Medicare Advantage Plans in New York

Medicare Advantage in New York bundle coverage that includes three parts: Medicare Part A, Medicare Part B, and Medicare Part D. Original Medicare is made up of Part A and Part B. Medicare Advantage is known as Part C and is an all-in-one plan that covers hospital insurance (Medicare Part A), medical insurance (Medicare Part B), and prescription drug coverage (Medicare Part D).

Medicare Advantage Plans in New York surpass Original Medicare in popularity every year. Part C plans and benefits are provided by insurance carriers and are connected to a service area of specific network providers, hospitals, and healthcare facilities.

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Top-rated Medicare Advantage Providers in New York

  • Humana
  • Empire Blue Cross Blue Shield
  • Cigna
  • Aetna
  • BlueCross BlueShield of Western New York
  • Excellus

Popular Medicare Advantage Plan Types in New York

Best network freedom: Medicare Advantage PPO

PPO Plans Benefits:

– Larger network

– No referrals

– PPO premiums ranging from $0 to $100 per month

Best for lowest out-of-pocket: Medicare Advantage HMO Plan

HMO Benefits:

– HMO Premiums are generally $0 cost monthly premium

– Lower out-of-pocket because

– Uses the HMO referral network

Best for low-income or health conditions: Medicare Advantage D-SNP

A special needs plan (SNP) is best for those on a minimal income or for individuals that have chronic health conditions. You can have Medicare AND Medicaid to help with the expenses of your Part B premium, copays, monthly premium, deductibles, or coinsurance.

New York Enrollment Statistics:

1. Number of lives enrolled in Medicare Advantage in New York: 1.6 million

2. Number enrolled by plan, specifically the three plans below:

Local HMO: 927,340

Local PPO: 270,434

Regional PPO: 104,589

3. Percentage of Medicare beneficiaries enrolled in Medicare Advantage in New York: 45%

4. Number of people enrolled in Medicare Advantage nationwide: Expected to reach 29.5 million in 2022

5. Percentage of Medicare beneficiaries enrolled in Medicare advantage Nationwide: 42%

How much does Medicare Advantage in New York cost?

Generally, most states have an HMO plan with a $0 cost-per-month premium and a PPO with a $0 fee-per-month premium. It is becoming more common for PPOs, though, to have premiums.

The availability of plans differs county to county in every state, including New York; however, the average plan in New York with a prescription drug plan is $40 a month. The Part D drug deductible is about $234.

How much do Advantage Plans cost in New York?

PPO Plan $0.00 to $40.00

HMO Plan $0.00

When can I enroll in a Medicare Advantage plan?

Only certain times of the year allow for enrollments in Medicare Advantage plans.

Initial Enrollment Period

Initial enrollment eligibility occurs when you become 65. This period lasts for seven months – three months before you turn 65, the month you turn 65, and three months after your birthday. At this point, you are eligible to join Medicare Part A and Part B health plans.

Open Enrollment Period – AKA Annual Election Period

From October 15th until December 7th, you can join, drop, or make changes to your Medicare Advantage Plan in New York. Coverage for Part C will start the following year on January 1st as long as the plan is signed and completed by December 7th.

Medicare Advantage Open Enrollment Period

From January 1rst until March 31rst, you can switch to another plan, join Original Medicare, or join a Medicare Supplement insurance plan.

Special Enrollment Periods – Special Circumstances

In life, some events will happen that may cause you to need to change your Medicare Advantage plan and Medicare prescription drug coverage plan. Special circumstances that occur that allow you to change your plans are:

  • Address change
  • Your plan changes its Medicare contract
  • Loss of your current coverage
  • The ability to get coverage with your employer, VA, Tricare, or PACE

In addition to the above, other special circumstances could include:

  • Eligibility for both Medicare and Medicaid
  • Extra Help eligibility– Assistance paying for monthly premiums, annual deductibles, and co-payments related to prescription drug coverage
  • State Pharmaceutical Assistance Program enrollment
  • Cancellation of a Medigap plan, also known as a Medicare Supplement insurance plan
  • Various special needs, such as a disability

5-star Special Enrollment Period

The five-star rating enrollment period goes from December 8th through November 30th and can only be used once. Plans are rated with satisfaction surveys.

These surveys help you compare plans based on performance and their quality. This rating is the highest rating received. To read more about this rating, visit here.

Ready to Learn More?

We help educate Medicare beneficiaries on their Medicare Advantage options and help them go through the process of reviewing and comparing plans. We work with most of the nation’s top-rated Medicare Advantage carriers. Call us today, or request a quote online to learn more about plan options.

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