EmblemHealth Medicare Advantage HMO Plan

With the EmblemHealth Medicare Advantage HMO plan, you get comprehensive coverage, just like with the HIP Prime HMO plan — but with an additional enhanced pharmacy benefit. And, you save with lower copays while your premium contribution stays the same.

You get coverage for your medical, preventive care, outpatient and hospital services. Your doctor visits and hospital services are covered with $0 copays. You also have 3-tier pharmacy coverage with $0 copays for generic and brand-name formulary drugs; while non-formulary drugs are covered with a $40 copay.

These benefits are neither offered nor guaranteed under contract with the FEHB Program, but are made available to all enrollees and family members who become Members of EmblemHealth Medicare Advantage HMO Plan.

Enrollment: 1-866-640-3856, (TDD: 711) from 8 a.m. to 8 p.m., seven days a week (excluding major holidays).

Customer Service: call the number on the back of your member ID card, from 8 a.m. to 8 p.m., seven days a week (excluding major holidays).


You can enroll in the EmblemHealth Medicare Advantage HMO plan if you:

  • Are enrolled in the HIP HMO High Option Plan(enrollment codes 511,512,513)
  • Live in the plan’s Medicare-approved service area, which includes New York City (The Bronx, Brooklyn, Manhattan, Queens and Staten Island), Nassau, Suffolk and Westchester counties
  • Are enrolled in Medicare Part A
  • Are enrolled in Medicare Part B


Enrollment codes and rates 2020

Below are the biweekly and monthly premium contributions, which are the same as with the HIP Prime HMO active plan.


Non-Postal Premium

Postal Premium




Type of Enrollment

Gov’t Share

Your Share

Gov’t Share

Your Share

Category 1 Your Share

Category 2 Your Share


High Option Self Only








High Option Self Plus One








High Option Self and Family








Non-Postal rates
 apply to most non-Postal employees. If you are in a special enrollment category, refer to the Guide to Federal Benefits for that category or contact the agency that maintains your health benefits enrollment.

Postal Category 1 rates
 apply to career employees covered by the National Postal Mail Handlers Union (NPMHU), National Association of Letter Carriers (NALC) and Postal Police bargaining units.

Postal Category 2 rates
 apply to other non-APWU, non-PCES, non-law enforcement Postal Service career employees, including management employees, and employees covered by the National Rural Letter Carrier’s Association bargaining unit.

Special Guides to Benefits are published for American Postal Workers Union (APWU) employees (see RI 20-2A) including Material Distribution Center, Operating Services and Information Technology/ Accounting Services employees and Nurses; Postal Service Inspectors and Office of Inspector General (OIG) law enforcement employees (RI 70-2IN); Postal Career Executive Service (PCES) employees (see RI 70- 2EX); and non-career employees (see RI 70-8PS).

Career APWU employees hired before May 23, 2011 will have the same rates as the Category 2 rates shown below. In the Guide to Benefits for APWU Employees (RI 70-2A) this will be referred to as the “Current” rate; otherwise, “New” rates apply.

For further assistance, Postal Service employees should call:

Human Resources, Shared Service Center, 1-877-477-3273, option 5 (TTY: 1-866-260-7507)

Postal rates do not apply to non-career postal employees, postal retirees, or associate members of any postal employee organization who are not career postal employees. Refer to the applicable Guide to Federal Benefits.

More Plan Details

Benefits at-a-glance: EmblemHealth Medicare Advantage HMO

This is just a summary. It does not contain the full details of your EmblemHealth Medicare Advantage HMO plan.

High Option - In Network

Medical Care

PCP office visit: $0 copay

Specialist office visit: $0 copay

Preventive Care

Routine physical exam: $0 copay

Women’s wellness services: $0 copay

Other Services

Outpatient mental health: $0 copay

Urgent care: $0 copay

Ambulatory surgery: $0 copay

Ambulance: $0 copay

Prescription drugs: $0 generic/$0 brand/$40 non-formulary copay

Hospital Services

Inpatient care: $0 copay

Anesthesia: $0 copay

Emergency room: $0 copay

For complete details about the benefits available through these plans, please read the Federal RI 73-001.

The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year.

As always, with your HIP FEHB High option plan (HIP Prime HMO) you have access to network doctors and hospitals throughout all five boroughs of New York City, Long Island, Westchester, Rockland and Orange counties.

And your network has grown! Through our expanded network you now also have access to 25,000 more medical professionals and 37 more hospitals and facilities throughout these additional counties: Albany, Broome, Columbia, Delaware, Dutchess, Fulton, Greene, Montgomery, Otsego, Putnam, Rensselaer, Saratoga, Schenectady, Schoharie, Sullivan, Ulster, Warren and Washington.

And rest assured, you will continue to have access to the area’s top hospitals, like:

  • The Hospital for Special Surgery
  • North Shore-Long Island Jewish Health System
  • Memorial Sloan-Kettering Cancer Center
  • NYU Hospital Center
  • Montefiore Medical Center
  • And many more    

Need to see a doctor?

In your secure member portal, myEmblemHealth, you have convenient access to your personal information, including benefits and valuable health management tools.

Stay on top of your benefits

When you sign in, you can:

  • Review your health benefits.
  • View your prescription history.
  • Look up covered drugs and locate a pharmacy.
  • Find claims information (such as claim or prior approval status, the amount paid toward your deductible and much more).
  • Order ID cards.
  • Download forms.
  • Update personal information, such as your email address.

Assess and track your health

With myEmblemHealth, you can take a more active role in your health by using a range of online self-management tools like the following:

  • Health Assessment (HA) — Get a customized picture of your health and receive recommendations to improve unhealthy behavior that affects your quality of life and your health status. We also encourage your adult covered dependents to complete their own HA.
  • Personal Health Record (PHR) — Keep your health records well-organized right in one secure place. Copies of your PHR can be printed and shared with your doctors.
  • Treatment Cost Calculator – Estimate your share of costs for many common conditions and services, based on your particular benefits and coverage information.

Go green and get rid of clutter

Having all your health plan information online is a great way to get rid of clutter, stay organized and keep on top of your health at your convenience. By going paperless, you can conveniently access your personal message center to read plan communications, while helping to save trees!

Get the following items and more electronically:

  • Explanations of benefits (EOBs)
  • Notifications regarding when your claims are processed
  • Personalized information about your health
  • Your plan newsletter
  • Timely communications about your coverage and benefits

Enrollment and Customer Service

If you are a prospective member and have questions about enrollment, call 1-866-640-3856, from 8 a.m. to 8 p.m., seven days a week (excluding major holidays). Use the Interactive Voice Response System after business hours. If you have a hearing or speech impairment and use a TDD, call 711.

If you are a current plan member, call the number on the back of your member ID card, from 8 a.m. to 8 p.m., seven days a week (excluding major holidays).

Choosing EmblemHealth Medicare Advantage HMO

By calling the number above, you can speak with an EmblemHealth Medicare expert or schedule a one-on-one consultation. We will provide you with a Medicare Advantage enrollment form. There are no enrollment codes to enter when completing the form. You can mail back the completed form or leave it with an EmblemHealth Medicare expert during your consultation. For premium rates, visit the Enrollment Rates section.

FEHB Drug Comparison Tool

Use our drug comparison tool to estimate your out-of-pocket prescription drug costs. Enter the medications you take and we'll show you your monthly out-of-pocket costs.

Click here to access it through ExpressScripts.

Your plan provides more than just coverage. You can take advantage of the many free programs and support services we offer to help you live a healthy lifestyle and manage your condition if you get sick or injured.

Health and wellness programs

Providing you with the right care at the right time is important to us. Our Health and Wellness programs are designed to supplement your doctor’s care. The services listed below can help you (or any enrolled family member) get well, feel better and improve overall quality of life. As a plan member you can get:

  • Help staying on a diabetes management plan
  • Heart disease support
  • Preventive cancer screenings
  • Domestic violence victim support and resources
  • Pregnancy management and support for depression after giving birth
  • Help to stop smoking
  • Chronic obstructive pulmonary disorder (COPD) support
  • Free checkups and immunizations for children and adults

We also serve our members and their communities by promoting overall wellness — body, mind and spirit. Take advantage of programs like Care for the Family Caregiver and Dignified Decisions — End of Life Care.

For more details about all these programs visit emblemhealth.com/stayhealthy

Healthy discounts

We’re here for you, with online tools, discounts and programs that make it easy to manage your health. With our Healthy Discounts* you get discounts and save money for services provided by participating health care professionals, such as:

  • Registered Dietitians – Save up to 25 percent on nutrition counseling.
  • Weight Loss Services – Save on Jenny Craig and NutriSystem.
  • Vitamins & Natural Supplements – Order online and save up to 45% on brand-name health products.
  • Health Club Memberships – Join selected clubs for the lowest publicly available rate or at least a 10% discount on enrollment fees and/or monthly membership fees.
  • Massage Therapy – Save up to 25 percent on therapeutic massage.
  • Acupuncture Therapy – Save up to 25 percent on acupuncture therapy.
  • Hearing Care – Save on hearing aid purchases and get other discounts through HearX, HearUSA and HearPO centers. At HearPO centers, you also get a low-price guarantee on hearing aids, free batteries, follow-up care and screenings, and a 60-day trial period with a 100% money-back guarantee.
  • Vision Affinity Discount Program – Receive discounts of up to 20 percent at participating vision providers.
  • Laser Vision Care – Save up to 25 percent of laser vision correction.
  • Health Care Services and Products – Get as much as half off the cost of over-the-counter drugs, dental care, home nursing care and more.

For more about these services, please visit emblemhealth.com/goodhealth.

* Please note: Services included in the Healthy Discounts programs are available only through participating vendors. These discount programs are not health care benefits and we do not insure them.

Provider Coverage

With our robust network of quality doctors, you can get care from many of the region’s leading doctors, clinicians and facilities, including hospitals and urgent care centers.

A partner in wellness

The Right Care, Right in Your Neighborhood

AdvantageCare Physicians are the newest addition to the EmblemHealth family and are now one of the largest primary and specialty care practices in New York City. With 37 locations throughout New York City and Long Island, you can find a convenient location near home or work.