Medicare Special Needs Plans Summary

The summary table below outlines the key components of the SNPs, such as Medicaid eligibility level, service area, and whether referrals are needed.

HIP Medicare Special Needs Network and Plan Summary for 2019
(VIP Prime Network)

Network Plan Name Plan Type PCP Req'd Referral Req'd OON Coverage In-Network Cost-Sharing Service Area Comments
VIP Prime Network EmblemHealth VIP Dual EmblemHealth Medicare HMO Yes Yes No Copays/
Coinsurance
14 counties Individual Medicare Plan. Special needs plan limited to individuals with both Medicare and full Medicaid coverage. Individuals with full Medicaid coverage are not required to pay cost-sharing.
VIP Prime Network EmblemHealth VIP Dual Group EmblemHealth Medicare HMO Yes Yes No Copays/ Coinsurance 14 counties Employer Group Plan. Special needs plan limited to individuals with both Medicare and full Medicaid coverage. Individuals with full Medicaid coverage are not required to pay cost-sharing.
VIP Prime Network EmblemHealth Affinity Medicare Ultimate Affinity Medicare HMO SNP Yes Yes No Copays/ Coinsurance 10 counties $0 PCP Copay, $0 Specialist Copay, Dental, Vision and Hearing Coverage, and OTC benefit at $60 Per Month/$720.
VIP Prime Network EmblemHealth Affinity Medicare Solutions Affinity Medicare HMO SNP Yes Yes No Copays/ Coinsurance 10 counties $0 PCP Copay, Dental, Vision and Hearing Coverage, and Routine Transportation.

OON = out-of-network; PCP = primary care provider; OTC= over-the-counter; Req'd = Required.

14 county1 = New York City (Bronx, Kings, New York, Queens, Richmond), Nassau, Suffolk, Orange, Rockland, Westchester, Dutchess, Sullivan, Ulster, and Putnam

10 county2 = Bronx, Kings, Nassau, New York, Orange, Queens, Richmond, Rockland, Suffolk and Westchester

Chapter 6 2019 Provider Networks and Member Benefit Plans