|Part D Benefit:||Yes|
|Rx Gap Coverage:||No|
|Plan Phone #:||877-411-3625|
|Summary of Benefits:||Not Available|
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.
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.
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.
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.
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|
|Occupational Therapist:||$20 co-payment|
|Physical Therapist:||$20 co-payment|
|Speech Terapist:||$20 co-payment|
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
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
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.
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.
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.
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 EmblemHealth VIP Essential with these top rated plans available in Richmond County:
- Aetna Medicare Elite Plan
- Aetna Medicare Standard Plan
- Fidelis Medicare $0 Premium
- Fidelis Medicare Advantage Flex
- Fidelis Medicare Advantage without Rx
EmblemHealth VIP Essential Availability
EmblemHealth VIP Essential is available in Staten Island, and all other areas of Richmond County.
This page was last updated on 10/25/2016.