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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. After the deductible is met, you will pay the costs for your drugs based on the tier and pharmacy you use. The plan offers a Part D premium reduction for those who qualify for the low-income subsidy, with a premium of $14.10. Once your total drug costs reach $2000, you enter the catastrophic coverage phase. During this phase, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The EmblemHealth VIP Dual Enhanced (HMO D-SNP) plan offers a wide range of benefits with varying cost-sharing. It covers inpatient and outpatient services, including mental health and substance abuse treatment, with a 20% coinsurance. Preventative, hearing, vision, and dental services are included, along with home health services at no cost, and skilled nursing facility stays with copays after the first 20 days. The plan also covers ambulance and emergency services with coinsurance, and provides coverage for home infusion, dialysis, and medical equipment, each with a coinsurance. Additional benefits include acupuncture, over-the-counter items, and nicotine replacement therapy. However, it is important to note that cardiac rehabilitation services and some services such as additional hours of care and personal care services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, though additional days and non-Medicare-covered stays are not covered. For these services, you will have a copay, and prior authorization is required.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) 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 and requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the EmblemHealth VIP Dual Enhanced (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, and Worldwide Emergency Services are covered by the EmblemHealth VIP Dual Enhanced (HMO D-SNP) plan. Emergency and Urgently Needed Services have a 20% coinsurance, while Worldwide Emergency Services are covered up to $50,000.
Primary Care See details
The EmblemHealth VIP Dual Enhanced (HMO D-SNP) plan covers Primary Care services with a 20% coinsurance, and covers Chiropractic Services with a 20% coinsurance, but does not cover Routine Chiropractic Care. The plan also covers Occupational Therapy Services with a 20% coinsurance. 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, each with their own coinsurance, ranging from 0% to 20%.
Preventive Services See details
Preventive services, including annual physical exams, are covered by the EmblemHealth VIP Dual Enhanced (HMO D-SNP) plan. Additional preventive services like health education, fitness benefits, remote access technologies, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit are covered, while in-home safety assessments, personal emergency response systems, medical nutrition therapy, and other services are not covered.
Hearing Services See details
The EmblemHealth VIP Dual Enhanced (HMO D-SNP) plan covers hearing exams with a coinsurance of at most 20% and covers routine hearing exams once per year, and fitting/evaluation for hearing aids once per year. Prescription hearing aids (all types) are covered up to $300 every three years, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The EmblemHealth VIP Dual Enhanced (HMO D-SNP) plan covers vision services, including eye exams with a 20% coinsurance, and eyewear with a 20% coinsurance and a combined maximum benefit of $300 every two years; however, upgrades are not covered. Routine eye exams are covered once per year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are all unlimited.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with 20% coinsurance. Other Dental Services include oral exams, dental x-rays, other diagnostic services, cleaning, fluoride treatment, and other preventive services, each with specific limits. Orthodontic Services are also covered. Restorative, adjunctive, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, prosthodontics, fixed, oral and maxillofacial surgery, and orthodontics are covered, but require prior authorization and have limitations.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with a 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance. Diabetic Equipment, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are also covered, all 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. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services also 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 prior authorization is required. 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. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the EmblemHealth VIP Dual Enhanced (HMO D-SNP) plan, but require prior authorization. There is no 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
Under "Other Services", acupuncture is covered with a limit of 10 treatments per year. Over-the-counter (OTC) items are covered with a maximum benefit of $60.00 every month, and the plan provides Nicotine Replacement Therapy (NRT) and Naloxone coverage as an OTC benefit.
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