EmblemHealth Essential for Richmond, NY

EmblemHealth Essential
Summary Rating:This Medicare drug plan has an average rating of 4.0
Part C Premium:
Part D Deductible:$0.00
Mail Order:No
Gap Coverage:No Gap Coverage
Formulary Drugs:3204
Plan ID:H3330-032
Plan Year:2014
Residents of:NY Residents
Plan Type:Local HMO
Summary of Benefits:

Medicare Advantage Plan Summary & Benefits

EmblemHealth Essential, NY Medicare Advantage PlanEmblemHealth Essential (H3330-032), Health Maintenance Organization Advantage Plan, Richmond County, NY

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.

Monthly Premium

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 1Tier 2Tier 3Tier 4Tier 5
  — Drugs per Tier:2241818605269288
  — Cost-Sharing in ICP:$2.00$10.00$35.00$95.0025%

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:

More Information

About The Insurer EmblemHealth Medicare HMO

The summary (overall) rating for this 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.