|Part D Benefit:||Yes|
|Rx Gap Coverage:||No|
|Plan Phone #:||877-411-3625|
|Summary of Benefits:||Not Available|
EmblemHealth 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 $32.00. This amount is paid directly to EmblemHealth.
This plan has a monthly premium, but it isn't the full cost. The plan's premium is in addition to your Medicare Part B premium. If your income is over $85,000 ($170,000 for married couples), or you have a penalty due to late enrollment, you'll pay the standard Part B premium.
IMPORTANT NOTICE: Double-digit price hikes for Medicare Part B premiums are coming in 2016. The base tier premium is expected to jump from $104.90 to $120.70.
In addition to the premiums you also pay your share when you use healthcare services. Each time you see your doctor, or if you are admitted as an inpatient (hospitalized), you'll pay copayments. Your prescription drugs also have a cost sharing component.
Maximum Out-of-Pocket Limit
2016 Medicare Advantage plans have an annual maximum out-of-pocket (MOOP) limit that protects you from financial disaster. The MOOP limit is $6,700, but plans can go as low as $3,400.
The most you will pay out-of-pocket if you enroll in this plan is $6,700. This amount does not include your monthly premium or the copayments. This is only the amount that you pay out of pocket.
Don't forget to look at the co-payments and co-insurance with Original Medicare (no out-of-pocket limits). If you stay on Original Medicare you'll need a Medicare Supplement to pay the gaps or pay it yourself.
Coverage, Copayments & Coinsurance
The EmblemHealth 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:
We do not currently have the outpatient care details for this plan. See the Summary of Benefits document for more details.
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:
We do not currently have the inpatient care details for this plan. See the Summary of Benefits document for more details.
Medicare covers some preventive care services, including cardiovascular screenings, alcohol misuse screening and counseling, depression screen, and diabetes screening. This plan covers preventive services as follows:
We do not currently have the preventive care details for this plan. See the Summary of Benefits document for more details.
Prescription Drug Coverage
This plan includes Medicare Part D coverage for your prescription medications. The formulary (00015374) has a total of 3,208 prescription medications. The table below outlines what you will pay (the copayment) at your pharmacy for medications at each tier level.
|Formulary Drug Details:||Tier 1||Tier 2||Tier 3||Tier 4||Tier 5|
|— Drugs per Tier:||212||1895||550||247||304|
|— Cost-Sharing in ICP:||$0.00||$10.00||$40.00||$95.00||33%|
If you are entitled to Part D assistance, your premium will be adjusted based on your percentage.
The Part D deductible on this plan is $0.00 (first dollar coverage).
Medicare Plan Rating
Medicare gave the EmblemHealth Essential plan an average rating of 3.0 out of 5 stars. This rating is Average, by Medicare's definition.
Medicare rates the quality of all Medicare Advantage plans. Ratings help shopper considering enrollment. Five stars represents the best quality. Plans rated less than 2.5 stars cannot be sold.
Compare EmblemHealth Essential with these top rated plans available in Richmond County:
- Aetna Medicare Connect Plus
- Aetna Medicare Standard Plan
- Healthfirst 65 Plus Plan
- Healthfirst Coordinated Benefits Plan
- Healthfirst Increased Benefits Plan
EmblemHealth Essential Availability
EmblemHealth Essential is available in Staten Island, and all other areas of Richmond County.
This page was last updated on 10/12/2015.