Introduction to Medicare Advantage in New York (Part C)

Medicare Parts A & B (a.k.a. “Original Medicare”) aims to be comprehensive – but it unfortunately doesn’t cover 100% of your medical needs. There are little-known out-of-pocket expenses which can become expensive if you don’t have a good Medicare supplement insurance policy to protect you. One of the more popular supplements, Medicare Part C (or “Medicare Advantage), is the focus of this particular article.

Federal Regulations for Medicare Advantage

Medicare Advantage may also be referred to as a Medicare “Replacement” insurance policy. This is because signing up for Medicare Advantage involves replacing your federal Medicare benefits with a different insurance policy from a private company. However, there are laws in place to make sure that your Advantage plan is at least identical to – if not better than – Original Medicare. These laws are in place to protect you, the consumer.

Medicare Advantage Enrollment In Yew York

New Yorkers are some of the biggest fans of Medicare Advantage in the country. A significant 35% – which is more than one-third of Medicare-qualified seniors – are signed up for a plan. And in the chart below, you can observe which Advantage plans are more popular than others:

Plan Type Enrollment Percentage
HMO Plans 59%
Local PPO Plans 13%
Special Needs Plans 11%
Regional PPO Plans 9%
Private Fee-For-Service Plans 5%
Other (Cost Plans, MSA’s, etc.) 3%

Plan Coverage & Cost

Many different factors, such as age and tobacco use, will influence your monthly premium. But there are ways to gather data and come up with a close estimate. Below, you can take a look at some of the estimated costs near you:

Most Popular Medicare Advantage Plans in New York

Medicare Advantage plans are distinguished from one another by the provider network you choose. The most popular plans are usually the most affordable ones, as you can tell from the chart below. However, more expensive plans – such as PPO or PFFS plans – might be worth the cost in areas with limited access to medical care.

Helpful Medicare Advantage Tips & Tricks

Doctor/Provider Network Restrictions

The provider network is the group of doctors and facilities from which your Advantage plan will allow you to receive medical care. If you want to see a doctor or use a facility which is outside of your provider network, your plan’s network restrictions may make that difficult or impossible without paying out-of-pocket. Make sure you check with your preferred doctor(s) and facilities before you decide on an Advantage plan.

Doctor/Providers List

Drug, Vision and Dental Coverage

While provider networks might seem unpleasantly complicated, but your ancillary coverage options can incorporate ease and convenience into a Medicare Advantage plan. You can add vision, dental, and even prescription drug coverage all to the same policy. This prevents you from dealing with the hassle of managing multiple, separate insurance policies. Just remember – the more benefits you add, the higher your monthly rate will be.

Enrollment Options & Best Time To Enroll

By far, the best time to enroll is during your 6 month IEP (see below) once you turn 65 and enroll in the federal Medicare program. Some companies may even approve you automatically without asking any questions about your health if you first qualify for federal Medicare benefits. If you wait, however, or if you are struggling with a serious health condition (such as End Stage Renal Disease), you may have to seek help from your local insurance agent or your state department of insurance. You can also take a look at our Medicare Advantage Enrollment Options page for more information.

  • Initial Enrollment Period: 6-month timeframe when you first enroll in Medicare to purchase a Medicare Advantage plan.
  • Annual Enrollment Period (AEP): This timeframe runs from October 15th through December 7th every year, and during this time you can change or cancel your Medicare Advantage and part D drug plan.
  • Special Enrollment Period (SEP): During special circumstances, you may be eligible to purchase/change a plan outside of the Annual Enrollment Period. Things such as moving out of the plans’ service area, losing group health or employer coverage, a company no longer offering plans in the area, etc. are all events that could trigger a SEP.

What Medicare Advantage Plan Is Best For Me?

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