EmblemHealth Essential Overview
EmblemHealth Essential for Richmond County, New York, by EmblemHealth Medicare HMO, is a Health Maintenance Organization (HMO) Medicare Advantage plan for seniors on Medicare. It gives you all of the same health insurance benefits as traditional Medicare and offers extras that Medicare does not cover.
The insurance premium is $0.00 per month. You also have co-payments and/or co-insurances with each healthcare service that you use. You can learn more about the basic coverage costs on the co-payments page.
The real benefit of an HMO plan like EmblemHealth Essential is lower, predictable out-of-pocket expenses. Although more restrictive than traditional Medicare, a Medicare Advantage HMO plan limits your annual out-of-pocket costs. With Medicare Parts A and B, there's no cap, leaving you vulnerable to excessive medical bills.
With an HMO you are required to use healthcare providers in the plan's network. If you don't you will incur additional costs. Also, be aware that your primary care physician must make refer you before you see a specialist.
EmblemHealth Essential Quality Rating
The Centers for Medicare and Medicaid Services (CMS) reviews and rates the quality of all Medicare Advantage plans. The 1 (worst) to 5 (best) star ratings assist people considering plans and offer an unbiased measure of quality.
The CMS has awarded EmblemHealth Essential Above Average as compared to all others (as of 15 October, 2013).out of 5 stars. That means Medicare deems this plan
EmblemHealth Essential Out-of-Pocket Expenses
Medicare Advantage plans are limited to a maximum out-of-pocket limit of $6,700 (annually). This out-of-pocket limit does not include your prescriptions or your monthly premiums. It only applies to your costs for healthcare services.
Although the mandatory limit is $6,700, the CMS allows plans to offer a lower limit that can be as low as $3,400. The out-of-pocket limit on this plan is $3,400. Be sure to take into consideration, along with the premium and the co-payments, when making your enrollment decision.
If you are comparing EmblemHealth Essential with your traditional Medicare benefits, it's important to remember that there are no limits to your out-of-pocket expenses with Medicare Part A or Medicare Part B. If you keep your traditional Medicare benefits, the only way to avoid high medical bills is to purchase Medicare Supplement insurance to supplement your coverage.
Compare Medicare Health Insurance Plans
Make sure you get the best health insurance for your unique situation. Compare EmblemHealth Essential with these Medicare Advantage plans:
- EmblemHealth VIP
- Aetna Medicare Standard Plan
- EmblemHealth VIP High Option
- UnitedHealthcare MedicareComplete Choice
- Empire MediBlue Plus
EmblemHealth Essential is available in the following New York cities: Staten Island, and all other areas of Richmond County.
CMS File Date: January 14, 2014.
This Medicare health insurance catalog is maintained by 7/17/2014.and was last updated on