EmblemHealth Medicare Advantage Reviews

EmblemHealth offers a limited number of HMO Medicare Advantage plans, available primarily in New York, with mediocre 5-star ratings from CMS and consumers.
By . Last update: June 17, 2024

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EmblemHealth Medicare Advantage Reviews
The EmblemHealth logo is a registered trademark of EmblemHealth Insurance Company.

Known for its commitment to affordability and accessibility, EmblemHealth plans include additional benefits such as wellness programs and preventive services to support the overall health of its members. However, limited plan options and mediocre 5-star ratings from CMS, are serious points of concern.

In this editorial review, we will explore the various EmblemHealth Medicare Advantage plans available, focusing on their coverage options, cost, and member feedback.

Table of Contents

Member Reviews for EmblemHealth

The following EmblemHealth reviews have been left by our members.

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PROS

  1. Comprehensive Coverage: EmblemHealth Medicare Advantage plans often include additional benefits like dental, vision, and hearing coverage, which are not typically covered by Original Medicare.
  2. Affordable Options: The plans are designed to be cost-effective, with various plan options to suit different budgets.
  3. Wellness Programs: Members have access to wellness programs aimed at preventive care and overall health improvement.
  4. Large Network: EmblemHealth has a substantial network of healthcare providers, ensuring members have access to a wide range of services.

CONS

  1. Limited Availability: EmblemHealth Medicare Advantage plans are primarily available in New York, which may limit options for those residing outside this area.
  2. Mixed Customer Reviews: Some members report issues with customer service and claims processing, which can impact the overall experience.
  3. Referral Requirements: Certain plans may require referrals to see specialists, which can be an inconvenience for some members.
  4. Variable Costs: Out-of-pocket costs can vary significantly depending on the plan chosen and the specific healthcare needs of the member.
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How Do EmblemHealth Medicare Advantage Plans Work?

EmblemHealth Medicare Advantage plan members get all their hospital coverage (Medicare Part A) and medical coverage (Medicare Part B) benefits through their plan. This covers screenings, preventive care, vaccinations, visits to doctors and specialists, hospital stays, skilled nursing, and hospice.

All EmblemHealth Medicare Advantage plans include coverage for:

  • Inpatient hospital admissions.
  • Doctor and specialist care.
  • Preventive care, screenings, and vaccinations.
  • Diagnostic services, lab work, X-rays and other imaging.
  • Outpatient services.
  • Ambulance transportation for emergencies.
  • Durable medical supplies and equipment.

Medicare rules say that all EmblemHealth plans must provide at least the same coverage and benefits as Original Medicare. But, each plan sets its own out-of-pocket costs.

Some EmblemHealth plans include extra benefits such as routine dental, vision, hearing, and wellness programs. These services aren't typically covered by Original Medicare.

When you join a EmblemHealth Medicare Advantage plan, you can manage all your healthcare needs under one plan. This often comes with lower out-of-pocket costs and extra benefits suited to your health and lifestyle.

However, it's important to note that lower costs aren't guaranteed. Costs depend on the specific plan and how much you use healthcare services. Also, the EmblemHealth plan you choose may have access restrictions, such as needing referrals and prior authorization. Original Medicare does not have these restrictions.

Extra Benefits from EmblemHealth

EmblemHealth Medicare Advantage plans often include several additional benefits designed to enhance overall health and well-being. Here are some of the most common extra benefits:

Dental, Vision, and Hearing Coverage

Many EmblemHealth plans offer comprehensive dental, vision, and hearing coverage, which are not typically included in Original Medicare. These benefits can include routine check-ups, cleanings, eyeglasses, and hearing aids.

Fitness Programs

EmblemHealth Medicare Advantage plans frequently include access to fitness programs such as SilverSneakers. These programs provide members with free or discounted access to gyms, fitness classes, and wellness resources.

Over-the-Counter Allowance

Some plans come with an over-the-counter (OTC) allowance, which gives members a set amount of money to spend on health-related items like vitamins, pain relievers, and first-aid supplies.

Telehealth Services

EmblemHealth has expanded its telehealth services, allowing members to access medical care from the comfort of their homes. This includes virtual visits with healthcare providers for both urgent and routine care.

Wellness and Preventive Care Programs

Wellness programs aimed at preventive care are a staple of EmblemHealth Medicare Advantage plans. These programs may include health education, disease management programs, and regular health screenings.

What Types of Plans Does EmblemHealth Offer?

Not all EmblemHealth plans are the same. And, EmblemHealth may not offer all plan types where you live, so it pays to explore using our Medicare Advantage Plan Finder tool. Here are the plan types EmblemHealth offers:[6]

Health maintenance organization (HMO) plans require that you use a specific network of doctors and hospitals. Also, with a EmblemHealth HMO plan you may need a referral from your primary care doctor in order to see a specialist. Out-of-network benefits are usually very limited. However, in an emergency you are not limited to care from your local hospital of emergency room.

NOTE: EmblemHealth may also offer Medicare Advantage Special Needs Plans (SNPs). Due to the highly specialized nature of D-SNP (dual eligible), C-SNP (chronic condition), and I-SNP (institutional) insurance plans, we review them separately.

How Much Do EmblemHealth Plans Cost?

Your costs in a EmblemHealth plan will depend on the specific plan selected, your location, your usage of plan services, and the plan’s out-of-pocket costs. Detailed information about out-of-pocket costs for all EmblemHealth Medicare Advantage Plans is available in our plan finder.

Generally, EmblemHealth will charge you a monthly premium, which can vary based on the level of coverage and additional benefits included. You must also continue to pay your Part B premium. If you're a high-income earner, Medicare may add a Income Related Monthly Adjustment Amount (IRMAA) to your premium.[5]

EmblemHealth’s monthly premiums are highly dependent on where you live. For instance, the average cost of a Medicare Advantage plan from EmblemHealth in New York is $136.38 per month, but in New York the average cost is $136.38 per month. These averages do not include Special Needs Plans.

EmblemHealth's Premiums vs. Competitors

The following list shows EmblemHealth's nationwide average monthly premium (excluding Special Needs Plans) vs. several competitors.

EmblemHealth
$10.11
AARP/UHC
$13.97
Aetna
$7.75
Wellcare
$26.20
UnitedHealthcare
$22.97

You also need to factor in copayments or coinsurance for healthcare services like doctor visits or hospital stays. The costs in each EmblemHealth plan we reviewed varied depending on the level of coverage and the type of services received.

Some plans may offer $0 premiums or low copayments for certain services, while others may have higher premiums but lower out-of-pocket costs. It's important to carefully review the costs and coverage details of each plan option to find the one that best fits your budget and healthcare needs.[7]

We analyzed the following popular EmblemHealth plans to give you an idea of what members pay to use healthcare services. This is just a sample, use our Medicare Advantage Plan Finder to see plans and costs where you live.

Important costs for plan ID H3330-021-3 reviewed in Westchester County, NY.
  • Monthly premium: $219
  • Out-of-pocket max: $8,850
  • Primary Care: $$0
  • Specialist: $$0
  • Tier 1 Prescriptions: $7.00 copay, $200 deductible
  • Urgent Care: $$0
  • Emergency Room: $$0
  • Ground Ambulance: $$0
  • Inpatient Care:
  • Extra Benefits: None
Important costs for plan ID H3330-038-0 reviewed in Westchester County, NY.
  • Monthly premium: $241
  • Out-of-pocket max: $8,850
  • Primary Care: $$0
  • Specialist: $$0
  • Tier 1 Prescriptions: $7.00 copay, $200 deductible
  • Urgent Care: $$0
  • Emergency Room: $$0
  • Ground Ambulance: $$0
  • Inpatient Care:
  • Extra Benefits: None

Is EmblemHealth a Good Medicare Advantage Plan?

EmblemHealth is a notable provider of Medicare Advantage plans, offering a variety of options tailored to different needs. The quality of an EmblemHealth plan depends on factors such as individual health requirements, budget, and personal preferences.

Several consumer intelligence companies and review websites provide insights into EmblemHealth's Medicare Advantage plans. Below is a summary based on available information.

Better Business Bureau (BBB) Rating

EmblemHealth has a B- rating from the Better Business Bureau (BBB), leaving room for improvement. The BBB rating reflects the company's efforts in resolving consumer complaints and maintaining a positive reputation.

PissedConsumer Reviews

On PissedConsumer , EmblemHealth receives mixed negative reviews from members. Many  members report issues with customer service and claims processing. Generally, consumers are not pleased with reliability and customer service. Most members want EmblemHealth to offer a solution to their issues, pointing to an overall frustration with customer care.

NCQA Health Plan Score

The National Committee for Quality Assurance (NCQA) rates health plans based on quality of care, patient satisfaction, and improvement efforts. EmblemHealth's Medicare Advantage plans have received varying ratings, generally falling between 3.0 and 3.5 stars, indicating moderate quality.

J.D. Power Ranking

As of the most recent data, EmblemHealth was not specifically ranked in J.D. Power's U.S. Medicare Advantage Study. Therefore, this aspect has not been included in our evaluation.

These sources provide a comprehensive view of EmblemHealth's Medicare Advantage plan quality, helping potential members make informed decisions.

EmblemHealth's Medicare Star Ratings

EmblemHealth's average 5-star rating: 3.00*
*Our calculation is weighted by enrollments in public plans, excluding Special Needs Plans, with CMS star ratings across 2 contracts covering 41,160 members.

If you want the government’s take on the quality of EmblemHealth’s Medicare Advantage plans, check out the Centers for Medicare and Medicaid Services' star ratings, which rank each plan from 1 (worst) to 5 (best) stars. The health agency assigns ratings based on quality of care and customer satisfaction measurements, and updates ratings every year.[9]

All Medicare Advantage plans are assessed using CMS's health plan criteria. Plans that come with prescription drug coverage are evaluated on additional drug plan metrics. Based on the latest year of data and adjusted for enrollment numbers, EmblemHealth’s 2024 Medicare Advantage plans have an average rating of 3.00 stars.[9] [11]

As of January 1, 2024, 0% of EmblemHealth members are enrolled in contracts with a Medicare star rating of 4 stars or higher.

You can view all plan ratings in your area with our Medicare Advantage Plan Finder tool.

EmblemHealth's Top Plans

Here's a list of EmblemHealth's most popular plans (by enrollments):[9][10]

Medicare Advantage Search and compare Medicare Advantage plans available in your area.

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Frequently Asked Questions

The following are the most frequently asked questions we found about EmblemHealth's Medicare Advantage plans:

MA Plan Pros

  1. The maximum out-of-pocket cost is $7,550 a year
  2. Many plans cost $0 extra a month
  3. Most plans include drug coverage
  4. Many include basic hearing, dental, and vision benefits
  5. May include gym discounts (Silver Sneakers)

MA Plan Cons
  1. Can only switch during Open Enrollment
  2. Not easy to compare because plans are not standardized
  3. No nationwide coverage (plans don't travel with you)
  4. Most are HMO plans that require referrals to see a specialist
  5. Plans can change health and drug coverage each year

Learn more in this article.

Some Medicare Advantage plans offer a zero-dollar monthly premium because what Medicare pays the plan, plus your Medicare Part B premium, cover the full cost. For healthy people who want to keep their monthly costs low, these plans are an attractive option. But, just be aware that the premium is not the only cost. Plans also have copays or coinsurance you must pay when you use services. To learn more about free Medicare Advantage plans, read Why are Some Medicare Advantage Plans Free?

There is no debate when it comes to which plan offers better coverage. Original Medicare and a supplement plan offer the best coverage, but it costs more up-front. For a complete breakdown of the differences between Medicare Advantage plans and Medigap plans, read: Medicare Advantage vs Medigap: Which is Best for You?

Researching your health plan options is important. Here are some key questions to consider before choosing a Medicare Advantage plan as well as additional companies to read about:

Key Questions

All plans potentially have monthly premiums, deductibles, copayments, and/or coinsurance, including plans from EmblemHealth. Are these costs within your budget?

  • Does the plan cover your prescriptions? Knowing how a plan covers them is important if you have regular prescriptions because costs and coverage vary widely from plan to plan.
  • Are your doctors in the plan’s network? If you have preferred providers, ensure they participate in the plan’s network.
  • Is routine dental, vision, and hearing covered? Traditional Medicare doesn’t cover these services. If you need it, be sure to explore plans that cover it.
  • What extras does the plan include? Plans may include many beneficial extras, like gym memberships (SilverSneakers), medical transportation, meal delivery, telehealth, and more.

If you have additional questions, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048).

About EmblemHealth

Headquartered in New York City, EmblemHealth is a prominent provider of Medicare Advantage plans. Its health insurance offerings include Medicare Advantage Plans (Medicare Part C), Medicare Part D Plans (prescription drug plans), Medicaid coverage, and dental and vision plans.

EmblemHealth recently expanded its Medicare Advantage plan offerings to include more comprehensive telehealth services and wellness programs, reflecting its commitment to accessible and preventive care.

You can enroll in an EmblemHealth plan during your Initial Enrollment Period (IEP) at age 65, during the annual Open Enrollment Period (Oct 15 - Dec 7), or during a Special Enrollment Period (SEP) based on special circumstances, such as moving or losing employer coverage.

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EmblemHealth Insurance Company
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https://www.emblemhealth.com/plans/medicare-advantage
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Citations

MedicareWire uses trustworthy sources to inform its work, including government websites, government data, actuarial service data, consumer intelligence websites, and peer-reviewed studies. All content is fact-checked for accuracy, timeliness, and relevance. We used the following information sources in this review: