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Medicare Advantage Plans in New York

When you become eligible for Medicare, there are several health insurance options available to you. The standard is Medicare Part A and Part B, which cover hospitalization and medical care. Or, you can opt for a Medicare Advantage plan in New York, which offers more coverage.

What do Medicare Advantage Plans Cover

Also known as Medicare Part C, Medicare Advantage combines the benefits of Medicare Part A and Part B. You get the same benefits, plus some or all of the following:

  • Prescription Coverage
  • Wellness Benefits
  • Dental Benefits
  • Vision Benefits

The only thing that Medicare Advantage plans do not cover is hospice care, but you still receive hospice benefits from your Medicare Part A coverage.

Think about what you need the most when shopping for a plan. For example, do you wear glasses? If so, you may want vision benefits. If you have dental issues, dental benefits may be something to consider. Shop around until you find the plan that offers the benefits you will use the most.

Understanding the Prescription Benefits

Medicare Advantage plans may include prescription benefits; these plans are called Medicare Advantage Prescription Drug plans. Medicare Part A and Part B, do not offer prescription coverage. If you want help with your prescriptions and have Part A and Part B, you will need a separate plan that covers medications.

Before you buy the first Medicare Advantage plan that offers prescription coverage, consult the formulary list or the list of drugs the plan covers. By law, the plan should cover at least two medications in each category or class. If you don’t see your prescription on the list and you don’t want to change prescriptions, you may need a different policy.

If you sign up for Medicare Advantage with prescription coverage right away, you can avoid the penalty Medicare charges for late enrollment. If a beneficiary goes without prescription coverage for 63 consecutive days, they’ll pay a penalty for late enrollment. The penalty is 1 percent of the “national base beneficiary premium” times the number of months you went without coverage. Medicare adds the penalty to your Medicare Part D (prescription coverage) premium and rounds it to the nearest $0.10. Signing up for a Medicare Advantage plan with prescription coverage exempts you from the penalty.

Choosing the Right Medicare Advantage Plan

When you shop around for a Medicare Advantage plan, you’ll be able to choose from the following types of policies:

  • Health Maintenance Organization — With an HMO, you choose one doctor; whom you consult for everything first. If your doctor thinks you need to see a specialist, he or she will give you a referral. You cannot see a specialist without a referral, and if you do, the insurance company may deny your claim.
  • Preferred Provider Organization — The PPO plan gives you a network of doctors and hospitals to use. If you stay within the network, you’ll save the most money because the insurance company has contracted rates with each provider within the network. You won’t pay more than the contracted amount, and you will probably pay less because your insurance may cover some of it if you’ve already met your deductible.
  • Private For-Fee-Service — Medicare pays your PFFS provider a fee each month, and then the insurance company decides the amount it will pay for each medical service. Your provider must agree to the price before they perform the service.
  • Special Needs Plan — The SNPs are strictly for those with “special needs.” This includes anyone with a chronic illness or injury and very low-income beneficiaries. The plan is customized for each individual as needed.

Paying for Medicare Advantage Plans in New York

Medicare Advantage plans in New York often have premiums in addition to the Medicare Part B premium that you must pay.

You may also have a deductible, which means that you must pay for services out of pocket until you reach this amount. Finally, you may have co-insurance or co-pays. This is financial responsibility alongside what the insurance company pays. It may be a flat fee or a percentage of the cost of service.

Medicare Advantage plans in New York give you another option aside from standard Medicare. If you need special coverage or you want prescription coverage, Part C plans could be a right for you.  Shop around until you have found the right provider, keep in mind you can always change plans during Open Enrollment each year as your needs may change from one year to the next.

 

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