The member pays copaysВ and coinsuranceВ as listed above for drug costs between $0 and $2,960. Tier 3 (Non preferred generic and brand drugs): $50 copay per 30-day supply Tier 2 (Preferred brand drugs): $7.50 copay per 30-day supply Tier 1 (Preferred generic drugs): $5 copay per 30-day supply Tier 4 (Specialty drugs): 25% coinsurance per 30-day supply Tier 3 (Non preferred generic and brand drugs): $100 copay per 30-day supply Tier 2 (Preferred brand drugs): $15 copay per 30-day supply Tier 1 (Preferred generic drugs): $10 copay per 30-day supply VIP Prime (HMO) Medicare plan coverage is subject to all terms, conditions and limitations contained in the certificate of insurance. It does not provide a complete benefit description. The information in this section is intended to provide general information and highlights regarding the VIP Prime (HMO) Medicare plan. Limitations, copayments and restrictions may apply. The benefit information provided is a brief summary, not a complete description of benefits. HIP Health Plan of New York (HIP) is a Medicare Advantage organization with a Medicare contract.

Live in the planвЂ™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.Continue to pay your Medicare Part B premium and remain enrolled in Part A.In order to sign up for the VIP Premier (HMO) Medicare plan, you must: Durable medical equipment: 20% coinsurance.Home health care, non custodial: $0 copay.Skilled nursing facility, non custodial: $0 copay Days 1-20, $164 copay Days 21-100.Prescription Drugs: copays apply вЂ“ see table below.Emergency room: $100 copay (waived if admitted).Inpatient care: $250 copay Days 1-7, $0 copay Days 8-90.AВ no cost fitness benefitВ with access to 15,000+ fitness locations nationwide.A Part D prescription drug benefit that meets the needs of Medicare-eligible retirees.Value-added wellness and disease management programs.A primary care physician (PCP) to partner in your health.VIP Premier (HMO) Medicare plan helps Medicare-eligible retirees meet their medical needs.

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