EmblemHealth VIP Value (HMO-POS)

EmblemHealth VIP Value (HMO-POS) is a HMO-POS plan offered by EmblemHealth, Inc. available for enrollment in 2026 to people living in Capital Region & Mid-Hudson Valley. This plan received an overall rating of 4 out of 5 stars in 2026.

It's important to know that EmblemHealth VIP Value (HMO-POS) 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 Value (HMO-POS).

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 Value (HMO-POS) prescription drug plan features an annual drug deductible of $215. Plan members enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs at standard pharmacies and through mail order. For Tier 2 generic prescriptions, there is no copay when using preferred mail order, while standard pharmacy and mail-order options require a $10 copay for a one-month supply. Brand-name and specialty medications are subject to coinsurance, with Tier 3 preferred brands requiring 25% coinsurance, which drops to 22% when using preferred mail order. Tier 4 non-preferred drugs carry a 28% coinsurance, or 25% through preferred mail order, while Tier 5 specialty drugs require a 29% coinsurance for a one-month supply. Utilizing preferred mail-order services provides the lowest out-of-pocket costs for many of these covered medications.

Additional Benefits

The EmblemHealth VIP Value (HMO-POS) plan offers affordable medical coverage with no copay for primary care visits and a $35 copay for specialists. Inpatient hospital stays require a $450 daily copay for the first five days, with no copay for additional days, while emergency room visits carry a $115 copay. Outpatient services feature no coinsurance and a copay ranging from no copay up to $350. For extra care, the plan provides routine dental, vision, and hearing benefits with no copay, alongside a $300 annual eyewear allowance and up to $3,000 every three years for hearing aids. Preventive dental services have no copay, while comprehensive dental care is covered with a 50% coinsurance up to a $2,000 annual limit. Members also benefit from a quarterly over-the-counter allowance of up to $80 with no copay or coinsurance.