Extra Help | Premium |
|---|---|
| No Extra Help | $175.00 |
| Extra Help | $174.40 |
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.
| Type of Care | Copay |
|---|---|
| Primary care doctor visit: | $0 |
| Specialist doctor visit: | $25 |
| Preventive care (services that keep you healthy): | $0 |
| Urgently needed services: | $35 |
| Emergency room: | $115 |
| Inpatient hospital coverage: | $290 per day 1-7, $0 each additional day |
| Lab services: | $0 or $15 |
| X-rays: | $25 or 20% of the cost |
| Type of Care | Copay |
|---|---|
| Foot care: | $25 |
| Dental services (no annual dollar limit): | Preventive and Comprehensive |
| Hearing aids: | Up to $2,400 every 3 years |
| Routine eyewear: | Up to $300 every year |
| 24-Hour Nurse Line: | Yes |
| Teladoc®: | $0 |
| SilverSneakers®: | Yes |
| Prescription drugs: | Yes |
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-$2,100 |
|||
|---|---|---|---|
| Tier | Deductible (The amount you pay before your plan starts to pay) |
Retail Pharmacy | Preferred Mail Order |
| Tier 1 Preferred Generic | $0 | 30-Day Supply: $0
|
30-Day Supply: $0 90-Day Supply: $0 |
| Tier 2 Generic | $0 | 30-Day Supply: $10 |
30-Day Supply: $0 90-Day Supply: $0 |
| Tier 3 Preferred Brand | $200 | 30-Day Supply: 25% |
30-Day Supply: 22% 90-Day Supply: 22% |
| Tier 4 Non-Preferred Drugs | $200 | 30-Day Supply: 28% |
30-Day Supply: 25% 90-Day Supply: 25% |
| Tier 5 Specialty | $200 | 30-Day Supply: 29% |
30-Day Supply: 29% 90-Day Supply: Not available in a long-term supply |
| Tier 6 Select Care Drugs | $0 | 30-Day Supply: $0 |
30-Day Supply: $0 90-Day Supply: $0 |
You pay no deductible and the lesser of 25% of the cost (22% if you use preferred mail order), or $35 for a one-month supply of insulin. You pay $0 for most adult Part D vaccines, including shingles, and some travel vaccines.
Set up Home Delivery and Refills for Prescription Drugs
Have your prescriptions and refills delivered directly to your home through Amazon Pharmacy or Express Scripts, Inc., our preferred mail order pharmacy.
Health Insurance Plan of Greater New York (HIP) is an HMO/HMO-POS plan with a Medicare contract and 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.
SilverSneakers is a registered trademark of Tivity Health, Inc. © 2025 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 10/01/2025
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