EmblemHealth VIP Dual Reserve (HMO D-SNP)

EmblemHealth VIP Dual Reserve (HMO D-SNP) is a HMO D-SNP plan offered by EmblemHealth, Inc. available for enrollment in 2025 to people living in Bronx, Kings, New York, and Queens. This plan received an overall rating of 3 out of 5 stars in 2026.

It's important to know that EmblemHealth VIP Dual Reserve (HMO D-SNP) 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 Dual Reserve (HMO D-SNP).

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 Dual Reserve (HMO D-SNP) Medicare plan features an annual prescription drug deductible of $615. This deductible represents the amount you must pay out-of-pocket for your covered medications before the plan begins to cover its share of your prescription costs. Specific drug coverage tier details, including copays and coinsurance rates for individual medication tiers, are currently unavailable for this plan. To determine your exact costs for specific prescriptions under this plan, you will need to consult the plan's formulary or contact the provider directly.

Additional Benefits

The EmblemHealth VIP Dual Reserve (HMO D-SNP) offers comprehensive medical coverage with no copays for most primary care, specialist, and outpatient services, though a 20% coinsurance typically applies to outpatient care, diagnostics, and medical equipment. Inpatient hospital stays, home health services, and preventive care are fully covered with no copay and no coinsurance. Emergency and urgent care also feature no copays, subject to a 20% coinsurance up to set maximum limits. For supplemental benefits, the plan provides dental care, vision exams, and hearing aids with no copays, though some services may require a 20% coinsurance or have annual coverage limits. Skilled nursing facility care is available with no copay for the first 20 days, followed by a 218 dollar daily copay for days 21 through 100. Additionally, beneficiaries can take advantage of acupuncture treatments and an 80 dollar monthly over-the-counter allowance with no copay or coinsurance.