A non-government entity
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:
Sign up for EmblemHealth VIP Dual Enhanced (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The EmblemHealth VIP Dual Enhanced (HMO D-SNP) Medicare Advantage plan features an annual prescription drug deductible of $615. This deductible represents the amount you must pay out-of-pocket for your medications before your plan coverage begins to pay. Understanding these upfront costs is a key step in evaluating whether this plan fits your budget and healthcare needs. Specific drug tier details, such as copays and coinsurance for generic or brand-name drugs, are not currently available for this plan. To determine how your specific prescriptions are covered, it is best to consult the plan's comprehensive formulary list. Comparing these drug costs ensures you select the best Medicare coverage for your personal health requirements.
Additional Benefits
The EmblemHealth VIP Dual Enhanced (HMO D-SNP) offers comprehensive medical coverage, with many outpatient, primary care, specialist, and diagnostic services requiring no copay and a 20% coinsurance. For inpatient hospital stays, members pay Medicare-defined copays and deductibles with no coinsurance, while home health care and preventive services are covered with no copay and no coinsurance. Emergency and urgent care also feature no copay and a 20% coinsurance, with worldwide emergency services fully covered up to a maximum benefit. This plan features strong supplemental benefits, including preventive and comprehensive dental care with no copay and no coinsurance. Vision and hearing services are also covered with no copay, though routine exams require a 20% coinsurance, and the plan provides allowances for eyewear and prescription hearing aids. Additionally, members can access acupuncture and receive an over-the-counter benefit of up to $40 per month with no copay and no coinsurance.
Inpatient Hospital See details
EmblemHealth VIP Dual Enhanced (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, though Medicare-defined copays and deductibles apply and prior authorization is required. This benefit does not cover upgrades, non-Medicare-covered stays, or additional days beyond Original Medicare limits.
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
Partial hospitalization is covered by EmblemHealth VIP Dual Enhanced (HMO D-SNP) with no copay and a 20% coinsurance, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by EmblemHealth VIP Dual Enhanced (HMO D-SNP), with ground and air ambulance services requiring prior authorization and carrying a 20% coinsurance and no copay. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
Emergency services under EmblemHealth VIP Dual Enhanced (HMO D-SNP) are covered with a 20% coinsurance and no copay, up to a maximum of $115 per visit, while urgently needed services also carry a 20% coinsurance and no copay, up to a $40 per visit maximum. Worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance up to a $50,000 maximum benefit.
Primary Care See details
EmblemHealth VIP Dual Enhanced (HMO D-SNP) covers primary care, specialist visits, physical therapy, mental health, and telehealth services with no copay and a 20% coinsurance. Some chiropractic services are covered, but routine and other chiropractic services are not covered. Routine foot care is covered for up to four visits per year with no copay and a 20% coinsurance.
Preventive Services See details
Preventive services are partially covered by EmblemHealth VIP Dual Enhanced (HMO D-SNP) with no copay and no coinsurance for covered care such as annual physical exams, kidney disease education, and diabetes self-management training. Sub-services that are not covered under this plan include in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs for chemotherapy hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, home/bathroom safety modifications, and counseling services.
Hearing Services See details
Hearing Services are partially covered under the EmblemHealth VIP Dual Enhanced (HMO D-SNP) plan, offering routine hearing exams and fitting evaluations for no copay, though routine exams require a 20% coinsurance. Prescription hearing aids are covered with no copay or coinsurance up to a $300 limit every three years, but OTC hearing aids as well as inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
EmblemHealth VIP Dual Enhanced (HMO D-SNP) covers routine eye exams and eyewear with no copay and no deductibles, though a 20% coinsurance applies to routine exams and contact lenses. Up to $150 in combined eyewear coverage is available every two years, but other eye exam services and eyewear upgrades 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, while other preventive and comprehensive dental services are available with no copay and no coinsurance. Covered benefits include routine cleanings, exams, x-rays, and comprehensive procedures like endodontics and periodontics, which may require prior authorization.
Home Infusion bundled Services See details
Home infusion bundled services are covered by EmblemHealth VIP Dual Enhanced (HMO D-SNP) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance with no copay, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the EmblemHealth VIP Dual Enhanced (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
EmblemHealth VIP Dual Enhanced (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment 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
EmblemHealth VIP Dual Enhanced (HMO D-SNP) covers diagnostic and radiological services, including lab tests, diagnostic procedures, therapeutic radiology, and outpatient X-rays, with no copay and a 20% coinsurance. Prior authorization is required for all of these covered services.
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
EmblemHealth VIP Dual Enhanced (HMO D-SNP) does not cover cardiac rehabilitation services in practice, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance with no copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by EmblemHealth VIP Dual Enhanced (HMO D-SNP) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
EmblemHealth VIP Dual Enhanced (HMO D-SNP) partially covers other services, offering acupuncture and over-the-counter items with no copay and no coinsurance, while meal benefits are not covered. Acupuncture is limited to 10 treatments per year, and the over-the-counter benefit provides up to $40 per month.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved