HIP VIP Medicare is a great fit for Medicare-eligible retirees. It offers quality coverage with a $0 deductible, low out-of-pocket costs, gym membership through SilverSneakers®, health coaching, and new for 2027, no referrals!
There are two HIP VIP Medicare plans:
The City of New York HIP VIP Medicare plans (VIP Premier (HMO) Medicare and VIP Rx Carveout (HMO) Medicare) help Medicare-eligible retirees meet their medical needs. You get:
Review eligibility requirements and enrollment criteria.
*VIP Premier (HMO) only.
| Key Features | In-Network Costs |
|---|---|
| PCP office visit | $0 copay |
| Specialist office visit | $30 copay |
| Diagnostic lab/x-ray | $0 copay |
| Routine physical exam | $0 copay |
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| Immunizations like flu, COVID-19, and pneumonia | $0 copay |
| Outpatient mental health | $5 copay |
| Ambulatory surgery | $0 copay |
| Ground ambulance | $50 copay |
| Inpatient hospital care | $250 copay days one (1) through three (3); $0 copay days four (4) and beyond. $0 copay for inpatient care in the Centers of Excellence |
| Anesthesia | $0 copay |
| Emergency room | $100 copay (waived if admitted within one day) |
| Annual routine hearing exam | $15 copay |
| Annual routine vision exam | $15 copay |
| Skilled nursing facility, Medicare-covered | $0 copay for days one (1) through 20, $164 copay for days 21 through 100. 100 days per benefit period |
| Home health care, Medicare-covered | $0 copay |
| Private duty nursing | $0 copay |
| Durable medical equipment | 20% coinsurance |
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The VIP Premier (HMO) Group Medicare plan includes Medicare Part D prescription drug coverage. You can enroll in this plan if your union welfare does not offer prescription drug coverage. The VIP Rx Carveout (HMO) Medicare plan only includes medical benefits and does not include prescription drug coverage.
*VIP Premier (HMO) only.
The VIP Premier (HMO) Group Medicare plan includes Medicare Part D prescription drug coverage that you can use at any pharmacy in our national network and includes home delivery service.
If you do not receive prescription drug coverage through your welfare fund, we will enroll you in the group Medicare Advantage Prescription Drug plan to make sure you get the prescription drug benefits you need. This will be through a rider that may have an additional cost.
Please note: If you are a VIP Premier (HMO) Medicare member and you enroll in a standalone prescription drug plan, you will automatically be disenrolled from the VIP Premier (HMO) plan.
When you get your prescriptions, you may have to pay a portion of the cost. This may include a copay (the flat amount you pay for drugs) or coinsurance (the percentage of the cost you pay for the drugs).
| Tier | Retail Pharmacy (30-Day Supply) | Mail-Order Pharmacy (30-Day Supply) |
|---|---|---|
| Tier 1 (Preferred Generic) | $10 copay | $5 copay |
| Tier 2 (Preferred Brand) | $15 copay | $7.50 copay |
| Tier 3 (Non-Preferred Drug) | $100 copay | $50 copay |
| Tier 4 (Specialty) | 25% coinsurance | 25% coinsurance |
| Tier 5 (Select Care Drugs) | $0 copay | $0 copay |
Part D Benefit Stages
This plan has no deductible.
You will pay the copays and coinsurance amounts listed above until your out-of-pocket drug costs reach your out-of-pocket maximum. In 2026, this is $2,100. In 2027, this will be $2,400. You will pay $0 for most vaccines, like shingles and travel vaccines. Once you reach the applicable out-of-pocket limit, you will pay $0 for all your covered prescription drugs.
AdvantageCare Physicians are a part of the EmblemHealth family and are now one of the largest primary and specialty care practices in New York City.
