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Medicare Plans in New York – Coverage and Benefits

If you are approaching the age of 65, you may be aware by now that it will soon be time for you to enroll in the federal Medicare program. This form of government-sponsored health insurance is designed to help retired citizens live out their golden years in relative health and comfort. Although it is designed to be priced affordably, there are certain treatments which are not completely covered. Don’t worry, we’ll address the importance of these coverage gaps later in the article.

But first, let’s talk about basic Medicare costs. Once you successfully enroll, you’ll immediately begin receiving benefits from Parts A and B of Traditional Medicare. These two parts cover the vast majority of your medical needs, from hospital treatment to doctor visits and more. Part B comes with required monthly premiums and an annual deductible which you can calculate for yourself here. And for anyone with a stunted employment history (less than 10 years/40 quarters), Part A will come with some additional mandatory fees as well.

Medicare Part A (Hospital Coverage)

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care
Medicare Part B (Medical Insurance)

  • Services from doctors and health providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services
Medicare Part C (Medicare Advantage)

  • Includes all benefits and services covered under Part A and Part B
  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan
  • Run by Medicare-approved private insurance companies
  • May include extra benefits and services for an extra cost
Medicare Part D (Drug Coverage)

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies
  • May help lower your prescription drug costs and help protect against higher costs in the future

Various Medicare Plans in New York

There are more than 3 million New York residents who depend on Medicare in whole or in part to help them meet their medical needs. Of those 3,093,591 people, 53% either haven’t bothered to supplement their coverage yet, leaving themselves vulnerable to expensive gaps in coverage, or they have that taken care of by some form of worker benefits. The next most popular form of supplemental coverage is Medicare Advantage, with 35% (1,082,757 New Yorkers) opting into Medicare Part C. Finally, 356,360 Medicare recipients (or 12%) prefer the affordability and flexibility of a Medigap supplemental insurance policy.

Important: before you can find comprehensive Medicare supplement coverage, you have to have Original Medicare coverage. The Medicare enrollment process is easy – clicking that link will get you started today.

Do New Yorkers Need Supplemental Insurance for Medicare?

Let’s start the discussion by easing one common worry: you are not legally required to supplement your Medicare benefits. Purchasing additional coverage is 100% optional, and can be done at your discretion. However, the longer you put it off, the more likely your life savings could fall victim to thousands of dollars in unexpected medical bills:

Medicare Part A Costs Medicare Part B Costs
  • $1,184 (as of 2014) Part A Annual Deductible for access to Basic Hospital Services
  • $296/day for an Inpatient hospital Stay between 61-90 days long
  • $147 Annual Deductible (as of 2014) for basic Part B Medical Coverage
  • 80/20 Coinsurance costs for all Medicare coverage; Medicare pays 80%, you pay 20% Out-of-Pocket

Thankfully, there are affordable options which can help protect you against these Medicare coverage gaps. We’re about to give you some valuable information on two of the top plans available: Medicare Advantage, and Medigap supplement insurance.

Medigap Plans in New York

Medigap supplemental insurance was named to reflect the “gaps” in Original Medicare which these policies are designed to neutralize. They were specifically formulated by a partnership by the US government, and private health insurance companies. The ten available plans (listed alphabetically in the table below) help to supplement your Traditional Medicare benefits at an affordable cost; they neither override nor replace your Medicare. And they are universal across all 50 states, so that the only thing you need to worry about is your price and your provider.

[chart category=”supplement” name=”planTypes” state=”NY” zipcode=”33313″]

New York Medicare Advantage Plans

Medicare Advantage is another name for Medicare Part C. This special type of Medicare is different from Original Medicare in that it is not directly associated with the federal government. A private insurance company takes over the duties of managing your Medicare benefits, and sometimes even offers you additional coverage and benefits for a slightly higher price. For some seniors, the simplicity of dealing with one single plan is fairly appealing, as are the additional optional benefits.

But if you switch to a Medicare Advantage plan, you should be aware of the risks you will be taking on before you make a final decision. For starters, you run the high risk of losing your current doctor. Medicare Advantage networks are notorious for having restricted medical networks in order to keep costs down. And speaking of managing a bottom line, the private companies which issue Advantage policies are much more vulnerable to market fluctuations than the government. So keep all of these things in mind when making your decision.

When you sign up for a Medicare Advantage plan, your ability to receive medical care will be limited to either a Preferred Provider (PPO) or Health Maintenance (HMO) Organization.

[chart category=”advantage” name=”topHMOPlans” zipcode=”33313″ state=”NY”]

[chart category=”advantage” name=”topPPOPlans” zipcode=”33313″ state=”NY”]

Specific Differences in Medigap and Medicare Advantage

This easy-to-read table helps compare and contrast Medigap and Medicare more effectively:

Questions Medicare Advantage Medicare Supplement
How are the plans funded? Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company. Your monthly premium takes care of the majority of your expenses.
Do I continue paying for Part B? Yes Yes
What does it cost me? Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly. While each plan does require a monthly premium, many of them are affordably priced.
What does the plan cover? Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be. All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.
Can I budget my health care expenses? It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket. Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.
Can my plan be cancelled? Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage. No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.
Are pre-approvals or pre-certifications required? Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care. No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.
Can I use any doctor or hospital? Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time. Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.
Can drug, vision, or dental coverage be included in the policy? Yes. No. These forms of coverage must be purchased separately.
Who is this plan type generally best suited for? If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you. If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.


Additional Information and Resources

Still have questions? Don’t get discouraged just yet. We’ve included the directory below to help you get in touch with local Medicare experts who are in the know. Go ahead and give some of them a call. They can help you find all the information you need.

[chart category=”general” name=”usefulContacts”]

Important Medicare Terms

  • HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
  • Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
  • Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.

Compare Medigap Plans Online


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