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Emblem Medicare Advantage Plans

Reviewed by Russell Noga, Licensed Medicare Insurance Broker (all 50 states) | Last updated October 8, 2026

EmblemHealth offers Medicare Advantage plans in parts of New York, and we found no verified 2027 change. Read your Annual Notice of Change to see what changes for 2027.

The New York market is shifting for 2027: HCSC’s HealthSpring leaves New York, Devoted Health enters and Elderplan moves to Special Needs Plans only.

See Medicare Advantage plans 2027.

✔ Licensed across all 50 states

✔ Built on CMS 2027 data

✔ No-cost plan comparison

Key Highlights

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EmblemHealth: no verified change.

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HealthSpring leaves NY.

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Devoted enters NY.

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Nationally, the average 2027 Medicare Advantage premium is $12 a month, down from $14.37 (CMS).

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The Annual Enrollment Period is October 15 to December 7, 2026.

Compare plans and enroll online

New York Medicare Advantage Changes

Insurer 2027 Change in New York
EmblemHealth No verified 2027 change; read your Annual Notice of Change
HCSC (HealthSpring) Leaving New York Medicare Advantage
Devoted Health Entering New York
Elderplan (MJHS) Special Needs Plans only
Healthfirst Continuing; no verified change

Benefits EmblemHealth Plans May Offer

EmblemHealth Plans May Include

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Hospital and medical coverage matching Original Medicare Part A and B

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Part D prescription drug coverage on most plans

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Routine dental, vision and hearing benefits

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Fitness programs and over-the-counter allowances

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Telehealth visits and care coordination programs

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A yearly out-of-pocket maximum on every plan

Benefits are not offered by every plan. They differ by plan and county and may change for 2027. Review the Evidence of Coverage for each plan before enrolling.

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

What to Check for 2027

Key Takeaway

Read your EmblemHealth Annual Notice of Change.

Keep an eye out: a non-renewal letter will arrive if your plan is ending. You stay covered through December 31, 2026. Taking no action sends you back to Original Medicare with no drug coverage.

Find & Compare Plans Online

Speak with a licensed insurance agent

1-833-641-4938TTY 711

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Comparing EmblemHealth Plans

Step by Step

1

Check your borough or county. EmblemHealth plans vary by area.

2

Check your doctors and hospitals. Confirm the 2027 network.

3

Price your drugs. Use the 2027 formulary.

4

Compare Special Needs Plans if eligible. Dual Special Needs Plans serve people with Medicare and Medicaid.

5

Look at the full cost picture. That means the premium, your copays and the out-of-pocket limit.

Plan Types

HMO Plans

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Usually lower premiums and copays

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Use in-network doctors except emergencies

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May need referrals for specialists

PPO Plans

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See out-of-network doctors at a higher cost

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Usually no referrals needed

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More flexibility if you travel

Type Who Qualifies What Is Different
Dual Special Needs Plan (D-SNP) People with both Medicare and Medicaid Coordinates both programs; costs are often very low, with extra benefits
Chronic Condition SNP (C-SNP) People who have qualifying conditions like diabetes, heart failure or chronic lung disease Doctors, drugs and programs designed around the condition
Institutional SNP (I-SNP) People who live in a nursing home or need that level of care at home Care delivered where the member lives

Emblem Medicare Advantage Plans, Prescription Drug Coverage and Extra Benefits

How Medicare Advantage Works

Medicare Advantage, sometimes called Part C, lets you receive your Medicare benefits through a Medicare-approved private insurer. These plans cover everything Original Medicare Part A and Part B cover, with the exception of hospice care, which Original Medicare continues to pay for. Most also bundle Part D drug coverage, and many may tack on extras like routine dental, vision and hearing benefits.

In exchange, EmblemHealth plans generally use networks of doctors and hospitals, and may require referrals or prior authorization for some services. Every Medicare Advantage plan has a yearly out-of-pocket maximum for covered medical care, which Original Medicare does not have. You keep paying your Part B premium, plus your plan’s premium if it has one.

Feature HMO PPO
Out-of-network care Not covered except emergencies and urgent care Covered at a higher cost
Referrals for specialists Usually required Usually not required
Premiums Usually lower Usually higher
Out-of-pocket maximum In-network limit In-network limit plus a higher combined limit
Best for Lower costs, local care Flexibility, travel, keeping specific doctors

Pros and Cons of Medicare Advantage

Advantages

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Often a low or $0 premium

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A yearly out-of-pocket maximum

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Drug coverage usually included

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Dental, vision and hearing benefits may be included in many plans

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One card and one plan

Tradeoffs

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Networks; except for emergencies, HMOs require in-network care

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Prior authorization and referrals are common

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Copays add up if you use a lot of care

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Plans and networks can change every year

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Moving to Medigap later may involve health questions

EmblemHealth Drug Coverage for 2027

Most EmblemHealth Medicare Advantage plans include Part D drug coverage. Each plan has its own formulary, drug tiers and pharmacy network, and plans commonly charge less at preferred pharmacies and through mail order. For 2027, any plan’s Part D deductible can be up to $700, and the out-of-pocket cap on covered drugs is $2,400.

Tier Typical Drugs Typical Cost
Tier 1 Preferred generics Lowest copay
Tier 2 Generics Low copay
Tier 3 Preferred brand-name drugs Moderate copay
Tier 4 Non-preferred drugs Higher copay or coinsurance
Tier 5 Specialty drugs Highest coinsurance

Each plan sets its own tiers. Review every plan’s formulary.

A drug you take may not be on a plan’s 2027 formulary, or it may come with a rule such as prior authorization. Even then, you have options:

If Your Drug Is Not Covered

1

Request a transition fill. During the first 90 days of a new plan or plan year, plans generally have to provide a temporary supply of a drug you already take, giving you time to change drugs or ask for an exception.

2

Talk to your doctor about other options. A covered drug from the same class could work just as well for less money.

3

Ask for a tiering or formulary exception. Your doctor sends a statement explaining why you need the drug or a lower copay. Plans have to decide within set time limits.

4

Challenge a denial. When the plan turns you down, you have the right to appeal through several levels of review.

See steps to appeal a Medicare Part D denial.

If Your Plan Is Ending

If your EmblemHealth plan will not be offered in your county for 2027, you should have received a non-renewal notice in early October. Your coverage does not stop right away: it continues through December 31, 2026, so you have time to choose.

If Your Plan Is Ending

1

Review your non-renewal letter. It verifies that your plan is ending and lays out your choices.

2

Write down your doctors and drugs. Comparing replacement plans requires them.

3

Compare your 2027 plan choices. Look at networks, drug coverage and the out-of-pocket maximum, not only the premium.

4

Pick a plan by December 31 to avoid a gap. If you enroll during Annual Enrollment by December 7, your coverage starts January 1, 2027.

5

Rely on your Special Enrollment Period if necessary. If your plan is ending, you generally have until the end of February 2027 to make a choice.

If you take no action: on January 1, 2027, you go back to Original Medicare, and you will have no drug coverage unless you pick a Part D plan. Being without drug coverage may result in a late enrollment penalty.

Medigap rights: if your Medicare Advantage plan exits your area, you generally get a guaranteed issue right, lasting up to 63 days after your coverage ends, to purchase certain Medicare Supplement plans with no health questions.

How to Compare EmblemHealth Plans for 2027

How to Compare

1

Review your Annual Notice of Change. It spells out every 2027 change to the plan you have now.

2

Verify your doctors and hospitals. Make sure every provider is in the 2027 network, not only the 2026 network.

3

Review your prescriptions. Verify every drug, the tier it falls on and any step therapy or prior authorization rules.

4

Look at the full annual cost. Total up the premium, usual copays and drug costs, and review the out-of-pocket maximum.

5

Look at star ratings. Medicare scores plans on quality and service using a 1 to 5 star scale.

6

Sign up by December 7. Coverage under your new plan begins January 1, 2027.

2027 Enrollment Dates

Enrollment Period Dates What You Can Do
Annual Enrollment Period October 15 to December 7, 2026 Join, change or drop a Medicare Advantage or Part D plan effective January 1, 2027
Medicare Advantage Open Enrollment January 1 to March 31, 2027 In Medicare Advantage, you can change to another plan or go back to Original Medicare one time
Initial Enrollment Period 7 months around your 65th birthday month Sign up for Medicare and choose your first plan
Special Enrollment Periods Varies Switch plans after events such as a move, a loss of other coverage or your plan exiting your area

Annual Enrollment is when most people make changes. If you like your current plan, no action is needed; it renews on its own. Even so, review your Annual Notice of Change, since networks, premiums, copays and drug lists can all change on January 1.

Special Needs Plans

Special Needs Plans (SNPs) are Medicare Advantage plans designed for particular groups. Their benefits, networks and drug lists are shaped around the members they serve, and many come with care coordinators. In 2027, SNPs are one of the few places large insurers are adding plans, even while cutting PPOs.

Turning 65 in 2027

When you turn 65 in 2027, you get a seven-month Initial Enrollment Period: the three months before your birthday month, the birthday month itself and the three months that follow. If you sign up in the first three months, coverage begins on the first day of your birthday month.

Turning 65 Checklist

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Enroll in Part A and Part B, unless you have qualifying employer coverage and decide to postpone Part B

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Choose between Medicare Advantage and Original Medicare plus Medigap

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Enroll in a drug plan, or a Medicare Advantage plan that includes drugs, to avoid a late Part D penalty

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If you go with Medigap, purchase during your six-month Medigap Open Enrollment Period

Star Ratings

Each fall, Medicare gives every Medicare Advantage and Part D plan a rating of 1 to 5 stars, based on factors such as preventive care, how well chronic conditions are managed, member complaints, customer service and accuracy of drug pricing. You can see the ratings in Medicare Plan Finder.

Using Star Ratings

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Ratings of 4 stars or more are generally a good indicator of quality and service

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A special enrollment period lets you move into a five-star plan once during the year

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A new plan may not have a rating yet, and that alone isn’t a bad sign

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Ratings reflect the plan as a whole, not how well it covers your particular doctors and drugs

Medicare Advantage or Medigap?

Medicare Advantage Original Medicare + Medigap
Monthly premium Often low or $0 (2027 average $12, CMS) Higher; varies by plan letter, age and ZIP
Doctors Usually a network Any provider in the U.S. that accepts Medicare
Costs when you get care Copays and coinsurance up to a yearly maximum Low and predictable; on Plan G, little or nothing once the Part B deductible is met
Drug coverage Usually included Add a separate Part D plan
Dental, vision, hearing Many plans may include some coverage Not included
Changing later Every year during Annual Enrollment Health questions in most states once your Medigap Open Enrollment Period ends

Guaranteed issue: when your Medicare Advantage plan exits your area, you can generally purchase certain Medicare Supplement plans with no health questions asked, up until 63 days after that coverage ends.

Help Paying Medicare Costs

When your income and savings are limited, two programs can greatly lower your Medicare costs:

Medicare Savings Programs

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Run by your state Medicaid office

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May cover your Part B premium, and in some cases deductibles and coinsurance

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Income and asset limits vary by state

Extra Help (Part D)

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Run by Social Security

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Lowers Part D premiums, deductibles and copays

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Those enrolled in a Medicare Savings Program qualify automatically

If you qualify for both Medicare and full Medicaid, you may also be able to join a Dual Special Needs Plan. See help for low-income Part D beneficiaries.

Getting Help

You do not need to compare plans by yourself, and help should not cost you anything. Here are the free options:

Free Help Comparing Plans

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Available any time: Medicare Plan Finder on Medicare.gov

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1-800-MEDICARE (1-800-633-4227), reachable 24 hours a day on all seven days of the week

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Your State Health Insurance Assistance Program (SHIP), which provides free, unbiased counseling

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A licensed agent or insurance broker, who can compare plans across several insurers for free

Gather your Medicare card, a list of your drugs and doses, your doctors and your preferred pharmacies before you call. That way a long conversation becomes a quick one.

Bottom Line

The Bottom Line

EmblemHealth remains a New York option. Compare it with other plans in your county during Annual Enrollment.

Compare plans and enroll online

Frequently Asked Questions

➤ Does EmblemHealth offer Medicare Advantage plans?

Yes, EmblemHealth offers Medicare Advantage plans in parts of New York. Availability, plan types and benefits vary by county, so search by ZIP code in Medicare Plan Finder or with a licensed agent to see which plans you can join for 2027.

➤ Is EmblemHealth changing for 2027?

We found no verified 2027 change for EmblemHealth Medicare Advantage. Read your Annual Notice of Change, which lists any changes to premiums, copays, networks and drug coverage that start January 1, 2027. If you received a non-renewal letter instead, your plan is ending.

➤ What plan types does EmblemHealth offer?

EmblemHealth may offer HMO and PPO plans and Special Needs Plans, including plans for people with both Medicare and Medicaid, depending on the area. Compare each plan’s network rules and out-of-pocket maximum before enrolling. Not all plan types are offered in every county.

➤ What is changing in New York Medicare Advantage for 2027?

HCSC’s HealthSpring is leaving New York, Devoted Health is entering, and Elderplan is moving to Special Needs Plans only. Healthfirst is continuing with no verified change. Members of exiting plans should have received non-renewal letters.

➤ Is EmblemHealth leaving Medicare Advantage?

We found no verified report that EmblemHealth is leaving Medicare Advantage for 2027. If your plan were ending, you would receive a non-renewal letter; otherwise your plan renews automatically. Still, compare your plan with other New York options during Annual Enrollment.

➤ What benefits may EmblemHealth plans include?

EmblemHealth Medicare Advantage plans may include drug coverage, dental, vision, hearing and over-the-counter benefits, depending on the plan. Not all plans offer all benefits, and amounts can change for 2027. Check each plan’s Evidence of Coverage before you enroll.

➤ Can I switch to EmblemHealth if my plan is leaving New York?

Yes, if an EmblemHealth plan is offered in your county, you can switch during Annual Enrollment or your Special Enrollment Period. Check that your doctors are in the 2027 network and that your drugs are covered before you enroll.

➤ When can I enroll in an EmblemHealth plan?

You can enroll during Annual Enrollment, October 15 to December 7, 2026, for coverage starting January 1, 2027. Medicare Advantage members can also make one change from January 1 to March 31, 2027. Enroll by December 7 to avoid a gap.

➤ Where can I get free Medicare help in New York?

HIICAP, New York’s State Health Insurance Assistance Program, offers free, unbiased Medicare counseling. You can also call 1-800-MEDICARE or use a licensed agent at no cost. Have your Medicare card, drug list and doctors ready before you call.

Have Questions?

Speak with a licensed insurance agent

1-833-641-4938

TTY users 711

Mon-Fri: 8am-9pm ET

Find & Compare Plans Online

Speak with a licensed insurance agent

1-833-641-4938TTY 711

Mon-Fri: 8am-9pm ET

ZRN Health & Financial Services, LLC, a Texas limited liability company

Russell Noga, licensed insurance agent
( 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.

CompareMedicareAdvantagePlans.org
215 RR 620 South Austin, TX 78734

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