Medicare Plan Overview

For over 58 years, HIP has been working hard to provide New Yorkers with quality health plans to meet all their health care needs. And for almost 30 of those years, we've been dedicated to serving the unique needs of our Medicare members. Currently, HIP offers six distinct Medicare Advantage products that provide Medicare-eligible members with more health care coverage than Original Medicare, as well as two dedicated Medicare Part D Prescription Drug plans.

According to Crain's New York Business Book of Lists 2006, our Medicare HMO plan is the largest Medicare health plan in New York City. In addition, Crain's ranked HIP #1 in overall HMO membership. Plus, in 2006, HIP's Medicare HMO plan retained Commendable Accreditation and its Commercial HMO/POS plans earned Excellent Accreditation from the National Committee for Quality Assurance (NCQA), an independent, not-for-profit organization dedicated to measuring the quality of America's health care.

HIP offers five Medicare Advantage Prescription Drug (MA-PD) Plans that provide all the coverage of Original Medicare plus Medicare Part D outpatient prescription drug coverage. Our MA-PD's include the traditional Health Maintenance Organization (HMO) Medicare plan called HIP VIP Medicare Plan, an in-network no-referral plan called HIP VIP Plus. We also offer three Special Needs Plans that are custom designed to meet particular needs. The HIP VIP Care Improvement Special Needs Plan is designed for Medicare individuals with diabetes, the HIP VIP Dual Eligible Special Needs Plan is designed for individuals who are eligible for Medicare and any level of Medicaid Assistance and the HIP VIP Medicaid Advantage Special Needs Plan is designed for individuals who are eligible for Medicare and for full Medicaid Assistance.

HIP also offers a Medicare Advantage (MA) Plan without Medicare Part D Prescription Drug coverage. This plan is called HIP VIP Rx Carveout.

In addition, HIP offers two Medicare Prescription Drug Plans (PDP's) which provides Medicare Part D Prescription Drug coverage. They are called HIP Standard Part D New York and HIP Enhanced Part D New York.

Please see plan descriptions below and click on the benefit summary links to your left to view more information.

Medical and Prescription Drug Coverage (MA-PD Plans)*

Traditional HMO Medicare Plan HIP VIP Medicare Plan

HIP VIP is our original Medicare Advantage product that provides Medicare beneficiaries with all the benefits of Original Medicare and much more. When you join this plan you must use HIP providers and obtain referrals for specialty care except for chiropractic, gynecologic, optometric, outpatient mental health and podiatric services. HIP VIP Medicare Plan provides Medicare Part D Prescription drugs, with coverage in the coverage gap for preferred generic formulary medications. To access the benefit summary for HIP VIP Medicare plan, please refer to the links on the left.

Open Access HMO Medicare Plan HIP VIP Plus Plan

HIP VIP Plus is an open access plan, which means you do not need a referral to see specialists in the HIP provider network. HIP VIP Plus works like the HIP VIP Medicare Plan but does not require referrals for in-network specialty care. HIP VIP Plus provides Medicare Part D Prescriptions Drugs, with coverage in the coverage gap for preferred generic formulary medications. To access the benefit summary for HIP VIP Plus, please refer to the links on the left.

Medicare Special Needs Plans

HIP VIP Care Improvement Plan

The HIP VIP Care Improvement Plan is an open access plan custom designed for eligible individuals with Medicare who have diabetes. Individuals who join this plan get all the coverage of Medicare, prescription drug coverage, reduced costs for certain diabetes medications, coverage for preferred generic formulary medications through the coverage gap, plus a disease management program to meet the additional needs of members with diabetes. To access the benefit summary for HIP VIP Care Improvement, please refer to the link on the left.

HIP VIP Dual Eligible Plan

The HIP VIP Dual Eligible Plan is a traditional HMO plan designed for eligible individuals who have Medicare and any level of Medicaid. Individuals who join this plan get all the coverage of Original Medicare, plus additional services (when medically necessary and approved) such as inpatient private duty nursing care, Home Health Aid assistance and a $210 (annual) reimbursement for eligible over-the-counter medications (cough and cold, proton pump inhibitors, analgesics and antacids). To access the benefit summary for HIP VIP Dual Eligible, please refer to the links on the left.

HIP VIP Medicaid Advantage Plan

The HIP VIP Medicaid Advantage Plan is a traditional HMO plan designed for eligible individuals who have Medicare and full Medicaid. Individuals who join this Plan get all the coverage of Original Medicare plus their fee for service Medicaid Services coordinated through HIP Provider Network. To access the benefit summary for HIP VIP Medicaid Advantage, please refer to the links on the left.

Medicare Advantage Plan (without prescription drugs) HIP VIP Rx Carveout Plan (Medical Only)

The Rx Carveout Plan is HIP's HMO Medicare Managed Care that does not have Part D Prescription Drug coverage. If you are not interested in enrolling in a Medicare Part D plan, the HIP VIP Rx Carveout plan provides Medicare beneficiaries all the benefits of Original Medicare with the exception of prescription drug coverage. When you join this plan, you must use HIP providers and obtain referrals for specialty care except for chiropractic, gynecologic, optometric, outpatient mental health and podiatric service. If you do not have creditable prescription drug coverage, you may have to pay a late enrollment penalty to Medicare when you join a Medicare Part D plan in the future. To access the benefit summary for HIP VIP Rx Carveout plan, please refer to the links on the left.

Prescription Drug Coverage **

HIP Standard Part D New York Plan

HIP Part D New York is a prescription-only plan for Medicare beneficiaries who do not want medical coverage through an HMO. This plan provides drug coverage based on HIP's formulary and the Part D guidelines established by Medicare. For more information on this plan, please go to the benefit summary link on the left.

HIP Enhanced Part D New York

HIP Part D New York Enhanced is our enhanced Medicare Part D plan. What makes this plan "enhanced" is the coverage of preferred generic formulary medications through the coverage gap phase. For more information on this plan, please go to the benefit summary link on the left.

Medicare Online Enrollment Center Information

Medicare beneficiaries may enroll in the HIP VIP Plans and HIP Part D New York Plans through the Centers for Medicare and Medicaid Services Online Enrollment Center, located at www.medicare.gov

HIP Customer Service Contact Information

For more information contact the HIP Customer Service at 1-800-HIP-TALK (1-800-447-8255) Monday to Sunday, 8am to 8pm. TTY: 1-888-447-4TDD (1-888-447-4833) Monday to Friday, 8:30am to 5:00pm. This number requires special telephone equipment. Calls to this number are free. HIP is a Health Plan that has Medicare Advantage contracts and a Medicare Prescription Drug Program contract with the Centers for Medicare and Medicaid Services (CMS).

Eligibility Requirements

* The above HIP MA-PD and MA Medicare medical plans are available to Medicare eligible individuals with Medicare Part A and B coverage who live in New York City (Bronx, Queens, Manhattan, Brooklyn, Staten Island) and Nassau, Suffolk and Westchester Counties and who do not have End Stage Renal Disease (ESRD), unless currently enrolled in a HIP Plan. Individuals interested in joining one of the Special Needs plans must have the "qualifying" condition to join diabetes for HIP VIP Care Improvement and Medicaid for the HIP VIP Dual Eligible Plan and the HIP VIP Medicaid Advantage Plan. An additional enrollment form is required for both HIP VIP Care Improvement Plan and the HIP VIP Medicaid Advantage Plans.

** The HIP Part D Prescription Drug plans are available to Medicare eligible individuals with either Medicare Part A, Medicare Part B, or both and who live in New York State.

Beneficiaries interested in finding out if they qualify for extra help with Medicare Prescription Drug Plan costs should call 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day/7days a week), or Your State Medicaid Office, or the Social Security Administration at 1-800-772-1213 between 7a.m. and 7p.m., Monday through Friday. TTY/TDD users should call 1-800-325-0778. Copayments, coinsurance, deductibles, and limitations may apply and vary by plan.

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