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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 2025, 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 3.5 out of 5 stars in 2025.
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 $14.10. 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 $590.00 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 $9350.00 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) plan has a $590 deductible for prescription drugs. After meeting the deductible, you will pay the costs for drugs in each tier. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS). If you qualify for LIS, you will pay $14.10 for Part D.
Additional Benefits
The EmblemHealth VIP Dual (HMO D-SNP) plan offers a wide range of benefits with varying cost-sharing. Many services, including primary care, outpatient services, and vision services, have a 20% coinsurance. The plan has no copay for home health and diagnostic services. The plan also provides coverage for hearing exams and prescription hearing aids with a maximum benefit, dental services with 20% coinsurance, and offers additional benefits like acupuncture and over-the-counter items. Emergency and ambulance services are covered, but some services, like cardiac rehabilitation, are not.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered; however, additional days, non-Medicare covered stays, and upgrades for inpatient hospital acute and additional days and non-Medicare covered stays for inpatient psychiatric care are not covered. You will be responsible for the Medicare-defined cost share.
Outpatient Services See details
Outpatient Services with the EmblemHealth VIP Dual (HMO D-SNP) plan covers outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient substance abuse services. Outpatient hospital and observation services have a 20% coinsurance, and outpatient substance abuse services have a 20% coinsurance. Outpatient blood services are not covered.
Partial Hospitalization See details
EmblemHealth VIP Dual (HMO D-SNP) covers partial hospitalization with a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the EmblemHealth VIP Dual (HMO D-SNP) plan. Ground and Air Ambulance Services have a 20% coinsurance, and there is no copay. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered under the EmblemHealth VIP Dual (HMO D-SNP) plan. Emergency Services and Urgently Needed Services have a 20% coinsurance, while Emergency Services has a maximum per visit amount of $110.00 and Urgently Needed Services has a maximum per visit amount of $45.00. Worldwide Emergency Services has a maximum plan benefit coverage of $50,000.00.
Primary Care See details
The EmblemHealth VIP Dual (HMO D-SNP) plan covers Primary Care services, including Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional services, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services, with a 20% coinsurance for most services. Chiropractic Services are covered, but routine care is not covered.
Preventive Services See details
The EmblemHealth VIP Dual (HMO D-SNP) plan covers preventive services, including Medicare-covered services, annual physical exams, health education, fitness benefits, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. However, the plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, or counseling services.
Hearing Services See details
The EmblemHealth VIP Dual (HMO D-SNP) plan covers hearing exams with at most 20% coinsurance, and Routine Hearing Exams and Fitting/Evaluation for Hearing Aid are covered once per year. Prescription Hearing Aids are covered with a maximum benefit of $300 every three years, and Prescription Hearing Aids (all types) are covered with 2 visits every three years, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered. OTC Hearing Aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams and eyewear. Eye exams have a 20% coinsurance, and eyewear also has a 20% coinsurance with a combined maximum benefit of $300 every two years.
Dental Services See details
The EmblemHealth VIP Dual (HMO D-SNP) plan covers dental services with 20% coinsurance for Medicare dental services. Other dental services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the EmblemHealth VIP Dual (HMO D-SNP) plan, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while other Medicare Part B drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the EmblemHealth VIP Dual (HMO D-SNP) plan. There is a 20% coinsurance for this service.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetic Devices with a 20% coinsurance, Medical Supplies with a 20% coinsurance, and Diabetic Equipment with a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the EmblemHealth VIP Dual (HMO D-SNP) plan. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have no copay, but require at most 20% coinsurance, with a minimum coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by the EmblemHealth VIP Dual (HMO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the EmblemHealth VIP Dual (HMO D-SNP) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the EmblemHealth VIP Dual (HMO D-SNP) plan, with a $0 copay for days 1-20 and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The EmblemHealth VIP Dual (HMO D-SNP) plan covers acupuncture, with a limit of 10 treatments per year, and over-the-counter (OTC) items up to $60.00 per month; however, meal benefits, dual eligible SNPs with highly integrated services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several other services 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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