The VIP® Premier (HMO) Group Medicare plan is a great fit for Medicare-eligible retirees. It offers quality coverage with low out-of-pocket costs, with $0 copays for most services. With this plan, you choose a primary care provider (PCP) who will manage and oversee your care, including administering referrals to network specialists and arranging for hospital stays.
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VIP Premier (HMO) Group Medicare
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Enrollment: 800-447-9169 (TTY: 711) From Oct. 1 to March 31, you can call from 8 a.m. to 8 p.m., seven days a week. From April 1 to Sept. 30., you can call from 8 a.m. to 8 p.m., Monday through Friday.
Customer Service: 877-344-7364 (TTY: 711) From Oct. 1 to March 31, you can call us from 8 a.m. to 8 p.m., seven days a week. From April 1 to Sept. 30, you can call us from 8 a.m. to 8 p.m., Monday through Saturday.
Plan Details
VIP Premier (HMO) Medicare plan helps Medicare-eligible retirees meet their medical needs. You get:
- Access to VIP Prime network of providers.
- A primary care physician (PCP) to partner in your health.
- $0 copays for many services.
- Value-added wellness and disease management programs.
- Part D prescription drug coverage that meets the needs of Medicare-eligible retirees.
- $0 fitness benefit that includes 15,000+ fitness locations nationwide.
Your in-network costs:
- PCP office visit: $0 copay.
- Specialist office visit: $30 copay.
- Diagnostic lab/X-ray: $0 copay.
- Routine physical exam: $0 copay.
- Immunizations like flu, COVID-19, and pneumonia: $0 copay.
- Outpatient mental health: $5 copay.
- Ambulatory surgery: $0 copay.
- Ground Ambulance: $50 copay.
- Inpatient care: $250 copay Days 1-3; $0 copay Days 4 and beyond. $0 copay for Inpatient care in the Centers of Excellence.
- Emergency room: $100 copay (waived if admitted within 1 day).
- Annual routine hearing exam: $15 copay.
- Annual routine vision exam: $15 copay.
- Skilled nursing facility, Medicare-covered: $0 copay for days 1-20, $164 copay for days 21-100.
- Home health care, Medicare-covered: $0 copay.
- Private duty nursing: $0 copay.
- Durable medical equipment: 20% coinsurance.
To sign up for the VIP Premier (HMO) Medicare plan, you must:
- Have Medicare Parts A and B.
- Continue to pay your Medicare Part B premium and remain enrolled in Part A.
- Live in the plan’s Medicare-approved service area, which includes New York City (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Nassau, Suffolk, Rockland, Orange, and Westchester counties.
Health Insurance Plan of Greater New York (HIP) is a Medicare Advantage organization with a Medicare contract. The benefit information provided is a summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments, and restrictions may apply.
The information in this section is intended to provide general information and highlights regarding the VIP Premier (HMO) Group and VIP Rx Carveout (HMO) Medicare plans. It does not provide a complete benefit description. Please see your Evidence of Coverage and cost-sharing guide for additional information.
Pharmacy Benefits
The VIP Premier (HMO) Group Medicare plan includes Medicare Part D prescription drug coverage that you can use at our national network of pharmacies that includes home delivery service.
If you are a City of New York retiree, and do not get prescription drug coverage through your union welfare fund, you must buy a rider. If you do not receive prescription drug coverage through your welfare fund, we will enroll you in this group Medicare Advantage Prescription Drug plan to make sure you get the prescription drug benefits you need.
When you get your prescriptions, you may have to pay a portion of the cost. This may include a copay (the flat amount you pay for drugs) or coinsurance (the percentage of the cost you pay for the drugs).
Retail Pharmacy (30-day supply)
Tier 1 (Preferred Generic): $10 copay
Tier 2 (Preferred Brand): $15 copay
Tier 3 (Non-Preferred Drug): $100 copay
Tier 4 (Specialty): 25% coinsurance
Tier 5 (Select Care Drugs) $0 copay
Home Delivery (Mail Order Pharmacy) (30-day supply)
Tier 1 (Preferred Generic): $5 copay
Tier 2 (Preferred Brand): $7.50 copay
Tier 3 (Non-Preferred Drug): $50 copay
Tier 4 (Specialty): 25% coinsurance
Tier 5 (Select Care Drugs) $0 copay
Part D Benefit Stages
This plan has no deductible.
In 2024, you pay the copays and coinsurance amounts listed above until your total out-of-pocket drug costs reach $8,000. You also pay no more than $35 for a one-month supply of covered insulin products and $0 for certain vaccines, like shingles, and travel vaccines. Once your out-of-pocket drug costs reach $8,000, you pay $0 for all your covered prescription drugs.
Starting in 2025, you will pay the copays and coinsurance amounts listed above until your out-of-pocket drug costs reach $2,000. You will pay no more than $35 for a one-month supply of covered insulin product, and $0 for most vaccines, like shingles and travel vaccines. Once you reach $2,000, you will pay $0 for all your covered prescription drugs.
Provider Coverage
With our robust network of quality doctors, you can get care from many of the region’s leading doctors, clinicians and facilities, including hospitals and urgent care centers.
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The Right Care, Right in Your Neighborhood
AdvantageCare Physicians are the newest addition to the EmblemHealth family and are now one of the largest primary and specialty care practices in New York City. With 37 locations throughout New York City and Long Island, you can find a convenient location near home or work.