EmblemHealth Essential for Richmond, NY
Medicare Advantage Plan Summary & Benefits
EmblemHealth Essential is a Health Maintenance Organization (HMO) healthcare plan for seniors and other beneficiaries residing in Richmond County, NY. It includes all of the benefits of Original Medicare and may include prescription drug coverage and other extras. The primary benefit of an HMO is that the out-of-pocket costs are lower and more predictable than with other types of plans.
Please note: You must use plan providers to avoid incurring additional costs. You will be responsible for the costs of out of network care. Referrals may be required for all but primary care physician visits.
The health care benefit information provided here is an overview only and not a comprehensive description of available benefits. Additional information about the plan benefits is available from your agent.
Summary of Benefits
When this page was published the Summary of Benefits document for this 2014 health plan was not available. Please Ask an Agent for the Summary of Benefits documentation before choosing this plan.
The monthly premium for this health insurance plan in Richmond County is $0.00 plus your monthly Medicare Part B premium. Most Medicare beneficiaries pay the standard monthly Part B premium in addition to their MA or MAPD plan premium. However, some beneficiaries are required to pay slightly higher Part B and Medicare Part D premiums because of their income (over $85,000 per year for singles or $170,000 for married couples), or due to late enrollment penalties.
Part D Prescription Drug Plan Information
This plan includes prescription drug coverage. The formulary (00014343) has a total of 3,204 prescription medications.
If you have Part D assistance, your premium will be adjusted based on your percentage.
|Formulary Drug Details:||Tier 1||Tier 2||Tier 3||Tier 4||Tier 5|
|— Drugs per Tier:||224||1818||605||269||288|
|— Cost-Sharing in ICP:||$2.00||$10.00||$35.00||$95.00||25%|
The Medicare Part D deductible with this health plan is $0.00. That means you have first dollar coverage.
Maximum Out of Pocket (MOOP) Benefit
The new healthcare law allows for a maximum limit of $6,700 on your out of pocket medical costs for 2014 Medicare Advantage plans. This amount is commonly called the plan MOOP (Maximum Out of Pocket). A plan's MOOP does not include your prescription drugs or the monthly premiums you pay for your health plan. Although the mandatory MOOP limit is $6,700, the Affordable Care Act law allows for a “Voluntary MOOP” that can be as low as $3,400. The MOOP on this plan is $3,400 .
Medicare doesn't cover routine hearing exams, hearing aids, or exams for fitting hearing aids. Medicare covers diagnostic hearing and balance exams if your doctor or other health care provider orders these tests to see if you need medical treatment. Here's how this plan covers hearing services:
- $0 co-payment for up to 1 supplemental hearing aid each year.
- $30 co-payment for diagnostic hearing exams covered by Medicare.
- $15 co-payment for up to 1 supplemental routine hearing exam each year.
- 50% of the cost for diagnostic hearing exams covered by Medicare.
- 50% of the cost for supplemental hearing exams.
- 50% of the cost for supplemental hearing aids.
- The plan will pay up to $1 000 for all of the following services combined: Supplemental
- Hearing Aids. .
- $1 000 plan coverage limit for supplemental routine hearing aids each year. This limit applies to both in-network and out-of-network benefits.
Compare Medicare Advantage Plans
Compare EmblemHealth Essential with these top rated Medicare Advantage Plans available in Richmond County:
- EmblemHealth VIP
- Aetna Medicare Standard Plan
- EmblemHealth VIP High Option
- UnitedHealthcare MedicareComplete Choice
- Empire MediBlue Plus
Related Medicare Plans in Richmond, NY
- Medicare Advantage Plans in Richmond County, NY
- New York Medigap Medicare Supplements
- Senior Dental Insurance Available in New York
- New York Medicare Part D Prescription Drug Plans
This page was last updated on: 10/28/2013
About The Insurer EmblemHealth Medicare HMO
The summary (overall) rating for this EmblemHealth Medicare HMO plan is 4.0 out of 5 based on reviews from 11903 user ratings from the previous year. For more information about the review process, visit http://cms.gov.