What is a New York Medicare Advantage Plan?
The advantages of Medicare Advantage (MA) health plans are found in what they can cover that Original Medicare cannot. Specifically, the MA plans (aka, Part C of Medicare) available in New York can include minor healthcare benefits such as prescription drug coverage, vision, hearing, dental, fitness, telehealth, and more. In contrast, Original Medicare only covers major medical healthcare services. To join a plan you must first be enrolled in both Medicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Medicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services..
Many people love the extra benefits they get with their MA plan, particularly a prescription drug plan. However, before you jump in with both feet, take the time to fully understand the trade-offs. The extra benefits and perks are nice, but they come at a cost. Specifically, when you become a Medicare Advantage plan member in New York you are agreeing to accept the plan's managed care health system. As an MA plan member, you agree to let the insurance plan be a gatekeeper and fully control your access to doctors and other healthcare providers.
Original Medicare vs. New York Medicare Advantage Plans: How Do They Compare?
The best way to understand the differences between Medicare Advantage and Original Medicare coverage is to evaluate the pros and cons of each type of coverage.
Pros and Cons: Medicare vs. New York Medicare Advantage Plans
- 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 When you believe you have an injury or illness that requires immediate medical attention to prevent a disability or death., 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 (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). 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 is a percentage of the total you are required to pay for a medical service. 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 plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... 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.
- There are eligibility requirements with Medicare Advantage plans. For example, you must have both Medicare Part A and Medicare Part B to join, and you cannot have End-Stage Renal Disease (ESRD), also known as kidney failure, is a condition that causes you to need dialysis or a kidney transplant. People with ESRD are eligible for Medicare coverage regardless of age. (ESRD) or one of a handful of other diseases.
New York Medicare Advantage Plans vs. Medigap
Three of the most common questions we get from New York seniors are:
- 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 answer these three questions right now.
Why New York Medicare Advantage Plans are Bad
First things first. Medicare Advantage plans are not bad. More than 20% of all Medicare beneficiaries choose enrollment in a Medicare Advantage plan. But, it's not for everyone. Before you enroll, learn the disadvantages of these plans if you are a senior in New York.
MedicareWire is a Medicare insurance consulting agency. We founded MedicareWire after seeing and hearing how confusing and frustrating it is to find, understand, and choose a plan. Our services are free to the consumer. advises people who have one or more serious chronic conditions to keep their Original Medicare, particularly if you have specialists treating you and you want to stay with them. Our opinion is that Medicare Advantage is an excellent option for those who qualify for both Medicare and Medicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States. (dual eligible), for those with retiree healthcare benefits, and for extremely healthy, active seniors.
Similarly, Original Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage., plus Medicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage., work best for people with chronic health conditions, as well as those who can afford a higher monthly A premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. . Most experts agree that this is the best health insurance seniors can get in New York.
You can learn more about Medicare supplements in New York on our New York Medicare supplements page.
The Disadvantage of Medicare Advantage Plans if You Live in New York
As you have already read, both Medicare Advantage and traditional Medicare have their benefits. But the two types of coverage are apples and oranges. However, if you remove the issue of doctor choice from the equation, the primary difference is when and how you pay. This fact remains the same no matter what type of Medicare Advantage plan you are considering (e.g., HMO, PPO, PFFS, Cost, or HSA).
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 copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service. when you use most medical services, and they add up fast. It does not matter if you have a Health Maintenance Organization (HMO) plan or a Preferred Provider Plan (PPO). The majority of your costs are due when you use health services.
However, with Original Medicare and a Medigap plan for supplemental coverage, you pay for most of your costs in advance with a higher premium. You control your costs by choosing a plan that pays the deductible(s) you want to be covered. 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 Medicare Supplement Plan F is the most comprehensive Medicare supplement plan available. This plan covers all Original Medicare deductibles, coinsurance, and copayments, leaving you with no out-of-pocket costs on all Medicare-approved services. or G, then keep your Original Medicare and add one of these supplements. These plans help you manage your Out-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. the best, giving you complete peace-of-mind.
- If you are a healthy senior and have good health in your family heritage, Medicare Supplemental Plan N is one of the ten standardized Medigap plans. Although it is one of the newest plans available, Medicare Plan N is quickly becoming a favorite with Baby Boomers aging into their... will let you save money by sharing some costs when you see your doctor. The plan benefits are excellent and pay just a little to see your doctor (up to $25 per visit).
- If you are a healthy senior but you cannot afford a Medigap Plan F, G, or N, Medicare Advantage is a good choice. Both Original Medicare and Medicare Advantage cover preventive care at no additional cost to keep you healthy
- 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.
- With both Medigap and Medicare Advantage, you must continue to pay your The Medicare Part B premium is the monthly charge paid by beneficiaries for their outpatient medical care, services, and supplies. A beneficiary's premium may be uplifted by an IRMAA surcharge if their income is above... (it typically comes straight out of your Social Security income, unless you're not yet taking it).
- With Medicare supplement insurance there are no service area restrictions. With Medicare Advantage, you must receive care within the plan's provider network unless you need emergency care.
- Medicare Advantage plans have an enrollment period. You get an individual enrollment period when you're first eligible. After that, there's an The Annual Enrollment Period is when Medicare beneficiaries can join, drop or change Medicare Advantage and Medicare Part D prescription drug plans. AEP begins on 15 October and ends on 7 December. to switch plans or go back to Original Medicare. Medigap plans do not have the same restrictions, but you can be turned down if you leave a Medigap plan and later want to come back. Medicare Advantage plans cannot generally turn you down as a Medicare supplement insurance company can.
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.
Some people love Medicare Advantage while others hate it. The only way to determine if it will work for you is to compare your health and financial situation with the plans available in your area. In this article you will learn how to do just that.
Compare the Best Medicare Advantage Plans in New York by County
Citations & Referencesmedicare.gov
- Medicare.gov: the official U.S. government site for Medicare | Medicare http://www.medicare.gov/
- Medicare.gov: the official U.S. government site for Medicare | Medicare https://www.medicare.gov/
- Find a Medicare plan https://www.medicare.gov/plan-compare/
- Medicare Benefits | SSA https://www.ssa.gov/medicare/
- Social Security's Low-Income Subsidy (LIS) program helps Medicare beneficiaries pay for their Medicare Part D prescription drugs by paying some of the costs. Also known as "Extra Help", beneficiaries who qualify for LIS receive premium... with Medicare Prescription Drug Plan Costs | SSA https://www.ssa.gov/medicare/prescriptionhelp/
- Medicare Benefits | SSA https://www.ssa.gov/benefits/medicare/
- Five-Star Quality Rating System | CMS https://www.cms.gov/medicare/provider-enrollment-and-certification/certificat...
- Medicare Open Enrollment | CMS https://www.cms.gov/Outreach-and-Education/Reach-Out/Find-tools-to-help-you-h...
The Medicare Advantage plan information on this page is maintained by David Bynon and was last updated on .