EmblemHealth VIP Value is a 2022 Medicare Advantage HMO plan, from EmblemHealth, that's available to Medicare beneficiaries living in Suffolk County, New York.
- It's a Health Maintenance Organization (HMO) health plan.
- It has the same coverage benefits as Original Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage..
- It offers additional benefits that Medicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Medicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. do not include.
- There's a $15 copayment to see your primary care doctor (Doctors, hospitals, pharmacies, and other healthcare providers that agree to health plan members' services and supplies at a set price are in-network providers. With some health plans, your care is only covered if you get...).
- The monthly premium is $0.00 (plus your monthly The Medicare Part B premium is the monthly charge paid by beneficiaries for their outpatient medical care, services, and supplies. A beneficiary's premium may be uplifted by an IRMAA surcharge if their income is above...).
- The health plan does not have an annual A deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share..
- The maximum Out-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. with this plan is $7,550 (in-network).
- EmblemHealth VIP Value includes a Medicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... plan for prescription medications. The annual Part D deductible is $325.00.
This HMO plan replaces your Part A and Part B Medicare coverage with a managed care health plan in Suffolk County, New York. If you enroll in EmblemHealth VIP Value you agree to let EmblemHealth manage your Medicare benefits.
IMPORTANT: With EmblemHealth VIP Value you are required to use healthcare providers in the plan's network. If you don't you will incur all costs. Also, you must see your primary care physician for referrals to specialists and other healthcare providers.
EmblemHealth VIP Value's monthly premium in Suffolk County is $0.00. That includes your prescription coverage, as well. Plus, you must continue to pay your monthly Medicare Part B premium. Some Medicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). include a monthly Part B premium reduction, also known as the Medicare give back. This plan's Part B premium reduction is NONE.
Co-payments and/or co-insurances also apply with most healthcare services, except preventive care mandated by CMS (see H3330-036 Summary of Benefits).
Although the health plan itself does not have a deductible, the prescription drug plan does. It's $325.00 per year. That means you pay 100% of your prescription costs until you've spent $325.00, then the plan will begin paying it's share.
IMPORTANT: When evaluating EmblemHealth VIP Value, look past the monthly premium. Identify the costs of the healthcare services you use most. Only then will you uncover the plan's value for your personal situation.
Maximum Out-of-Pocket (MOOP) Limit
Unlike Original Medicare, Medicare Advantage plans must set an annual Maximum Out-of-Pocket limit on inpatient and outpatient healthcare services. The EmblemHealth VIP Value plan MOOP is $7,550 . Once you reach this amount of spending on your copayments, all of your Medicare Part A and Part B services will be covered at no additional charge for the remainder of the year.
NOTE: MOOP does not include what you spend on monthly A premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. . It also does not apply to your prescription drugs, Part D deductible, or any other extra benefits bundled in the plan.
CRITICAL: Be sure to evaluate the annual premiums and MOOP of EmblemHealth VIP Value versus what you might expect to pay for a Medicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage. in Suffolk County. Some Medicare Supplements offer less overall financial risk than Medicare Advantage plans with a similar annual cost.
If you qualify for Medicare but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov. To learn more about this plan, visit the EmblemHealth Medicare website.
Additional Medicare Plan Options in Suffolk County
Are you eligible for a Suffolk County, NY Medicare Special Needs Plan (SNP)? SNPs are a special type of Medicare Advantage plan designed to help people with special needs. Here are some of the SNP plans in your area:
- UnitedHealthcare Nursing Home Plan 1 (Local PPO), for Institutional beneficiaries
- Wellcare Dual Access (Local HMO), for Dual-Eligible beneficiaries
- Longevity Health Plan (Local HMO), for Institutional beneficiaries
- Aetna Medicare Assure Plan (Local HMO), for Dual-Eligible beneficiaries
- Empire MediBlue HealthPlus Dual Connect (Local HMO), for Dual-Eligible beneficiaries
Not qualified for an SNP? Here are some additional plans you might consider:
- HumanaChoice H5970-024 (PPO)
- Aetna Medicare Elite Plan (PPO)
- Aetna Medicare Value Plan (HMO)
- Empire MediBlue Select (HMO)
- Humana Gold Plus H3533-027 (HMO)