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EmblemHealth VIP Dual Enhanced (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for EmblemHealth VIP Dual Enhanced (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 Enhanced (HMO D-SNP) in 2025, please refer to our full plan details page.
EmblemHealth VIP Dual Enhanced (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, Westchester. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that EmblemHealth VIP Dual Enhanced (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 Enhanced (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 Enhanced (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 Enhanced (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 Enhanced (HMO D-SNP) plan has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy, your monthly premium for Part D drugs is $14.10. During the initial coverage phase, after you meet your deductible, you will pay the costs for your drugs. After your total drug costs reach $2000, you will enter the next coverage phase.
Additional Benefits
The EmblemHealth VIP Dual Enhanced (HMO D-SNP) plan offers a wide range of benefits with varying cost-sharing. Many services, including primary care, outpatient services, and vision care, have a 20% coinsurance. Additionally, the plan covers inpatient hospital stays, ambulance services with no copay, and hearing services with a maximum $300 benefit for hearing aids every three years. This plan also includes coverage for dental, home health, and skilled nursing facility services, with specific copays or coinsurance amounts. The plan provides additional benefits like acupuncture, and over-the-counter items with monthly coverage. However, some services, such as cardiac rehabilitation and certain preventive services, are not covered.
Inpatient Hospital See details
Inpatient Hospital-Acute and Inpatient Hospital Psychiatric benefits are covered, with a copay. Additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services, each with a 20% coinsurance. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the EmblemHealth VIP Dual Enhanced (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no copay for any ambulance service. Both ground and air ambulance services have a 20% coinsurance. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the EmblemHealth VIP Dual Enhanced (HMO D-SNP) plan. Emergency Services and Urgently Needed Services have a 20% coinsurance, and Worldwide Emergency Services has a maximum plan benefit coverage of $50,000.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have a 20% coinsurance, while Occupational Therapy Services, Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a minimum 20% coinsurance. Podiatry Services offer routine foot care with a 20% coinsurance, up to 4 visits per year. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive services, including annual physical exams, are covered. The plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission 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
Hearing services include coverage for routine hearing exams, with a coinsurance of at most 20%, and fitting/evaluation for hearing aids, with a limit of one visit per year. Prescription hearing aids are covered with a maximum benefit of $300 every three years; however, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a 20% coinsurance, and eyewear with a 20% coinsurance and a combined maximum of $300 every two years. Upgrades are not covered.
Dental Services See details
The EmblemHealth VIP Dual Enhanced (HMO D-SNP) plan covers dental services with 20% coinsurance for Medicare dental services. Other services such as oral exams, dental x-rays, cleaning, fluoride treatments, and other preventive and restorative services are covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Part B insulin drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the EmblemHealth VIP Dual Enhanced (HMO D-SNP) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical equipment is covered under the EmblemHealth VIP Dual Enhanced (HMO D-SNP) plan. Durable medical equipment (DME) has a 20% coinsurance, and requires authorization. Prosthetic devices and medical supplies have a 20% coinsurance, and diabetic equipment has a 20% coinsurance for diabetic supplies and diabetic therapeutic shoes/inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the EmblemHealth VIP Dual Enhanced (HMO D-SNP) plan. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic, Therapeutic, and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the EmblemHealth VIP Dual Enhanced (HMO D-SNP) plan with no copay and no coinsurance, but require authorization. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the EmblemHealth VIP Dual Enhanced (HMO D-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the EmblemHealth VIP Dual Enhanced (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 for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The EmblemHealth VIP Dual Enhanced (HMO D-SNP) plan covers acupuncture with a limit of 10 treatments per year. This plan also offers over-the-counter (OTC) items as a supplemental benefit with a maximum coverage amount of $20.00 every month, including nicotine replacement therapy and Naloxone coverage. 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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