EmblemHealth VIP Dual (HMO D-SNP)

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.

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.

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 (HMO D-SNP) Medicare plan features an annual prescription 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 initial cost is an essential step when evaluating if this plan aligns with your healthcare budget and prescription needs. Specific details regarding copayments, coinsurance, and drug coverage tiers are currently unavailable for this plan. To get a complete picture of your potential medication costs, it is recommended to review the plan's formulary directly to see how your specific prescriptions are covered. This ensures you avoid unexpected expenses and find the most cost-effective Medicare drug coverage for your needs.

Additional Benefits

The EmblemHealth VIP Dual (HMO D-SNP) plan offers comprehensive coverage where many essential services, including preventive care, home health services, and preventive dental care, are available with no copay and no coinsurance. For other major services such as primary care, outpatient hospital visits, and durable medical equipment, members generally pay no copay but are responsible for a 20% coinsurance. Inpatient hospital stays require Medicare-defined copays with no coinsurance, while skilled nursing facility care features no copay for the first 20 days. Additional perks include routine and comprehensive dental treatments with no copay or coinsurance, alongside a $150 eyewear allowance every two years and a $300 hearing aid benefit every three years. Members also benefit from a $40 monthly over-the-counter allowance and up to 10 acupuncture treatments per year with no copay and no coinsurance. Emergency and urgent care are covered with a 20% coinsurance and no copay, which includes worldwide emergency coverage up to a $50,000 maximum limit.