at a glance
- EmblemHealth is a not-for-profit insurer that sells Medicare Advantage (Part C) plans.
- EmblemHealth currently serves 3 million members in the New York and tristate area.
- Different plan options offer various levels of coverage, and plan costs can vary by coverage and your location.
EmblemHealth is a not-for-profit health insurer that sells Medicare Advantage (Part C) plans in New York City, Long Island, Westchester County, and some upstate regions. These plans are sold under the EmblemHealth name.
EmblemHealth also owns and operates several other companies. These include ConnectiCare, an insurer that sells Medicare Advantage plans in Connecticut.
New Yorkers can choose from several EmblemHealth Part C plans. However, not every plan is offered in every county or has the same level of coverage. Plans offered in your county may change each year.
Like all HMOs, EmblemHealth’s plans require you to choose from a specific list of in-network providers for care. HMO-POS plans offer more flexibility here, but typically cost more per visit for out-of-network providers.
Your deductible, monthly premium, and copay amounts will vary based on the plan you choose and the county where you live.
Many EmblemHealth plans cost $0 per month; however, any premium for Part C is added to your Part B monthly premium. Copays typically average between $0 to $50, depending on your plan and the service.
Next, we’ll provide an overview of what each EmblemHealth Medicare Advantage plan offers.
EmblemHealth HMO plans
HMO plans EmblemHealth offers include:
- VIP Essential (HMO). This plan includes comprehensive coverage for dental, vision, hearing, and acupuncture, as well as SilverSneakers fitness benefits.
- VIP Gold (HMO). This plan includes comprehensive coverage for dental, vision, hearing, acupuncture, and SilverSneakers.
- VIP Gold Plus (HMO). This plan covers everything VIP Gold does, but you’ll pay $0 for many medical services, including visits to your primary care physician (PCP), specialists, and urgent care.
- VIP Part Rx Saver (HMO). This plan has no annual deductible for Tier 1, Tier 2, and Tier 3 medications and includes coverage for dental, vision, hearing, acupuncture, and SilverSneakers.
- VIP Passport (HMO). This plan covers routine care and others like mental health services, preventative care, It also includes preventive dental, SilverSneakers, hearing aids, vision care, and more.
- VIP Reserve (HMO). This plan covers all that Original Medicare does and other srevices such as comprehensive dental, hearing aid allowance, eyewear allowance, and a SilverSneakers.
- VIP Value (HMO). This plan has a $0 monthly premium, option to add SilverSneakers and/or comprehensive dental benefits at a low cost. You’ll pay some costs when going to the doctor and you’ll have a yearly eyewear allowance.
EmblemHealth HMO D-SNPs
Dual Eligible SNPs (D-SNPs) are for people who are eligible for both Medicare and Medicaid.
Your costs for each plan will vary based on your level of assistance through Medicare’s Extra Help program. Some plans cost $0 for all covered services. Others may require copays and a monthly premium.
The D-SNPs offered by EmblemHealth vary by location but always include prescription drug coverage. They are:
- VIP Dual (HMO D-SNP). This plan covers comprehensive dental, vision, hearing aids, SilverSneakers, and up to 10 acupuncture visits. It also includes $50 per month for qualifying over-the-counter purchases in certain counties.
- VIP Dual Select (HMO D-SNP). This option includes comprehensive dental, hearing aids, vision, and a $60 monthly for qualifying over-the-counter purchases.
- EmblemHealth VIP Dual Reserve (HMO D-SNP). This plan includes typical Part C coverage and extra benefits such as $147 monthly for qualifying over-the-counter (OTC) items including healthy food items and produce.
- VIP Solutions (HMO D-SNP). This plan includes extras like like preventive dental, $0 for 10 additional acupuncture visits, hearing aid allowance, and eyewear allowance.
EmblemHealth offers several stand-alone prescription drug (Part D) plans in most of New York state and in many other states throughout the country.
These plans include VIP Rx and VIP Rx Plus. Both have a $0 copay for preferred generic prescription drugs and varying costs for medications on other tiers.
The deductibles and monthly premium costs for EmblemHealth Part D plans vary by location.
EmblemHealth Medicare Advantage (Part C) plans are available throughout most of New York state, although not every plan is offered in every area. In some of the northernmost parts of the state, including St. Laurence County, EmblemHealth offers only Part D prescription drug plans.
The plans offered and their costs may vary based on your ZIP code.
Some of the covered services include:
- inpatient hospital care
- annual physical
- limited home healthcare
- clinical research expenses
- hospice care
- limited skilled nursing facility care
- emergency ambulance services
- outpatient preventive and medically necessary services
- durable medical equipment such as mobility scooters, blood sugar monitors, and hospital beds
- screenings for conditions including diabetes, heart disease, HIV, mental health, and certain types of cancer
- substance misuse screenings and counseling
- smoking cessation counseling
- pneumonia and flu shots
Most EmblemHealth plans also include extras, such as:
The county where you live will determine the monthly premiums, copays, and coinsurance you pay for an EmblemHealth plan.
The table below highlights some of the costs you may see for a few EmblemHealth plans in many New York counties:
|Monthly premium||PCP copay||Specialist copay|
|EmblemHealth VIP Value (HMO)||$0||$15||$50|
|EmblemHealth VIP Rx Saver (HMO)||$0||$5||$40|
|EmblemHealth VIP Gold (HMO)||$54.60–$97||$0||$25|
|EmblemHealth VIP Dual Reserve (HMO D-SNP)||$0–42.50||$0||$0|
Part C plans are available from private insurers, such as EmblemHealth. Where you live will determine the plans you can buy, as well as their costs.
By law, each plan must cover the medical services covered by original Medicare. Many also include additional coverage, such as Part D prescription drug plans and dental care.
Part C plans usually have an in-network list of medical providers and suppliers you’ll need to use to ensure maximum coverage.
You can search and compare Part C plans by ZIP code here.
EmblemHealth is a nonprofit insurer that sells Medicare Advantage plans throughout most of New York state.
EmblemHealth’s Medicare Advantage plans cover all the services original Medicare does. Most also cover dental care, vision care, and hearing aids.
Plan holders can also access a 24-hour nurse-operated hotline.