Our VIP Gold plan offers benefits and extras to help you stay healthy. It may be a good option if you see doctors regularly and want reliable coverage.
Medicare Advantage
EmblemHealth VIP Gold (HMO)
Quality Care With Extras
Get care from top doctors and hospitals in our VIP Bold Network with no referrals required. Plus, enjoy affordable prescription drug coverage and extras like dental, vision, and hearing that support your health.
Medical deductible: $0
Maximum out-of-pocket: $9,250
| Plan Features | VIP Gold |
|---|---|
| Monthly Premium | $175 ($174.40 with Extra Help) |
| Network | VIP Bold |
| Plan Service Area | Available in the following counties: Suffolk, Westchester |
| Summary of Benefits and Coverage | View PDF |
| Show More | |
| Primary Care Provider (PCP) Visit | $0 copay |
| Specialist Visit | $25 copay |
| Preventive Care | $0 copay |
| Dental Services | $0 copay for preventive services $0 – $150 copay for comprehensive services |
| Urgently Needed Services | $35 copay |
| Emergency Care | $115 copay |
| Inpatient Hospital Coverage | $290 per day for days 1–7 $0 per day for each additional day |
| Ambulatory Surgery Center Visit | $0 copay for diagnostic colonoscopy $225 copay for other ambulatory surgery services |
| Outpatient Facility Services | $0 copay for diagnostic colonoscopy $295 copay for other outpatient hospital services |
| Lab Services | $0 or $15 copay* |
| X-rays | $25 copay or 20% of the cost* |
| Foot Care | $25 copay |
| Routine Eyewear | Up to $300 every year |
| Hearing Aids | Up to $2,400 every three years |
| Acupuncture | $25 copay for chronic lower back pain, limited to 12 visits |
| Teladoc® | $0 copay |
| Fitness Program | SilverSneakers® membership at no additional cost |
| Show Less | |
*Lower cost when services are provided in a doctor’s office or independent facility.
For a complete list of covered services, see the Evidence of Coverage (EOC).
Drug deductible: $200; for Tiers 3, 4, and 5
Initial coverage stage: $0 - $2,100
| Tier | Retail Pharmacy (30-Day Supply) | Mail-Order Pharmacy |
|---|---|---|
| Tier 1 Preferred Generic | $0 copay | 30-day supply: $0 copay 90-day supply: $0 copay |
| Tier 2 Generic | $10 copay | 30-day supply: $0 copay 90-day supply: $0 copay |
| Tier 3 Preferred Brand | 25% of the cost | 30-day supply: 22% of the cost 90-day supply: 22% of the cost |
| Tier 4 Non-Preferred Drugs | 28% of the cost | 30-day supply: 25% of the cost 90-day supply: 25% of the cost |
| Tier 5 Specialty | 29% of the cost | 30-day supply: 29% of the cost 90-day supply: n/a |
| Tier 6 Select Care Drugs | $0 copay | 30-day supply: $0 copay 90-day supply: $0 copay |
See more EmblemHealth Medicare Advantage plan options.
Helpful Resources
Tools and information to help you manage your care and coverage.
Learn About Medicare
Find important information about Medicare, what sets EmblemHealth apart, and how to enroll when you’re ready.
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. © 2026 Tivity Health, Inc. All rights reserved.
Teladoc and related marks are trademarks of Teladoc Health, Inc. and are used by EmblemHealth with permission.
Last Updated: 06/30/2026
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