Medicare Advantage Plans in New York City

Welcome!

Today, I will share some insights about Medicare Advantage plans in New York City. Whether you’re in the Bronx, Kings (Brooklyn), New York (Manhattan), Queens, or Richmond (Staten Island), this guide will help you navigate your options. If you’re new to Medicare, don’t skip the important terms section below as it will clarify key concepts. 😊

Note: If you live in other areas of New York state, you plan option will change and should be noted when speaking to a licensed agent.

Featured New York Medicare Agent

Brian Krantz

Phone: 516-900-7877
Email: brian@planmedicare.com

Office Locations:

48 South Service Road, Suite 400, Melville, NY 11747
745 5th Ave, Suite 500, New York, NY 10151

Important Medicare Terms You Should Know

Medicare Beneficiary – This refers to you, the individual eligible for Medicare benefits.

Private Insurance Companies – Medicare Advantage plans in New York City are offered by private insurance companies approved by Medicare. These companies manage the health plans, not Medicare itself.

Original Medicare – Medicare Part A and Medicare Part B make up Original Medicare, covering 80% of your healthcare costs, leaving you responsible for the remaining 20%. This can be covered by either a Medicare Supplement plan or a Medicare Advantage plan.

Medicare Advantage Plans – Also known as Medicare Part C, these plans typically don’t charge a monthly premium but include copays and coinsurance up to an annual out-of-pocket limit. You cannot have both a Medicare Advantage plan and a Medicare Supplement plan simultaneously.

Medicare Supplement Plans (Medigap) – These plans charge a fixed monthly premium and are designed to cover the 20% of costs that Original Medicare doesn’t cover. Common Medigap plans include Plan G and Plan N.

Medicare Part D (Prescription Drug Plan) – Part D covers prescription drugs. Many Medicare Advantage plans include prescription drug coverage, but if you have a Medigap plan, you’ll need to purchase a standalone Part D plan.

Star Ratings – Medicare assigns star ratings (1 to 5 stars) to each plan, with 5-star plans offering the best quality and services. Be sure to review the star ratings for Medicare plans in New York City to make the best choice.

Medicare Advantage Plans in New York City

There are numerous Medicare Advantage plans available across the five boroughs of New York City, offered by 19 different insurance companies. These plans vary based on your health needs and eligibility. Here’s a list of some major providers offering Medicare Advantage plans in the city:

• Aetna Medicare
• Centers Plan for Healthy Living
• Cigna
• Elder Plan
• EmblemHealth
• Empire BlueCross BlueShield
• Healthfirst Medicare Plan
• Humana
• WellCare by Fidelis Care
• UnitedHealthcare

Each of these companies offers multiple health plan options. Remember, not every broker or insurance company will offer all the plans, so be sure to compare before choosing.

Eligibility and Plan Types

Some Medicare Advantage plans are designed for people with chronic conditions or those who qualify for both Medicare and Medicaid (often referred to as Special Needs Plans or SNPs). The types of health plans available in New York City include:

• Health Maintenance Organization (HMO) – HMOs make up about 70% of all plans.
• Preferred Provider Organization (PPO) – PPOs make up the remaining 30%.
• Special Needs Plans (SNP) – These plans, which are available as both HMO and PPO, account for 48% of all plans. These plans are available for D-SNP which is income based eligibility and I-SNP which is based on living in a senior living institution. Those qualifying for special needs plans will also have accessibility to special enrollment periods throughout the year.

HMO vs. PPO Plans: What to Know

• HMO Plans – These plans require referrals from your primary care provider to see specialists. You must stay within a specific network of providers.
  • Lower out-of-pocket costs
  • Smaller service areas
• PPO Plans – These plans allow more flexibility in choosing doctors and specialists, as they don’t require referrals. Out-of-network care is often available at a higher cost.
  • No referrals required
  • Larger service area
  • Higher out-of-pocket costs

Out-of-Pocket Maximums for Medicare Advantage Plans in New York City

Each Medicare Advantage plan has an annual out-of-pocket cost limit. Here’s a breakdown of out-of-pocket maximums for plans in New York City:

• $3,400 – $4,999 – 6% of plans
• $5,000 – $7,499 – 32% of plans
• $7,500 or greater – 62% of plans

Typically, plans with lower maximums are HMO plans, while PPO plans may have higher maximums but more flexibility.

How to Choose the Best Medicare Advantage Plan

Medicare doesn’t allow companies to market health plans using the word best, so in this instance, choosing the best Medicare Advantage plan in NYC completely depends on your specific healthcare needs which is accomplished through an analysis with a licensed agent approved to discuss plan benefits. Below are some considerations.

• In-network providers – Make sure your preferred health care providers are within the plan’s network.
• Prescription drug coverage – Ensure the plan covers your necessary medications and you clearly understand any deductibles you may be responsible for.
• Specialist care – If you frequently see specialists, you may prefer a PPO plan that doesn’t require referrals.

For personalized advice, consult a Medicare agent in New York City to compare your coverage options.

How to Apply for Medicare Advantage in New York City

State law requires working with a licensed agent to apply for Medicare Advantage. You have three options:

1. Talk to an independent insurance agent who offers plans from multiple companies.
2. Contact an agent representing a specific insurance company.
3. Contact Medicare.gov directly and speak with an agent employed by the federal government.

Choosing a Medicare Supplement Plan in New York City

If you’re considering a Medicare Supplement plan (Medigap) instead of a Medicare Advantage plan, here are a few steps:

1. Start by comparing Plan G and Plan N, the two most popular Medigap plans.
2. All Medicare Supplement plans provide the same benefits, but pricing can differ between insurance companies.
3. Shop around to avoid overpaying for the same Medigap coverage.

Seven Things You Need to Know About Medigap Plans

1. Medigap is different from Medicare Advantage, but both are types of medical insurance.
2. Medigap works with Original Medicare only.
3. You need both Medicare Part A and Part B to buy Medigap or be determined as Medicare-eligible.
4. The best time to enroll in Medigap is during your Open Enrollment Period.
5. After Open Enrollment, switching plans can be costly.
6. There are 10 standardized Medigap plans.
7. Your Medigap policy will remain active as long as you continue to pay premiums.

Conclusion

If you’re looking for an experienced insurance agent in New York City to help guide you through your Medicare Advantage options, we’re happy to assist. Annual reviews are essential, as health insurance plans and benefits change frequently.

Please fill out the form below to connect with a licensed agent in your area.