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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 2026, 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 out of 5 stars in 2026.
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 $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 Enhanced (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. You will need to pay this amount out-of-pocket for your covered medications before the plan begins to cover its share of your prescription costs. Detailed information regarding drug tiers, copayments, and coinsurance is not currently available for this specific plan. To determine your exact coverage and costs, you should review the plan's formulary or contact the provider directly to see how your specific medications are classified.
Additional Benefits
The EmblemHealth VIP Dual Enhanced (HMO D-SNP) plan offers robust medical coverage with no copays for inpatient hospital stays, primary care, and specialist visits. While there is no copay for most outpatient services, emergency care, and diagnostic tests, these services typically require a twenty percent coinsurance. Additionally, emergency services worldwide are covered with no copay or coinsurance up to a fifty thousand dollar limit. Preventive and comprehensive dental services, home health care, and diagnostic hearing exams are fully covered with no copay and no coinsurance. For other essential needs like durable medical equipment, dialysis, and vision services, members will pay no copay and a twenty percent coinsurance. Skilled nursing facility stays feature no copay for the first twenty days, followed by a daily copay of two hundred eighteen dollars for days twenty-one through one hundred.
Inpatient Hospital See details
Inpatient hospital services are partially covered by EmblemHealth VIP Dual Enhanced (HMO D-SNP), offering acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization is required. This benefit does not cover additional hospital days, upgrades, or non-Medicare-covered stays.
Outpatient Services See details
EmblemHealth VIP Dual Enhanced (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for outpatient hospital services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
EmblemHealth VIP Dual Enhanced (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
EmblemHealth VIP Dual Enhanced (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 other health-related locations are not covered.
Emergency Services See details
Emergency services are covered under the EmblemHealth VIP Dual Enhanced (HMO D-SNP) plan with a 20% coinsurance and no copay for both emergency care (up to $115 per visit) and urgently needed services (up to $40 per visit). Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance up to a $50,000 maximum plan benefit limit.
Primary Care See details
EmblemHealth VIP Dual Enhanced (HMO D-SNP) covers primary care, specialist visits, therapy, mental health, and telehealth services with no copay and a 20% coinsurance. Routine podiatry is covered for up to four visits per year with no copay and a 20% coinsurance, though chiropractic services are not covered in practice.
Preventive Services See details
Preventive services are covered by EmblemHealth VIP Dual Enhanced (HMO D-SNP) with no copay and no coinsurance, including an annual physical exam up to a $40 limit, kidney disease education, and other screenings. Additional preventive services are partially covered with no copay or coinsurance for health education and remote access technologies, though sub-services such as fitness benefits, nutritional/dietary benefits, and in-home support are not covered.
Hearing Services See details
Hearing services are partially covered by EmblemHealth VIP Dual Enhanced (HMO D-SNP), which provides diagnostic hearing exams with no copay and no coinsurance. While some prescription hearing aid services are covered, specific types (including inner ear, outer ear, and over the ear), routine hearing exams, fitting/evaluations, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered under EmblemHealth VIP Dual Enhanced (HMO D-SNP) with no deductible, no copay, and a 20% coinsurance. Although some services are covered, routine eye exams, other eye exams, contact lenses, and eyeglasses are not covered.
Dental Services See details
EmblemHealth VIP Dual Enhanced (HMO D-SNP) covers Medicare-covered dental services with no copay and a 20% coinsurance. Preventive and comprehensive dental services, such as exams, cleanings, x-rays, implants, and oral surgery, 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 Enhanced (HMO D-SNP) covers home infusion bundled services with no copay, subject to prior authorization. Under this benefit, Medicare Part B insulin carries a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the EmblemHealth VIP Dual Enhanced (HMO D-SNP) plan with no copayment and a 20% coinsurance.
Medical Equipment See details
EmblemHealth VIP Dual Enhanced (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and a 20% coinsurance. 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 by EmblemHealth VIP Dual Enhanced (HMO D-SNP) with no copay and a 20% coinsurance, subject to prior authorization. This coverage applies to outpatient diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
EmblemHealth VIP Dual Enhanced (HMO D-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by EmblemHealth VIP Dual Enhanced (HMO D-SNP) with no copay and require prior authorization, but only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation services are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
EmblemHealth VIP Dual Enhanced (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and a prior three-day inpatient hospital stay is not required for admission, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered by the EmblemHealth VIP Dual Enhanced (HMO D-SNP) plan, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage.
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