New York State Medicare

New York Medicare options are in a league of their own. Just like taxes and other regulatory burdens that come with having one of the largest cities in the world driving your politics, Medicare has a whole truckload of additional parameters and concepts to understand in the entire state of New York. For the purposes of this page, we will try to break down the most important concepts for New York state residents to know. 

Over 3,800,000 Medicare beneficiaries are in New York. New York has a very high Medicare Advantage penetration rate at almost 45%. In most states there are a ton of Medigap insurers, but in New York at the time of writing this there are only 13. This is likely due to the state having extremely strict regulations with Medicare Supplements. Stand-alone Part D prescription drug plans range from $7.20 to $101 a month. 

Medicare Advantage Plans In New York State

Medicare Advantage plans are private health insurance options that take the place of your traditional Medicare. These plans are required to cover all of the same services as Parts A and B, but they can have different cost sharing parameters. Also, Medicare Advantage plans often have things like Part B givebacks, $0 Premiums, and extra benefits like Dental, Vision and Hearing at no cost. Though these benefits can be enticing, Network Adequacy and Prior Authorization should be top factors when considering the appropriate Medicare setup. Medicare Advantage will most certainly have a more limited network and procedure approval rate than Traditional Medicare plus a Medigap plan. If Medigap plans are not affordable for you, you should definitely consider the Medicare Advantage plan due to its Maximum out of Pocket.

Just like any other state when considering Medicare Advantage versus Traditional Medicare with a Medigap Plan and Stand-Alone Part D drug plan it’s a comparison between premium costs, out of pocket potential, and Medicare Advantage networks. In a state like New York, you can have a vast different from one county to the next regarding the network adequacy of a specific Medicare Advantage plan. However, statistically, New York would be among the higher acceptance rate states for Medicare Advantage.

Medigap Plans In New York State

Medigap plans pair with Traditional Medicare to pay for some of or all of the out-of-pocket expenses associated with Parts A and B of Medicare. Medicare Supplement Plans are standardized in most states and have premiums that correspond with their Plan Letter identifier. Medigap Plan G is the nation’s most popular Medicare Supplement or secondary plan now that Plan F is not available to people aging into Medicare after January 1st, 2020. Medigap Plan G has a $233 Calendar Year deductible called the Part B deductible. This deductible can change each year based on what Congress decides it needs to be. The Part B deductible increased $35 in the last few years. 

As far as Medigap plans go, New York is a full-time guaranteed issue state. This means New York Medicare beneficiaries can enroll in a Medigap plan of their choosing 365 days a year without having to pass medical underwriting. Their health nor their age have anything to do with the rate they pay. While this seems like a good idea, it is important to note that because of this New York has some of the highest Medigap rates in the entire country. This is likely another reason their Medicare Advantage plan enrollment rate is so high.

Medicare and Medicaid

Medicaid eligibility can be a primary factor for consideration of plan enrollment or lack thereof. In New York if you are eligible for Medicaid it is possible that the Medicare and Medicare combination is all that is necessary for your coverage selection. However, there are dual eligible plans designed for people in this situation that can add additional benefits at no cost to the beneficiary. The network adequacy we mentioned above is likely a consideration here, so geography will play a major factor in whether or not the additional benefits are worth the freedom to choose any doctor or hospital that accepts Medicare.

Summary Of Medicare In New York

There are a multitude of factors to consider when picking a Medicare option in New York, and one article could never sum it all up. If you download our 7 Costly Mistakes Guide or Request Information on our site an agent can call and research your specific scenario. You can also call us anytime at 662-844-3300. 

If reading all of this jargon is not your thing, please consider watching the video related to Medicare in New York. 

Medicare Supplements

User Guide

This guide can be helpful if you’re considering buying a Medigap policy or already have one. It’ll help you know how Medicare Supplement plans work.

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