EmblemHealth VIP Gold (HMO)

EmblemHealth VIP Gold (HMO) is a HMO plan offered by Health Insurance Plan of Greater New York available for the 2026 plan year to people living in Brooklyn, Long Island, Westchester. This plan received an overall rating of 4 out of 5 stars in 2026.

It's important to know that EmblemHealth VIP Gold (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.

Key Plan Facts

Below are a few key facts and commonly-asked questions about EmblemHealth VIP Gold (HMO).

Plan Costs:

The cost of a Medicare Advantage Plan is made up of four main parts.

• First, the monthly premium — the amount you pay every month.
• Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
• Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
• Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.

You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.

Common Services:

Drug Coverage

The EmblemHealth VIP Gold (HMO) prescription drug coverage includes an annual drug deductible of $200. Plan members enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs across standard retail and mail order options. Tier 2 generic drugs also feature no copay when filled through preferred mail order, or a low $10 copay for a one-month supply at standard pharmacies. For higher-tier medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brands require a 25% coinsurance at standard pharmacies, which is reduced to 22% for preferred mail orders. Tier 4 non-preferred drugs have a 28% coinsurance at standard pharmacies and 25% through preferred mail order, while Tier 5 specialty drugs require a 29% coinsurance for a one-month supply.

Additional Benefits

EmblemHealth VIP Gold (HMO) provides robust healthcare coverage with no copay or coinsurance for primary care visits, annual physicals, and preventive screenings. Specialist consultations, urgent care, and outpatient services are highly accessible, typically requiring low flat copayments like $25 for specialists. For inpatient hospital stays, members pay a $290 daily copay for the first seven days, after which there is no copay. Supplemental benefits include routine dental care with no copay, alongside routine vision and hearing exams for a $25 copay. This plan also features generous allowances with no copay for prescription hearing aids up to $2,400 every three years and eyewear up to $300 annually. Furthermore, members pay no copay for home health services and the first 20 days of skilled nursing facility care.

Plan Providers

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpring^SM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.