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EmblemHealth VIP Dual (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for EmblemHealth VIP Dual (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on EmblemHealth VIP Dual (HMO D-SNP) in 2026, please refer to our full plan details page.
EmblemHealth VIP Dual (HMO D-SNP) is a HMO D-SNP plan offered by EmblemHealth, Inc. available for enrollment in 2025 to people living in NYC, Long Island, Hudson Valley, Capital Region. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that EmblemHealth VIP Dual (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
EmblemHealth VIP Dual (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about EmblemHealth VIP Dual (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.
For EmblemHealth VIP Dual (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $58.80. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The EmblemHealth VIP Dual (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. This deductible is the amount you must pay out-of-pocket for your covered medications before the plan begins to pay its share. Understanding this upfront cost is an important step in evaluating if this plan fits your healthcare budget. Specific drug coverage tier details, including copayments and coinsurance rates for different medication levels, are currently not available for this plan. To determine your exact out-of-pocket costs for specific prescriptions, you should consult the plan's formulary. This will help you verify if your specific medications are covered and what tier they fall under.
Additional Benefits
The EmblemHealth VIP Dual (HMO D-SNP) plan offers comprehensive medical coverage featuring no copay and no coinsurance for inpatient hospital stays, preventive services, and home health care. For outpatient services, primary care, specialist visits, and durable medical equipment, members generally pay no copay and a 20% coinsurance. Emergency and urgent care services are also covered with no copay and a 20% coinsurance, alongside worldwide emergency coverage. Preventive and comprehensive dental services are fully covered with no copay and no coinsurance, while Medicare-covered dental and vision services require a 20% coinsurance and no copay. Skilled nursing facility stays feature no copay for the first 20 days, followed by a daily copay of $218 for days 21 through 100. Routine transportation, prescription and over-the-counter hearing aids, and over-the-counter items are not covered under this plan.
Inpatient Hospital See details
EmblemHealth VIP Dual (HMO D-SNP) covers inpatient acute and psychiatric hospital services with no copay and no coinsurance, though prior authorization is required. This benefit is partially covered, as upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
EmblemHealth VIP Dual (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, outpatient substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for outpatient hospital services.
Partial Hospitalization See details
EmblemHealth VIP Dual (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance, with prior authorization required.
Ambulance and Transportation Services See details
EmblemHealth VIP Dual (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, though prior authorization is required. Routine transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
EmblemHealth VIP Dual (HMO D-SNP) covers emergency services and urgently needed services with a 20% coinsurance and no copay, up to a maximum of $115 and $40 per visit, respectively. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance up to a maximum benefit limit of $50,000.
Primary Care See details
EmblemHealth VIP Dual (HMO D-SNP) covers primary care, specialist visits, physical therapy, mental health, and telehealth services with no copay and 20% coinsurance. Chiropractic services are not covered under this plan, and podiatry is partially covered with no copay and 20% coinsurance for up to four routine visits per year.
Preventive Services See details
Preventive services are covered by EmblemHealth VIP Dual (HMO D-SNP) with no copay and no coinsurance, including annual physical exams up to a $40 maximum. Additional preventive benefits are only partially covered, with health education and remote access technologies included, while fitness, counseling, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, and home safety services are not covered.
Hearing Services See details
Hearing services are partially covered by EmblemHealth VIP Dual (HMO D-SNP), which features diagnostic hearing exams with no copay and no deductible. Routine hearing exams, hearing aid fitting evaluations, and all prescription and OTC hearing aids are not covered under this plan.
Vision Services See details
EmblemHealth VIP Dual (HMO D-SNP) covers vision services with no copay, 20% coinsurance, and no deductible, but some services are covered while routine eye exams, other eye exams, contact lenses, eyeglasses, lenses, frames, and upgrades are not covered.
Dental Services See details
EmblemHealth VIP Dual (HMO D-SNP) covers Medicare-covered dental services with no copay and a 20% coinsurance. Preventive and comprehensive dental services, including cleanings, exams, and restorative treatments, are covered with no copay and no coinsurance, though prior authorization is required for comprehensive care.
Home Infusion bundled Services See details
EmblemHealth VIP Dual (HMO D-SNP) covers Home Infusion bundled Services with no copay and no coinsurance, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the EmblemHealth VIP Dual (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by EmblemHealth VIP Dual (HMO D-SNP) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, and diabetic supplies. Prior authorization is required for durable medical equipment and prosthetics, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the EmblemHealth VIP Dual (HMO D-SNP) plan with no copay and a 20% coinsurance, subject to prior authorization. Covered care includes diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
EmblemHealth VIP Dual (HMO D-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by EmblemHealth VIP Dual (HMO D-SNP) with no copay and 20% coinsurance, though prior authorization is required. While some services are covered, specific sub-services such as cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
EmblemHealth VIP Dual (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 copay per day for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
EmblemHealth VIP Dual (HMO D-SNP) covers some services under its other services benefit, but acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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