Medicare in New York

Medicare Beneficiaries of New York can Seek Assistance of Expert for Finding Best Option

Medicare Plans in New York

Around 3.5 million residents of New York received Medicare coverage in the year 2018 in one or the other form. All the Medicare beneficiaries have a number of Medicare coverage options in New York, which they can consider depending upon their need and requirements.

Original Medicare in New York

Around 2,112,754 beneficiaries are enrolled in Medicare Part A or Part B in New York and like any other U.S. states, Original Medicare comprises of both Medicare Part A and Part B. Part A is hospital insurance and covers inpatient hospital, skilled nursing facility, some home health visits, and hospice care whereas Part B covers outpatient services, including doctor visits, some home health care services, preventive services, and durable medical equipment. New York residents can sign up for Original Medicare during the 7 months period that start three months before they turn 65, including their birthday month and the three months after their birth month. Residents are required to sign up for Medicare during this period and if they fail to do so then they can enroll during the General Enrollment Period that runs from January 1 to March 31 every year by paying a late enrollment penalty for Part A and higher premiums for Part B.

Most of the Medicare beneficiaries in the state prefer Original Medicare as the enrollees of original Medicare have access to a wider range of healthcare providers and they do not need to obtain referral and prior authorization like Medicare Advantage plans. To cover the out-of-pocket expenses, original Medicare enrollees buy Medigap policies. This year Medicare Part A has a deductible of $1,364 for each episode of illness along with a fixed daily costs for extended stays. After the Part B enrollees meet the annual deductible of $185 this year, Part B will cover the 80% of the medical expenses. However, Original Medicare is less expensive for enrollees who get diagnosed with a serious illness and avail lot of medical services.

Medicare Advantage Plans in New York

Medicare Part C or Advantage healthcare program is designed to allow people receive Original Medicare benefits through a private, Medicare approved insurance company. Medicare Advantage is an alternative way to obtain Original Medicare benefits, as these plans provide same level of coverage as Original Medicare with the exception of hospice care. Besides, Medicare Part C plans also provide additional benefits like routine dental and vision care, hearing as well as wellness programs. Another important benefit of these plans is that these plans include a maximum out-of-pocket spending limit that varies from plan to plan. Once the beneficiaries out-of-pocket expenses reach this amount then the Medicare Advantage plan pays 100% of the covered healthcare costs for the rest of the year. To enroll in Medicare Part C, the beneficiaries must be entitled to Medicare Part A and should be enrolled in Medicare Part B and should live in the plan’s service area. Some of the Medicare Advantage plans available in New York include:

  • Health Maintenance Organizations (HMOs),
  • Preferred Provider Organization (PPO) plans,
  • Special Needs Plans (SNPs),
  • Private Fee-for-Service (PFFS) plans,
  • Medical Savings Account (MSA) plans

Medicare Part D

Medicare beneficiaries in New York have few ways to get Medicare prescription drug coverage depending on whether they have enrolled in Original Medicare or Medicare Advantage plan. Since Original Medicare does not provide prescription drug benefits apart from certain situations so the beneficiaries need to enroll in Medicare Part D. medicare Part A covers medication costs that members get during an inpatient hospital or skilled nursing facility stay whereas Medicare Part B covers an outpatient setting like a doctor’s clinic. Thus, to have medication coverage beyond this, members need to enroll in Medicare Part D. Original Medicare beneficiaries can avail prescription drug coverage by enrolling in Medicare Part D, as these plans provide stand-alone coverage that works along with Original Medicare benefits. Medicare Part D plans are offered by private insurance companies that are approved by Medicare. Another way to obtain prescription drug coverage is to enroll in Medicare Advantage Prescription Drug plan that combines health insurance as well as Medicare Part D benefits into comprehensive one plan. People enrolled in Medicare Advantage plan instead of Original Medicare should enroll in a Medicare Advantage Prescription Drug plan and not in medicare Prescription Drug plan. Every Medicare Prescription Drug plan varies in terms of cost, benefits and availability in different counties of the New York, so people looking to enroll in this plan need to check whether this plan is available in their area or not. Besides, they also need to check the plan formulary to ensure that their medications are covered before enrolling in a Medicare Prescription drug plan.

Medicare Supplement Plans in New York

Medicare Supplement health insurance plans are ideal for all those individuals and families who have enrolled in Original Medicare and wish to have complete peace of mind, as these plans will help to cover costs that Original Medicare doesn’t cover. Individuals who like to have flexibility to visit any doctor who treat Medicare patients and not just the doctors within a network. If one has to travel to different parts of the U.S. and want to visit any doctor who accepts Medicare patients. Medicare Supplement insurance plans help cover costs that original Medicare does not cover like copayments, coinsurance, deductible and other out-of-pocket expenses. In New York there are ten standardized Medicare Supplement plans, each labeled with the letters A through N. Plans of same letter offer similar benefits regardless of the location of the carrier. The best time to enroll in Medicare Supplement plans is during the Medigap Open Enrollment Period, which begins of the first day of the month in which you achieve age 65 or older and enrolled in Medicare Part B. During this period members have the guaranteed issue to enroll in any plan of their choice without fear of medical underwriting, higher monthly premiums or exclusion from complete coverage.

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