Emblem Medicare Advantage Plans 2025

Navigating your Medicare options?

Emblem Medicare Advantage Plans for 2025 stand out with tailored benefits for New Yorkers, such as zero copay visits and broad prescription coverage. Get detailed insights on plans that fit your lifestyle and healthcare needs without the clutter of unnecessary jargon.


Key Takeaways

  • EmblemHealth offers a diverse range of Medicare Advantage Plans tailored to the unique healthcare needs of New York residents, with plan options like VIP Gold providing comprehensive benefits including a $0 copay for primary care visits.


  • The Medicare Advantage Plans from EmblemHealth include prescription drug coverage, access to specialized networks, and extra benefits such as dental, vision, fitness, and hearing aid services, with a focus on proactive health and well-being.


  • EmblemHealth places a strong emphasis on member satisfaction through initiatives like the Medicare Connect Concierge service, cultural and linguistic support, financial protections such as no balance billing for people who are dual eligible, and efforts encouraging preventive care.

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Exploring EmblemHealth’s Range of Medicare Advantage Plans


Emblem Medicare Advantage Plans, Exploring EmblemHealth's Range of Medicare Advantage Plans


EmblemHealth’s Medicare Advantage Plans are noteworthy for their diversity. EmblemHealth understands that one size does not fit all when it comes to healthcare.

As such, they offer an array of plans tailored to the unique needs of New York residents, ensuring that every member receives the best possible coverage.

But it’s not just about variety. EmblemHealth’s Medicare Advantage Plans are designed with the member’s health and well-being at their core.

From comprehensive coverage to pharmaceutical prescription assistance programs, these plans offer a range of benefits that many qualified Medicare beneficiaries will find invaluable.


EmblemHealth VIP Gold and Other Plan Options

Among the variety of EmblemHealth’s plans, the VIP Gold is a noteworthy option. This plan offers a host of benefits, including a $0 copay for primary care doctor visits and a $25 copay for specialist visits.

This, coupled with coverage for specific in-network benefits up to an annual limit of $7,550, makes VIP Gold a comprehensive solution for members enrolled in the plan.

However, the VIP Gold is not the sole plan offered by EmblemHealth. The company provides a variety of plans tailored to different needs and circumstances. Whether you’re based in Bronx, Kings, New York, or Queens counties, you can rest assured that there’s an EmblemHealth plan that’s just right for you.


Prescription Drug Coverage and Extra Benefits


Emblem Medicare Advantage Plans, Prescription Drug Coverage and Extra Benefits


One of the key benefits of EmblemHealth’s Medicare Advantage Plans is their comprehensive prescription drug coverage. These plans cover a wide variety of drugs, benefiting many qualified Medicare beneficiaries. Members can easily find a complete list of covered drugs in their comprehensive plan formulary.

However, the advantages extend beyond just prescription drug coverage. EmblemHealth’s plans also offer supplementary benefits such as:

  • Dental care


  • Eye exams and prescription lenses


  • Fitness programs


  • Hearing aids


These additional benefits are designed to encourage interested patients to take a proactive approach to their health and well-being.


Access to Specialized Networks

EmblemHealth’s Medicare Advantage plans provide benefits beyond extensive coverage. They also provide members with access to specialized networks, designed to cater to the unique needs of different members.

These networks ensure that every member, whether they’re a Qualified Medicare Beneficiary (QMB) or a Specified Low-Income Medicare Beneficiary (SLMB), receives coverage tailored to their specific needs.

Members also have access to a variety of services, such as behavioral health services and chiropractic care. By fostering seamless collaboration between medical and behavioral health providers, EmblemHealth ensures that members receive comprehensive care.

These specialized networks, combined with supplementary assistance such as home and community-based services, underscore EmblemHealth’s commitment to providing tailored, high-quality care to all members.

Customized Care Coordination Services


Emblem Medicare Advantage Plans, Customized Care Coordination Services


For EmblemHealth, care coordination is more than merely managing healthcare services. The company offers customized care coordination services, designed to support the unique needs of each member.

From support for D-SNP members to health assessments and member usage history data, EmblemHealth’s care coordination services are all about ensuring that members receive the care they need, when they need it.

The committed Care Management team at EmblemHealth forms the backbone of these services. This team works tirelessly to deliver tailored assistance to members, ensuring that they receive the appropriate care, education, and support for their specific situations.

Whether it’s in-person consultations with providers, care management, or care coordination services, EmblemHealth is committed to providing personalized, comprehensive care to all members.


Support for D-SNP Members Enrollees

Specifically, D-SNP members receive personalized care and assistance from the Care Management team at EmblemHealth. From nurse case managers conducting concurrent reviews and overseeing care during hospitalizations to individualized care plans, D-SNP members can rest assured that their unique needs are being met.

Yet, that’s not the end. D-SNP members can also benefit from the EmblemHealth’s HMO D-SNP, designed for individuals enrolled in Medicare and with full New York State Medicaid.

This plan may include:

  • $0 monthly premiums based on the member’s Low-Income Subsidy level


  • covering services at no cost to the member


  • a reward upon successful completion of their annual health assessment.


Health Assessment and Member Usage History Data

Health assessments constitute a major component of EmblemHealth’s care coordination services. These assessments, specifically designed for adults, provide personalized online reports and recommendations to address existing medical conditions and enhance overall health.

EmblemHealth also utilizes member usage history data to inform and optimize their care coordination practices. By aggregating data from their care management and claims systems, EmblemHealth can better understand each member’s needs and ensure they receive the most appropriate care.

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EmblemHealth’s Commitment to Member Satisfaction

For EmblemHealth, member contentment is the top priority. The company has implemented a range of measures to meet the cultural and linguistic needs of their diverse membership.

From cultural competency presentations for healthcare providers to tailored communications, EmblemHealth is committed to creating an inclusive, welcoming environment for all members.

The Medicare Connect Concierge is one mechanism EmblemHealth uses to amplify member satisfaction. This specialized telephone service is designed to assist Medicare members with their healthcare requirements, offering tailored healthcare solutions and secure access to healthcare information online.


Enhancing Cultural and Linguistic Needs


Emblem Medicare Advantage Plans, Enhancing Cultural and Linguistic Needs


EmblemHealth acknowledges the significance of cultural competency in healthcare. The company offers educational resources, such as The Guide to Providing Culturally Competent Care e-learning program from the U.S. Department of Health & Human Services, to enhance the cultural competency of providers and their staff.

EmblemHealth also employs strategies to overcome language barriers, providing services in more than 200 languages. Whether a member needs assistance in English, Spanish, or any other language, EmblemHealth ensures that they can access the support they need in a language they understand.


Streamlined Member Support with Medicare Connect Concierge

Medicare Connect Concierge extends beyond simply being a telephone service. It provides members with a single point of contact for all their healthcare needs, making it easier to receive personalized assistance.

Whether members need help with their healthcare requirements or want to access their healthcare information online, Medicare Connect Concierge is there to help.

Medicare Connect Concierge offers the following services:

  • Supports English, Spanish, and Chinese


  • Can offer services in any other language needed by the member


  • Available from 8 a.m. to 8 p.m., seven days a week, from October 1 to March 31


This ensures that phone number members can access support during a wide range of hours.

Financial Protections for Members


Emblem Medicare Advantage Plans, Financial Protections for Members


EmblemHealth recognizes that healthcare expenses could be a major worry for members. That’s why the company offers financial protections, including no balance billing for dual eligibles and clear information on cost-shares and deductibles.

Balance billing of dual eligible individuals for any Medicare deductibles, coinsurance, or copayments is prohibited by Federal and State laws. EmblemHealth adheres to these laws, ensuring that members can access the care they need without worrying about unexpected costs.


No Balance Billing Dual Eligibles

Dual eligible individuals, those qualifying for both Medicaid and Medicare, including partial duals or QMB members with limited benefits due to their dual-eligibility status, are shielded from balance billing by providers treating dual eligible patients.

Federal and state laws, as well as provider contracts, prohibit Medicare billing for these members for any Medicare deductibles, coinsurance, or copayments, ensuring proper handling of Medicare and Medicaid payments.

EmblemHealth’s commitment to these protections ensures that dual eligible and QMB members are not responsible for their Medicare Advantage plan cost-shares for Medicare-covered Part A and Part B services.

This commitment underscores EmblemHealth’s dedication to offering affordable, accessible healthcare to all members.


Understanding Cost-Shares and Deductibles

EmblemHealth advocates for clarity regarding cost-shares and deductibles. The company calculates these costs by asking members to share in the cost of care through coinsurance once the deductible has been met.

While the exact out-of-pocket expenses can vary depending on the specific plan, EmblemHealth provides clear information on these costs.

This includes:

  • A $0 copay for ACPNY PCP and ACPNY Specialist


  • A $15 copay for all other PCPs


  • A $30 copay for all other specialty providers


  • A $50 copay for urgent care.

Encouraging Healthy Living and Preventive Care


Emblem Medicare Advantage Plans, Encouraging Healthy Living and Preventive Care


EmblemHealth’s dedication to member health goes beyond extensive coverage. The company also encourages healthy living and preventive care, offering incentives for annual PCP visits and screenings, as well as mail order pharmacy benefits.

The Member Rewards Program, an integral part of this initiative, allows members to earn rewards between $10 and $100 for completing eligible preventive care services and screenings.


Incentives for Annual PCP Visits and Screenings

Through the Member Rewards Program, members can earn rewards for a variety of services, such as annual wellness visits and preventive care screenings. As members complete the process of the Health Assessment (HA) within the initial 90 days of enrollment and annually thereafter, they also qualify for rewards.

VIP Dual and VIP Dual Reserve D-SNP members have the added opportunity to earn rewards through the Medication Therapy Management Program.

These members can earn rewards by filling Select Care Drugs (Tier 6) medications for conditions such as high blood pressure, high cholesterol, and diabetes, after completing a comprehensive medication review with an EmblemHealth pharmacist.


Mail Order Pharmacy Benefits

Beyond the Member Rewards Program, EmblemHealth also provides a mail order pharmacy service. This service provides free home delivery of medications, promoting medication adherence and making it easier for members to access their prescription drugs.

Members can also benefit from cost savings through initiatives like Home Delivery and Smart90SM, which are designed to lower prescription drug expenses. With an estimated delivery time of approximately two weeks, members can rest assured that their medications will arrive in a timely manner.

Navigating the Enrollment Process

Enrolling in an EmblemHealth plan is a simple process. The company provides clear eligibility criteria and enrollment periods, making it easy for prospective members to join the plan that’s right for them.

Whether you’re enrolling in Medicare for the first time as you turn 65, or contemplating a switch to a Medicare Advantage plan, EmblemHealth supplies the necessary resources and guidance to simplify the enrollment process for Medicare Advantage enrollees.


Steps to Join an EmblemHealth Plan

A few primary steps are involved when enrolling in an EmblemHealth plan. First, you’ll need to compare the various Medicare Advantage plans to find the one that suits your needs. Once you’ve selected a plan, you can enroll online or by phone.

For assistance during the enrollment process, feel free to contact EmblemHealth. They’re available to help with your enrollment and can provide the necessary documentation and forms to make the process as smooth as possible.


Resources for Assistance and Education

EmblemHealth offers a variety of resources to aid the enrollment process. This includes the Health Insurance Information, Counseling, and Assistance Program (HIICAP), which offers free counseling and assistance with Medicare options.

Additionally, EmblemHealth offers a dedicated page of valuable materials to help patients manage their care and reduce costs.

They also provide education and support through their Care Management Programs, ensuring that members have the support they need to navigate their healthcare journey.


EmblemHealth’s Medicare Advantage Plans offer comprehensive, personalized coverage that caters to the unique needs of each member. From the VIP Gold plan to extensive drug coverage, cultural and linguistic support, and financial protections, EmblemHealth is committed to providing exceptional healthcare services to its members.

With resources for assistance and education, a commitment to healthy living and preventive care, and a streamlined enrollment process, EmblemHealth makes it easy to manage your healthcare. So why not explore EmblemHealth’s Medicare Advantage Plans today and discover a healthcare solution tailored just for you?


Frequently Asked Questions


→  Does EmblemHealth work with Medicare?

Yes, EmblemHealth offers Medicare Advantage plans for individuals who are eligible for Medicare Parts A and B. These plans help cover out-of-pocket healthcare costs.


  Who has the highest star rated Medicare Advantage plans?

Humana Insurance Company has the highest star rated Medicare Advantage plans.


  What are the 4 types of Medicare Advantage plans?

Medicare Advantage plans include Preferred Provider Organization (PPO) Plan, Private Fee-for-Service (PFFS) Plan, Special Needs Plan (SNPs), and Medical Savings Account (MSA) Plan.

These offer various coverage options for individuals.


  Is emblem health Medicaid?

Yes, EmblemHealth offers Medicaid plans, including their state-sponsored Medicaid Managed Care plan called Enhanced Care which has no monthly premium payment. Pharmacy co-pays may be required in some instances.


 What is the EmblemHealth VIP Gold plan?

The EmblemHealth VIP Gold plan offers a $0 copay for primary care doctor visits, a $25 copay for specialist visits, and coverage for specific in-network benefits up to an annual limit of $7,550 for members enrolled.

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Russell Noga
( Medicare Expert )

Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.