EmblemHealth VIP Essential Richmond County, New York 2017 Medicare Advantage Plan H3330-032

HMO Plan
5-Star Rating:{plan}, a Medicare Advantage plan available in Richmond County, NY, an average Medicare rating of 3.5 out of 5 stars.
Plan ID:H3330-032
Plan Year:2017
Full Premium:$41.00/mo
Annual MOOP:$6,700
Part D Benefit:Yes
Rx Deductible:$400.00/year
Rx Gap Coverage:No
Online Pharmacy:No
Plan Phone #:877-411-3625
Summary of Benefits:Not Available

EmblemHealth VIP Essential Medicare Advantage Plan for Richmond County, New York seniors on Medicare.EmblemHealth VIP Essential is a Health Maintenance Organization (HMO) Medicare Advantage plan, by EmblemHealth, available in Richmond County, New York. It offers all of the basic benefits of Original Medicare and may include additional coverage.

With an HMO plan, like this one from EmblemHealth, your out-of-pocket costs are much lower than Original Medicare. That's the big advantage.

IMPORTANT: You must use providers in the EmblemHealth network to avoid incurring additional costs. You are responsible for all costs incurred out of network. Referrals are generally required to see specialists.

Monthly Premium

The monthly premium for this plan in Richmond County, NY is $41.00. This amount is paid directly to EmblemHealth.

If you enroll in this plan you will pay your Medicare Part B premium plus this plan's monthly premium. Most people pay the standard Part B premium, but some beneficiaries pay higher Part B premiums due to their annual income (over $85k for singles or $170k for married couples). Late enrollment penalties can also increase your Part B premium.

What you pay in premiums is independent of the health care services you use. You also have copayments and/or coinsurances (cost sharing) that you pay out of pocket when you use health care services or fill prescriptions.

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Maximum Out-of-Pocket Limit

There is a maximum out of pocket limit of $6,700 on your healthcare costs in 2017. This is commonly called the plan MOOP. The MOOP does not include your prescriptions or your monthly premium.

Although the mandatory MOOP limit is $6,700, Medicare allows for a lower “Voluntary MOOP” that can be as low as $3,400. This plan's MOOP is $6,700. Take this figure into as much consideration along with the premium and the copay.

If you are comparing this plan with Original Medicare, factor in that there are no out-of-pocket limits on Medicare Parts A and B. With Original Medicare you'll need a Medicare Supplement to cover what the government doesn't.

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Coverage, Copayments & Coinsurance

The EmblemHealth VIP Essential plan offers the same basic benefits as Original Medicare. The big difference is copayments and coinsurances. Below you will find (where available) what you will pay for common health care services.

Doctor Visits

Most plans have copayments when you see your primary care doctor or a specialist. Here's how this plan works:

Primary Care Doctor:0 to 20% co-insurance
Physician Specialist:$23 co-payment
Chiropractor:$20 co-payment
Occupational Therapist:$20 co-payment
Physical Therapist:$20 co-payment
Speech Terapist:$20 co-payment
Psychotherapist:$20 co-payment
Psychiatrist:$20 co-payment
Podiatrist:$20 co-payment

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Preventive Care

Medicare covers a wide range of preventive care services, including cardiovascular screenings, alcohol misuse screening and counseling, depression screen, and diabetes screening, to name just a few. Here's how this plan covers the following at no cost:

  • Abdominal aortic aneurysm screening
  • Alcohol misuse counseling
  • Bone mass measurement
  • Breast cancer screening (mammogram)
  • Cardiovascular disease (behavioral therapy)
  • Cardiovascular screenings
  • Cervical and vaginal cancer screening
  • Colorectal cancer screenings
  • Depression screening
  • Diabetes screenings
  • HIV screening
  • Medical nutrition therapy services
  • Obesity screening and counseling
  • Prostate cancer screenings (PSA)
  • Sexually transmitted infections screening and counseling
  • Tobacco use cessation counseling
  • Vaccines including Flu shots Hepatitis B shots Pneumococcal shots
  • 'Welcome to Medicare' preventive visit
  • Yearly 'Wellness' visit

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Urgent Care and Emergency Room

Urgent care and emergency room services are covered under Medicare Part B and have copayment or coinsurance fees. Some Medicare Advantage plans waive these fees if you are admitted as an inpatient within a specified number of days.

Urgent Care:$35 co-payment
Emergency Care:$75 co-payment
Co-insurance waived if admitted within 1 Days
Worldwide Coverage:Yes
Ambulance:$100 co-payment

Hospital Stays

If you are admitted to a hospital or clinic for treatment and stay overnight, you are an inpatient. Most plans have tiered costs for inpatient treatment. Here's how this plan covers you:

  • Day 1 to 5 you pay $351 per day
  • See the Summary of Benefits for additional copayment periods.
The hospital benefit period is Admit To Discharge.

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Prescription Drug Coverage

EmblemHealth VIP Essential includes Medicare Part D coverage for your prescription medications. The table below outlines what you will pay (the copayment) at your pharmacy at each tier level.

TierDrug ClassCopay
1Preferred Generic$0
3Preferred Brand$47
4Non-Preferred Brand$100
5Specialty Tier25%

If you are entitled to Part D assistance, your premium will be adjusted based on your percentage.

The Part D deductible is $400.00. This is the amount you will pay until the plan begins to pay its portion.

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Medicare Plan Rating

Medicare gave the EmblemHealth VIP Essential plan an average rating of 3.5.0 out of 5 stars. This rating is Not Rated, by Medicare's definition.

Medicare evaluates the quality of all Medicare Advantage plans. Plans are rated using a one to five-star scale, with five stars being the highest quality. If a plan is rated less than 2.5 stars, Medicare will not allow new members to enroll.

Compare Plans

Compare EmblemHealth VIP Essential with these top rated plans available in Richmond County:

EmblemHealth VIP Essential Availability

EmblemHealth VIP Essential is available in Staten Island, and all other areas of Richmond County.

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This page was last updated on 10/25/2016.