Date Issued: 9/29/2015

For coverage effective January 1, 2016, the Medicare annual enrollment period begins October 15, 2015 and ends December 7, 2015. Please speak with your patients and encourage them to make sure their health coverage meets their needs and that they check to ensure any associated costs and coinsurance requirements are within their budget. Any health plan changes must be made during this open enrollment period. Below is a summary of benefit plan changes for 2016:


  • Added Comprehensive Dental to VIP HMO and VIP High Option Plans
  • Reduced premium for Essential HMO Members in Westchester County
  • Introduction of premium for Essential HMO in New York, Queens & Richmond Counties
  • Over-the-Counter (OTC) medications decreased to $20 per month for HMO SNP
  • OTC medications decreased to $15 per month for PPO SNP
  • Rx Tier 5 - specialty cost-sharing decrease for non-SNP plans from 33% to 25%
  • Lower Initial Coverage Limit (ICL): $2,950 for non-SNP plans
  • Premium & cost-sharing increases for all plans, except for those described above
  • Non-renewal of MLTC Plus (HMO SNP) Plan

Note: Members can access a full list of services and any benefit limitations by referencing their Evidence of Coverage (EOC).

Please be sure to refer your Medicare patients to other Medicare providers. To locate participating providers, please use the “Find a Doctor” directory at and create all your referrals using our secure provider website at

To identify Medicare members, look for the Medicare network names - Medicare Essential, VIP Prime, or Medicare Choice PPO - on the front of the member ID card, or sign in to our secure provider website to view the member’s eligibility. You can also see your network participation and review/edit your practice information on our provider website.

Policy & Alerts