About EmblemHealth Coverage in East Setauket
EmblemHealth operates 15 distinct plans in East Setauket, NY, with a combined in-network roster of 635 doctors across 56 medical specialties. Among the five largest insurers we track in East Setauket, EmblemHealth ranks #2 by provider count, the leader is Aetna with 684 in-network doctors. Use this page to confirm a specific provider is in-network, understand which EmblemHealth plans have the widest reach in East Setauket, and compare coverage against other major insurers before scheduling care.
EmblemHealth sells HMO, OAP, HSA, EPO plan types in East Setauket. A PPO (Preferred Provider Organization) lets you see any provider without a referral; out-of-network care is covered but you pay a higher share. An HMO (Health Maintenance Organization) requires you to pick a primary-care doctor and get referrals for most specialist care, usually in exchange for lower premiums. An EPO (Exclusive Provider Organization) is in-network only, like an HMO, but skips the referral requirement. A POS (Point of Service) plan blends HMO-style in-network with PPO-style out-of-network options. Your plan name is on your member ID card.
EmblemHealth is a Medicare Advantage carrier in East Setauket with 4 plans available to seniors, listed below with star ratings and premiums. EmblemHealth does not currently sell ACA marketplace plans in NY; commercial coverage shown above comes through employer groups.
Data is sourced from the federally-mandated CMS Transparency in Coverage filings that every insurer must publish monthly. Medicare Advantage plans come from the CMS MA Landscape File. Last refreshed May 29, 2026. Networks change between filings, so even when a doctor appears here we recommend calling their office with your member ID to confirm current network status before your visit.
Plan Type Mix in East Setauket
EmblemHealth organizes its East Setauket network into several plan types, each with different rules about which doctors you can see and what referrals you need. The bars below show the unique-provider share of the 635-doctor network that offers plans of each type.
A high PPO share means most EmblemHealth doctors in East Setauket accept the insurer’s broader preferred-provider plans. these give you maximum choice and don’t require referrals to specialists. A high HMO share signals a tighter gatekeeper model: lower premiums but you usually need your primary-care doctor to refer you before a specialist will bill. EPO and POS bars sit between those two on both flexibility and cost.
Because individual doctors typically participate in multiple EmblemHealth plan types at once, these percentages don’t sum to 100%. the same provider can appear as both PPO and OAP coverage. What the chart tells you is which plan categories have meaningful depth in East Setauket.
Percentages don’t sum to 100% because most doctors participate in several plan types simultaneously.
EmblemHealth Plans in East Setauket
EmblemHealth contracts with doctors at the network level in East Setauket. Each network below is a contract; your specific plan (printed on your member ID) maps to one of them.
HIP PRIME HMO
HMO
516
HIP ACCESS I
146
EMBLEMHEALTH SILVER PREMIER-P
139
EMBLEM HEALTH HMO PLUS
HMO
66
EMBLEMHEALTH PLATINUM VALUE-P
65
EMBLEMHEALTH GOLD OPEN ACCESS
OAP
61
EmblemHealth Silver Premier
59
EMBLEMHEALTH SILVER VALUE-M
53
EMBLEMHEALTH BRONZE PLUS H.S.A.
HSA
52
EMBLEM HEALTH EPO VALUE
EPO
22
EMBLEMHEALTH SILVER PREMIER
19
HIP HMO PREFERRED w/ DME PDN (PSC CUNY ADJUNCTS)
HMO
7
EmblemHealth Medicare Advantage Plans in East Setauket
4 EmblemHealth Medicare Advantage plans available to seniors in East Setauket. Each plan combines Medicare Parts A, B and usually D (prescription drugs) into one product, with star ratings and monthly premiums shown.
Star ratings (1-5) reflect overall plan quality measured by CMS. a 4-star plan generally indicates above-average member experience and care coordination. Premiums shown are the monthly cost on top of the standard Medicare Part B premium.
Source: CMS Medicare Advantage Landscape File. Star ratings reflect overall plan performance per CMS quality measures. Premiums shown are monthly Part C+D consolidated.
Top Specialties Accepting EmblemHealth
EmblemHealth’s East Setauket network spans 56 distinct medical specialties. The mix reflects where the insurer has negotiated the deepest physician contracts. primary-care specialties and behavioral health tend to dominate, with surgical and sub-specialty networks typically narrower.
Click any specialty below to see a filtered list of just those in-network providers in East Setauket, including ratings, locations, years of experience, and contact information. For specialties with fewer than 10 in-network providers, you’ll likely want to check nearby cities too. the section further down on this page has your geographic options.
Physician Experience in EmblemHealth’s East Setauket Network
Years since medical school graduation is a reasonable proxy for experience, though it doesn’t capture fellowship training, subspecialty certifications, or years spent in specific clinical settings. For EmblemHealth’s East Setauket network the breakdown below gives a quick sense of whether you’re picking from a predominantly early-career roster or one weighted toward veteran practitioners.
A network heavy on early-career doctors (0–5 years) often means lower wait times for new patients and exposure to the latest training, while veteran providers (30+ years) typically bring deeper pattern recognition for unusual presentations. A balanced distribution. roughly one-quarter in each bucket. is a healthy signal that the insurer has depth at every career stage, not just new graduates filling out its directory.
Telehealth Coverage in East Setauket
117 of 635 EmblemHealth in-network providers (18%) offer telehealth visits in East Setauket. Video appointments are typically covered for follow-ups, medication refills and adjustments, mental-health sessions, dermatology triage, and low-acuity primary care.
Availability and reimbursement still vary by state regulation and specific plan. Psychiatry, behavioral-health, and primary-care telehealth is near-universal at this point; procedural specialties (cardiology, orthopedics) typically offer video visits for pre-op consults and post-op follow-up but not initial diagnostic visits. Call the office with your EmblemHealth member ID to confirm your plan covers the visit type you need.
Top specialties offering telehealth in East Setauket
Top Hospitals Serving EmblemHealth Patients in East Setauket
Hospitals with the most EmblemHealth-network physicians practicing there. Large affiliation counts indicate that EmblemHealth has a durable relationship with the facility, which typically means smoother prior-authorizations for admissions, lab work, and follow-up care coordinated under one roof.
Hospital coverage is a separate contract from physician coverage. your EmblemHealth plan may cover a doctor who admits at Hospital X but classify the hospital itself as out-of-network, leaving you with a surprise facility bill. Before scheduling anything inpatient or procedural, call both the doctor’s office and the hospital billing line with your member ID to confirm both sides are in-network for the specific plan you hold.
Suny/stony Brook University Hospital
Stony Brook, NY
John T Mather Memorial Hospital Of Port Jefferson
Port Jefferson, NY
St Charles Hospital
Port Jefferson, NY
North Shore University Hospital
Manhasset, NY
St Catherine Of Siena Hospital
Smithtown, NY
Long Island Community Hospital
Patchogue, NY
Coverage Compared in East Setauket
Side-by-side provider counts for the five largest commercial and government insurers tracked in East Setauket. These numbers show raw network breadth. they don’t adjust for quality, specialty mix, or your specific plan’s tier structure, but they’re a useful first filter when choosing a carrier at open enrollment.
If EmblemHealth’s provider count looks limited for your needs, the alternatives below may fit better. Click any row to open that insurer’s East Setauket provider list with the same filters, plan breakdown, and hospital affiliations that you’re seeing here.
Nearby Cities with EmblemHealth Coverage
Cities closest to East Setauket where EmblemHealth has an in-network provider base of meaningful size. Useful if you’re willing to drive a short distance for a hard-to-find specialist, have two offices to choose between, or are planning a move inside the region.
The mileage figures are straight-line distances computed from average practice-address coordinates, not drive-time. Counts reflect each nearby city’s EmblemHealth network size. a small count doesn’t mean no coverage, just that your in-East Setauket options are likely more plentiful.
Frequently Asked Questions
Common questions about EmblemHealth coverage in East Setauket
How do I find an EmblemHealth in-network doctor in East Setauket, NY?
EmblemHealth has 635 in-network providers across 56 medical specialties in East Setauket. This list is compiled from federally-mandated CMS Transparency in Coverage filings, last verified May 29, 2026. Filter by specialty, plan type, gender, telehealth or experience above to narrow your search, then click any provider for full credentials and contact details. Always confirm coverage with your specific plan before scheduling.
What EmblemHealth plan types are available in East Setauket?
EmblemHealth sells 4 distinct plan types in East Setauket: HMO (563 doctors), OAP (61 doctors), HSA (52 doctors), EPO (22 doctors). PPO plans give you the broadest provider choice without referrals; HMO plans require a primary-care referral but typically have lower premiums; EPO plans skip the referral but stay in-network only; POS plans blend HMO in-network rules with PPO out-of-network options. Choose by reading what's printed on your member ID card and matching it to one of the rows in the Plans section above.
Does EmblemHealth offer Medicare Advantage in East Setauket?
Yes. EmblemHealth offers 4 Medicare Advantage plans in East Setauket for 2026, with plan types including HMO, HMO D-SNP. The average CMS star rating across these plans is 3.5 of 5. Medicare Advantage (Part C) bundles Parts A and B with usually Part D prescription drug coverage, often adding dental, vision, and wellness benefits. Enrollment is open during the annual election period each fall.
What's the highest-rated EmblemHealth Medicare Advantage plan in East Setauket?
EmblemHealth VIP Gold (HMO) (HMO) holds EmblemHealth's top CMS star rating in East Setauket at 4.0 of 5, with a $175 monthly premium. Star ratings reflect overall plan quality based on member experience, customer service, drug pricing, and clinical care measures. Plans rated 4 or higher generally indicate above-average performance.
Which hospitals in East Setauket accept EmblemHealth?
Hospitals where EmblemHealth doctors most commonly practice in East Setauket include SUNY/STONY BROOK UNIVERSITY HOSPITAL, JOHN T MATHER MEMORIAL HOSPITAL OF PORT JEFFERSON, ST CHARLES HOSPITAL, NORTH SHORE UNIVERSITY HOSPITAL. This is inferred from physician affiliations rather than direct insurer-hospital contracts, so confirm hospital network status separately with both your EmblemHealth plan and the hospital's billing department before scheduling any inpatient or surgical procedure. Even when a doctor is in-network, the hospital where they admit may not be.
Which medical specialties have the most EmblemHealth providers in East Setauket?
EmblemHealth's East Setauket network is largest in Physician Assistant (94), Nurse Practitioner (70), Internal Medicine (47). Primary care, behavioral health, and physical therapy tend to dominate insurer networks because high patient volumes drive deeper provider contracts. Surgical sub-specialties typically have narrower networks. Click any specialty in the section above to see a filtered list of those in-network providers.
How does EmblemHealth compare to other insurers in East Setauket?
EmblemHealth ranks #2 of 6 major insurers tracked in East Setauket by provider count, with 635 doctors. Aetna leads at 684 providers. Larger network size means more provider choice but doesn't guarantee that your specific doctor is in-network with any insurer. The Coverage Compared section above shows side-by-side counts for the top five carriers in East Setauket.
How do I verify a doctor is in-network with EmblemHealth?
Three steps: first match the doctor's name against this list, second call the provider's office with your member ID to confirm they currently accept your specific EmblemHealth plan, and third check EmblemHealth's own member portal for the most authoritative real-time status. Networks change between monthly federal filings; our data was last refreshed May 29, 2026.
What if my doctor isn't listed here?
This list reflects EmblemHealth's submitted network data as of the last federal filing on May 29, 2026. Doctors join and leave networks between filings, so a current in-network provider may be missing if they joined recently. Call the doctor's office to ask whether they currently accept EmblemHealth, then check EmblemHealth's own member portal for confirmation.
When was this EmblemHealth data last updated?
The EmblemHealth East Setauket provider list was last refreshed May 29, 2026. Doctor and network data come from the federally-mandated CMS Transparency in Coverage filings that every insurer must publish monthly. Medicare Advantage plans come from the CMS MA Landscape File. Refresh cadence: monthly for provider data, annually for marketplace and Medicare plans.
Related healthcare resources
Patient resources for East Setauket EmblemHealth members.
Common health topics
Common medications
Common procedure costs
Data freshness
Last verified May 29, 2026 · Source: CMS Transparency in Coverage federal filings · Refresh cadence: monthly