What are Medicare Advantage Plans and Can I Get One in New York?
Unlike Original Medicare, which only covers major medical, a Medicare Advantage plan can include many extras, including prescriptions, vision, hearing, dental, and fitness, just to name a few. And, good news, they are available in New York.
Althought the extra benefits are nice to have, it's important to fully understand what you're getting if you join a Medicare Advantage plan in New York. Specifically, Medicare Advantage is managed care health insurance and the plan controls your access to healthcare providers. If you have ever had an HMO plan through your employer's group health insurance, you have a good idea of what managed care is all about.
Medicare vs. Medicare Advantage: What's the Difference?
The big differences between traditional Medicare coverage and what you get with Medicare Advantage are easy to see by pointing out the pros and cons. Neither type of insurance is perfect. They each suit different needs.
The Pros and Cons of New York Medicare Advantage Plans vs Original Medicare
- With Medicare Advantage you must use New York healthcare providers within the plan's network. With Original Medicare, you can use the Medicare-approved provider of your choice.
- If you travel and have a medical emergency, Medicare Advantage covers you. However, if you are a snowbird and winter or summer in another state, non-emergency doctor outside of your plan's network won't be covered.
- All Medicare Advantage plans sold in New York protect you with an annual maximum out-of-pocket (MOOP) limit. Once you reach this spending limit the plan pays all additional copays and coinsurance that you'd normally pay out-of-pocket. Original Medicare does not have an out-of-pocket maximum.
- Most Medicare Advantage plans come bundled with a New York Medicare Part D plan for prescription coverage. With Original Medicare, you must enroll in a stand-alone Part D plan. But, the stand-alone plans offer more choices to get lower-cost prescriptions.
- With Original Medicare your costs (copays, coinsurance, etc) are predictable, and you can get a Medicare supplement to help pay these costs. In the Medicare Advantage program, each plan can charge what they want for copays and coinsurance, making it very difficult to compare actual costs.
Medicare Advantage vs. Medigap
Most New York seniors just getting their Medicare benefits want to know which type of plan is better. We commonly see these three questions:
- Why are Medicare Advantage plans bad?
- What are the disadvantages of Medicare Advantage plans?
- Is it better to have Medicare Advantage or Medigap?
Let's take a minute or two to compare and contrast, shall we?
Why New York Medicare Advantage Plans are Bad
This is a myth. There's nothing wrong with Medicare Advantage plans. In fact, over 20 percent of all Medicare beneficiaries in New York choose Medicare Advantage.
What you really need to know is that these plans are not for everyone. Some people are better served with traditional Medicare and a Medicare supplement. The question is, which option is best for you?
In particular, if you have one or more chronic conditions, Original Medicare could be a better option because you have the ability to choose your doctors. MedicareWire believes that Medicare Advantage is the best option for healthy people and for people who qualify for both Medicare and Medicaid.
Conversely, Original Medicare and a Medicare supplement work best for people with chronic health conditions (based on overall cost), as well as those who can afford a higher monthly premium, even when they are well.
The Disadvantage of Medicare Advantage Plans if You Live in New York
The disadvantage of Medicare Advantage plans is the strength of New York Medigap plans. You see, when you take doctor choice out of the equation, the big difference between Medicare Advantage and Medigap is when you pay for services.
With Medicare Advantage you pay a little each month (with some plans you pay nothing). This is the monthly premium. But you also pay a copay when you use most medical services, and they add up fast. However, with traditional Medicare and a Medigap plan for supplemental coverage, you pay for most of your costs in advance with a higher premium. This makes your health care costs predictable, and for most people on a fixed budget, that's very comforting.
When Should I Consider Medigap Instead of Medicare Advantage?
- If you can afford Medigap Plan F or G, then keep your Original Medicare and add one of these supplements.
- If you are a healthy senior and have good health in your family heritage, Medigap Plan N will let you save money by sharing some costs when you see your doctor.
- If you are a healthy senior but you cannot afford a Medigap Plan F, G, or N, Medicare Advantage is a good choice.
- If you are turning age 65, have one or more chronic health conditions that require frequent doctor visits, and you do not qualify for both Medicare and Medicaid (dual eligible), the most Medigap coverage you can afford is the best option.
- If you qualify for both Medicare and Medicaid, regardless of your health condition, Medicare Advantage is your best option.
- If you have special needs (i.e., a full-time nursing home resident, diabetes, etc.) and an appropriate Medicare Advantage Special Needs Plan (SNP) is available, this is your best option.
Frequently Asked Questions About New York Medicare Advantage Plans
Medicare Advantage plans vary from County to County in New York. This is due to the local nature of healthcare provider networks. If you enter your zipcode into this tool it will show you all of your plan options and 5-star ratings.
Most Medicare Advantage plans available in New York include a Part D plan, but not all. Before joining a plan, be sure to check that all of your most important medications are covered. You can do that with this tool.
To understand the pros and cons of Medicare Advantage, you need to compare it with Original Medicare and factor in your health and financial situation. This article can help you compare which type of plan is best.