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Neighborhood Care

EmblemHealth Value (HMO-POS)

You will pay $0 to see your primary care doctor and $35 to see specialists. In addition, you will get benefits Medicare does not cover, like preventive and comprehensive dental ($2,000 annual limit in and out-of-network), hearing aid allowance, eyewear allowance, and a SilverSneakers® membership including $80 quarterly for over-the-counter (OTC) items.

Available in the following counties: Albany, Broome, Columbia, Delaware, Dutchess, Greene, Orange, Rensselaer, Saratoga, Schenectady, Warren, and Washington

 

 Provider Network: VIP Bold

 

Plan Option Premium
EmblemHealth VIP Value $0.00

Quick Links

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: $35
Preventive care (services that keep you healthy): $0
Urgently needed services: $40
Emergency room: $115
Inpatient hospital coverage: $450 per day 1-5, $0 each additional day
Lab services: $0 or $15
X-rays: $25 or 20%
Type of Care Copay
Foot care: $25
Dental services (in and out-of-network): Preventive - $0 1 exam, cleaning, fluoride treatments, and standard x-rays every 6 months. Comprehensive 50%. $2,000 annual limit 
Hearing aids: Up to $3,000 every 3 years
Routine eyewear: Up to $300 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-$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 $215

30-Day Supply: 25%

30-Day Supply: 22%

90-Day Supply: 22%
Tier 4 Non-Preferred Drugs $215

30-Day Supply: 28%

30-Day Supply: 25%

90-Day Supply: 25%
Tier 5 Specialty $215

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.

 

Plan Documents

  • Summary of Plan Benefits

  • Evidence of Coverage

    Coming Soon
  • LIS Plan Summary

  • EmblemHealth Medicare Star Ratings

    Coming Soon

  • Preventive and Comprehensive Dental Benefits

Medicare HMO Provider & Pharmacy Directories

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. 

Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

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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VIP Value (HMO-POS)

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