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HIP Health Plan Medicare Plans

HIP, the Health Plan of New York was founded in the 1940 and covers those who live in New York City, Nassau and Suffolk County, as well as Westchester.  Look below to find your area:

New York City

HIP VIP (HMO) There is a $0 monthly plan premium in addition to the beneficiary's monthly Medicare Part B premium.  Members must go to in-network doctors, specialists and hospitals and referral is required for in-network specialists.  For hospital stays, members pay $150 per day from days 1-7, and there is a $0 co-pay for additional hospital days.  There is a $0 co-pay per stay in an inpatient mental care facility and members are given 190 days per lifetime.  Members pay $25 per day from days 1-20 in a skilled nursing facility and $50 per day from days 21-100.  There is a $0-$15 copay for each primary care doctor visit, $30 copay for each urgent care visit, and $15-$30 copay for each specialist visit.

HIP VIP Plus (HMO) There is a $22 monthly plan premium in addition to the beneficiary's monthly Medicare Part B premium.  Members must go to in-network doctors, specialists and hospitals and referral is required for in-network specialists.  For hospital stays, members pay $100 per day from days 1-7, and there is a $0 co-pay for additional hospital days.  There is a $0 co-pay per stay in an inpatient mental care facility and members are given 190 days per lifetime.  Members pay $25 per day from days 1-20 in a skilled nursing facility and $50 per day from days 21-100.  There is a $10 copay for each primary care doctor visit, a $20 copay for each urgent care visit, and a $20 copay for each specialist visit.

Rx Carveout (HMO) There is a $0 monthly plan premium in addition to the beneficiary's monthly Medicare Part B premium.  Members must go to in-network doctors, specialists and hospitals and referral is required for in-network specialists.  For hospital stays, members pay $50 per day from days 1-7, and there is a $0 co-pay for additional hospital days.  There is a $0 co-pay per stay in an inpatient mental care facility and members are given 190 days per lifetime.  Members pay $25 per day from days 1-20 in a skilled nursing facility and $50 per day from days 21-100.  There is a $10 copay for each primary care doctor visit, a $20 copay for each urgent care visit, and a $20 copay for each specialist visit.

Nassau County

HIP VIP (HMO) There is a $0 monthly plan premium in addition to the beneficiary's monthly Medicare Part B premium.  Members must go to in-network doctors, specialists and hospitals and referral is required for in-network specialists.  For hospital stays, members pay $150 per day from days 1-7, and there is a $0 co-pay for additional hospital days.  There is a $0 co-pay per stay in an inpatient mental care facility and members are given 190 days per lifetime.  Members pay $25 per day from days 1-20 in a skilled nursing facility and $50 per day from days 21-100.  There is a $5-25 copay for each primary care doctor visit, a $35 copay for each urgent care visit, and a $20-35 copay for each specialist visit.

HIP VIP Plus (HMO) There is a $42 monthly plan premium in addition to the beneficiary's monthly Medicare Part B premium.  Members must go to in-network doctors, specialists and hospitals and referral is required for in-network specialists.  For hospital stays, members pay $100 per day from days 1-7, and there is a $0 co-pay for additional hospital days.  There is a $0 co-pay per stay in an inpatient mental care facility and members are given 190 days per lifetime.  Members pay $25 per day from days 1-20 in a skilled nursing facility and $50 per day from days 21-100.  There is a $10 copay for each primary care doctor visit, a $20 copay for each urgent care visit, and a $20 copay for each specialist visit.

Rx Carveout (HMO) There is a $0 monthly plan premium in addition to the beneficiary's monthly Medicare Part B premium.  Members must go to in-network doctors, specialists and hospitals and referral is required for in-network specialists.  For hospital stays, members pay $100 per day from days 1-7, and there is a $0 co-pay for additional hospital days.  There is a $0 co-pay per stay in an inpatient mental care facility and members are given 190 days per lifetime.  Members pay $25 per day from days 1-20 in a skilled nursing facility and $50 per day from days 21-100.  There is a $10 copay for each primary care doctor visit, a $20 copay for each urgent care visit, and a $20 copay for each specialist visit.

Suffolk County & Westchester County

HIP VIP (HMO) There is a $98.90 monthly plan premium in addition to the beneficiary's monthly Medicare Part B premium.  Members must go to in-network doctors, specialists and hospitals and referral is required for in-network specialists.  For hospital stays, members pay $150 per day from days 1-7, and there is a $0 co-pay for additional hospital days.  There is a $0 co-pay per stay in an inpatient mental care facility and members are given 190 days per lifetime.  Members pay $25 per day from days 1-20 in a skilled nursing facility and $50 per day from days 21-100.  There is a $5-20 copay for each primary care doctor visit, a $30 copay for each urgent care visit, and a $20-30 copay for each specialist visit.

HIP VIP Plus (HMO) There is a $127 monthly plan premium in addition to the beneficiary's monthly Medicare Part B premium.  Members must go to in-network doctors, specialists and hospitals and referral is required for in-network specialists.  For hospital stays, members pay $150 per day from days 1-7, and there is a $0 co-pay for additional hospital days.  There is a $0 co-pay per stay in an inpatient mental care facility and members are given 190 days per lifetime.  Members pay $25 per day from days 1-20 in a skilled nursing facility and $50 per day from days 21-100.  There is a $10 copay for each primary care doctor visit, a $20 copay for each urgent care visit, and a $20 copay for each specialist visit.

Rx Carveout (HMO) There is a $75 monthly plan premium in addition to the beneficiary's monthly Medicare Part B premium.  Members must go to in-network doctors, specialists and hospitals and referral is required for in-network specialists.  For hospital stays, members pay $100 per day from days 1-7, and there is a $0 co-pay for additional hospital days.  There is a $0 co-pay per stay in an inpatient mental care facility and members are given 190 days per lifetime.  Members pay $25 per day from days 1-20 in a skilled nursing facility and $50 per day from days 21-100.  There is a $15 copay for each primary care doctor visit, a $30 copay for each urgent care visit, and a $30 copay for each specialist visit.

Dual Eligible and Medicaid Advantage

There is a $0 monthly plan premium in addition to the beneficiary's monthly Medicare Part B premium.  Based on the beneficiary's level of need, there is generally no co-pay for primary care doctor visits, specialist visits, impatient hospital and mental health care.

Part D

HIP has two plans under Medicare Part D: Standard and Enhanced.  Standard offers a $310 deductible and a $4 co-pay on a tier one preferred generic drug.  Enhanced offers a $0 deductible and a $5 c-opay on a tier one preferred generic drug.