Original Medicare vs a plan · Kings County, NY · 2027 plan year
Original Medicare vs EmblemHealth VIP Saver (HMO)
Medicare.gov compares Medicare Advantage plans with each other. This page also shows Original Medicare, so you can see the full trade-off: premiums, copays, the yearly limit, extra benefits, and the rules about doctors and approvals.
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EmblemHealth VIP Saver (HMO)
- Plan premium
- $40.40 a month
- Yearly limit, in network
- $9,850
- 2027 star rating
- 4 of 5
- Prior authorization needed for
- 14 services
In New York, you can go back to Medigap later
New York requires Medigap companies to sell you a plan at any time of year, and your health does not change the price. So you can try Medicare Advantage and go back to Original Medicare with Medigap later.
Read about Medigap rights on Medicare.govYour yearly cost, side by side
Move the controls to match your year. Totals include premiums, the Part B premium, copays, and drug costs.
Want to check your exact drugs? Medicare.gov lets you enter each drug and shows what each plan charges for it. Enter your drugs on Medicare.gov
Medicare.gov lists $371 to $773 a month for a 65-year-old woman who does not use tobacco. We start at the lowest price. Health questions can raise the price after your first 6 months with Part B.
Original Medicare
With Medigap Plan G at $371 a month and Wellcare Value Script (PDP)
$9,881 a year
- Premiums
- $7,414
- Medical costs
- $292
- Drugs
- $2,175
Most you can pay in a bad year, before drugs: $7,706.
EmblemHealth VIP Saver (HMO)
HMO from EmblemHealth
$6,169 a year
- Premiums
- $2,999
- Medical costs
- $1,330
- Drugs
- $1,840
Most you can pay in a bad year, before drugs: $12,849.
With these settings, EmblemHealth VIP Saver (HMO) costs about $3,712 less a year than Original Medicare.
Tipping point for EmblemHealth VIP Saver (HMO): with this drug use, if your medical copays and coinsurance in this plan pass $5,042 in a year, Original Medicare with Plan G costs less. The plan caps those costs at $9,850.
These are estimates, not quotes. Check every number with Medicare (Medicare.gov or 1-800-MEDICARE) and with the plan before you choose. What you pay depends on your doctors and hospitals, your drugs and pharmacy, and the care you use. Drug costs use typical prices for generic and brand-name drugs. Original Medicare amounts are 2027 projections from the 2026 Medicare Trustees Report. CMS sets the final amounts in November.
Text us about this comparisonWhat you pay each time you get care
In-network costs for one visit or one stay. The Original Medicare amounts follow your Medigap choice above: Plan G.
Primary doctor visit
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
EmblemHealth VIP Saver (HMO)
$0 copay
Specialist visit
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
EmblemHealth VIP Saver (HMO)
$40
Lab tests
Original Medicare + Medigap Plan G
$0
most Medicare-covered tests
EmblemHealth VIP Saver (HMO)
$0-$15
Prior authorization
MRI or CT scan
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
EmblemHealth VIP Saver (HMO)
$0-$300
Prior authorization
Emergency room
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
EmblemHealth VIP Saver (HMO)
$115
Urgent care
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
EmblemHealth VIP Saver (HMO)
$40
Outpatient surgery
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
EmblemHealth VIP Saver (HMO)
$0-$225
Ground ambulance
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
EmblemHealth VIP Saver (HMO)
$265
Prior authorization
Hospital stay, 5 days
Original Medicare + Medigap Plan G
$0
Plan G pays the $1,788 Part A deductible
EmblemHealth VIP Saver (HMO)
$1,925
for a 5-day stay
Prior authorization
See every cost in one table
| What you pay in network | Original Medicare + Medigap Plan G | EmblemHealth VIP Saver (HMO) |
|---|---|---|
| Monthly premium | Part B $209.50 + Medigap Plan G $371 + drug plan $37.30 | $40.40 + Part B $209.50 |
| Yearly limit on what you pay | You pay the $292 Part B deductible. Plan G pays the rest. | $9,850 in network |
| Medical deductible | $292 Part B. Plan G pays the $1,788 Part A deductible. | $0 |
| Primary doctor visit | $0, after the $292 yearly Part B deductible | $0 copay |
| Specialist visit | $0, after the $292 yearly Part B deductible | $40 copay |
| Lab tests | $0, most Medicare-covered tests | $0-$15 copayPrior authorization |
| MRI or CT scan | $0, after the $292 yearly Part B deductible | $0-$300 copayPrior authorization |
| X-rays | $0, after the $292 yearly Part B deductible | $25 copay, 20% coinsurancePrior authorization |
| Emergency room | $0, after the $292 yearly Part B deductible | $115 copay |
| Urgent care | $0, after the $292 yearly Part B deductible | $40 copay |
| Outpatient hospital | $0, after the $292 yearly Part B deductible | $0-$399 copayPrior authorization |
| Surgery center | $0, after the $292 yearly Part B deductible | $0-$225 copay |
| Ground ambulance | $0, after the $292 yearly Part B deductible | $265 copayPrior authorization |
| Hospital stay | $0, Plan G pays the $1,788 Part A deductible | $385 per day for days 1-7; $0 per day for days 8-90Prior authorization |
| Skilled nursing facility | $0, Plan G pays days 21-100 | $0 per day for days 1-20; $221 per day for days 21-100Prior authorization |
| Mental health visit | $0, after the $292 yearly Part B deductible | $35 copay |
| Physical therapy | $0, after the $292 yearly Part B deductible | $35 copay |
| Home health care | $0, Medicare-covered home health | $0 copayPrior authorization |
| Medical equipment | $0, after the $292 yearly Part B deductible | 10%-20% coinsurancePrior authorization |
| Part B drugs | $0 after the $292 Part B deductible | 0%-20% coinsurancePrior authorization |
| Drug deductible (Part D) | $700 with Wellcare Value Script (PDP) | $650 |
| Drug tiers (one month, retail) | Generic: $0 copayPreferred Brand: 25% coinsuranceNon-Preferred Drug: 39% coinsuranceInjectable Drugs: 15% coinsuranceSpecialty Tier: 25% coinsuranceSelect Care Drugs: $11 copay | Preferred Generic: $0 copayGeneric: $2 copayPreferred Brand: 20% coinsuranceNon-Preferred Drug: 25% coinsuranceSpecialty Tier: 25% coinsuranceSelect Care Drugs: $0 copay |
Not sure which of these costs apply to you?
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A higher drug plan premium is not, by itself, a reason to switch
With Original Medicare, you buy a separate drug plan. In New York, 9 drug plans are for sale for 2027, from $37.30 to $238.30 a month. Half of them cost $169.30 a month or less.
- Every 2027 drug plan limits what you pay for covered drugs to $2,400 a year. The drug coverage in Medicare Advantage plans has the same limit.
- The premium is one part of your yearly cost. The calculator above adds premiums, medical costs, and drug costs, so you can see the whole year.
- A Medicare Advantage plan can cost less in a light year. But you also take on its network and prior authorization rules.
- If your income is limited, Extra Help can pay most of your drug plan premium and drug costs. Check Extra Help at SSA.gov
Doctors, referrals, and prior authorization
Cost is one side. The other side is how you get care. These rules come from the CMS plan files. Prior authorization means the plan must approve a service before you get it.
Original Medicare
- Any doctor or hospital in the U.S. that takes Medicare
- No referrals
- Prior authorization only for a short list of services
EmblemHealth VIP Saver (HMO)
HMO
- You use doctors and hospitals in the plan network. Outside the network, the plan pays for emergencies and urgent care.
- No referral needed to see a specialist.
Prior authorization for 14 services
Diagnostic tests, MRI or CT, Radiation therapy, Outpatient hospital, Ambulance, Home health, Partial hospitalization, Cardiac rehab, Pulmonary rehab, Medical equipment, Prosthetics, Hospital stay, Skilled nursing, Part B drugs
Extra benefits
| Extra benefit | Original Medicare | EmblemHealth VIP Saver (HMO) |
|---|---|---|
| Dental | No | Comprehensive |
| Eye exam | No | Yes |
| Glasses or contacts | No | Yes, $200 allowance |
| Hearing aids | No | Yes, up to $1,500 |
| Over-the-counter allowance | No | No |
| Fitness benefit | No | No |
| Rides to care | No | No |
| Meals after a hospital stay | No | Yes |
| Emergency care abroad | Plan G and Plan N pay 80% after a $250 deductible | Yes |
| Part B premium giveback | No | No |
What changed for 2027
EmblemHealth VIP Saver (HMO)
New Plan · New for 2027
No change found in the fields we track.
More 2027 plans in Kings County
- Aetna Medicare Elite (PPO), H5521-120
- Healthfirst 65 Plus Plan (HMO), H3359-001
- Healthfirst Increased Benefits Plan (HMO), H3359-019
- Wellcare Fidelis Simple (HMO-POS), H5599-004
- Wellcare Simple Open (PPO), H2775-106
- AARP Medicare Advantage from UHC NY-0012 (PPO), H3418-001
- AARP Medicare Advantage from UHC NY-0005 (HMO-POS), H3379-001
- Wellcare Giveback Open (PPO), H2775-111
County guide: 2027 plans in Kings CountyState guide: New York
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Sources and method
Plan data comes from the CMS 2027 Plan Benefit Package and landscape files. The data is from 2026-10-10. We checked a sample of plans field by field against Medicare.gov. Original Medicare amounts are the 2027 projections in the 2026 Medicare Trustees Report (Tables V.E1 and V.E2). CMS sets the final amounts in November. Medigap prices are the range Medicare.gov showed for ZIP 11201 on 2026-10-09. Totals use typical Medicare-allowed amounts for each service and typical drug prices.
- EmblemHealth VIP Saver (HMO) on Medicare.gov · plan website · drug list · doctor directory
- Medigap prices for ZIP 11201 on Medicare.gov
- CMS Plan Benefit Package files, 2027
- CMS 2027 landscape files (premiums and limits)
- CMS 2027 plan crosswalk
- CMS 2027 Star Ratings
- 2026 Medicare Trustees Report: projected 2027 Part A and Part B amounts (Tables V.E1 and V.E2)
- CMS 2026 Part A and Part B amounts
- Medicare.gov: Medigap guaranteed issue rights
These are estimates, not quotes, and they are for education only. Check every number with Medicare and with the plan before you choose. What you pay depends on your doctors and hospitals, your drugs and pharmacy, and the care you use. Plans can change their benefits, premiums, drug lists, and networks each year.
Pinnie is not an insurance agent or broker and does not sell Medicare plans. Pinnie is not connected with or endorsed by the U.S. government or the federal Medicare program. For all your options, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.