Medicare Plan Options

You have numerous options when you want to choose a Medicare plan. Those who only require minimal health care coverage may find that Original Medicare is their best option. New York’s Medicare Advantage program may be a better choice if you have more extensive health care needs. Medicare Advantage Plans can provide you with the coverage you need, along with additional benefits, such as vision, hearing, dental. Some Medicare Advantage Plans also include prescription drug coverage. You might find that you benefit from purchasing a separate supplemental or prescription drug coverage plan.

Original Medicare

Original Medicare is composed of two parts. Part A covers hospitalizations, hospice care, skilled nursing facilities, and home care home, while Part B includes doctor’s visits, durable medical equipment, preventative services, medically necessary services, mental health coverage, and clinical research. Original Medicare has no limits on out-of-pocket fees. If you want prescription drug coverage, you’ll need a separate Medicare Part D plan.

Medicare Advantage Plans

Original Medicare Parts A and B are included in every Medicare Advantage Plan. Medicare Advantage Plans may also cover hearing, vision, dental, and some fitness programs, and many plans also offer prescription drug coverage. New York has four types of Medicare Advantage Plans, including HMO, PPO, PFFS, and SNP plans. You can only select Medicare Advantage Plans that are available in the New York county where you live. If you move, you’ll need to enroll in a new plan.

Medicare Prescription Drug Coverage Plans

While Original Medicare doesn’t provide coverage for prescription drugs, you can add a Part D plan for a separate fee. The cost of the plan depends on several factors, including your pharmacy, the drug’s tier, and whether the company that manufactures the drug offers financial assistance to lower its cost.  Most Medicare Advantage Plans include prescription drug coverage, but not all of them do. You don’t have to automatically enroll in a Part D plan when you first enroll in Original Medicare or obtain coverage through a Medicare Advantage Plan, but if you want to enroll at a later date, you may have to pay a penalty for as long as you have your policy.

Supplement Insurance Plans

If you’re concerned that Original Medicare is leaving gaps in your coverage and you’re paying too many fees, consider a Medicare Supplement Insurance Plan, also known as Medigap. Medigap plans can cover copays for Parts A and B, as well as any excess Part B charges. However, these plans don’t cover the $148.50 Part B premium. If you need to travel outside the country, some Medicare Supplemental Insurance Plans provide medical coverage. Medigap does not work with any Medicare Advantage Plan.

Medicare in New York by the Numbers

People enrolled in Original Medicare  Average plan cost Annual state spending per beneficiary Spending per beneficiary compared to the national average
2,055,281 Plan A: $0 to $471 per month*
 
Plan B: $148.50 per month**
$10,464 4%

 
*Most people pay no premium, but this can vary depending on how long they paid Medicare taxes.
**This is the average number, but it can vary based on income.

Medicare Resources in New York

When you’re about to turn 65, choosing between all of the Medicare options can seem overwhelming, and you might be worried about making the right choice. Fortunately, New York seniors can rely on several statewide organizations and resources that provide free and unbiased counseling and information to help them select the best Medicare option for their needs.

Area Agencies on Aging (AAA)

Area Agencies on Aging provide a variety of services for seniors in communities across New York. Every county in New York has a local office. AAA offices can provide you with access to a variety of benefits and information about health care choices, including Medicare and resources that can help you with issues, such as wills, estate planning, and health care proxies. AAA offices also help with transportation to medical appointments, provide nutritious meals to needy seniors, and work with other organizations in their communities to promote the needs and interests of older New Yorkers.

Contact Information: Website | 518-474-5731

Health Insurance Information, Counseling and Assistance Program (HIICAP)

Located in Offices for the Aging across New York, more than 500 HIICAP counselors are available to answer your questions about your health care options, including Medicare, Medicaid Advantage, Medigap, Supplemental Insurance Plans, and long-term care insurance. This organization provides free, unbiased information for seniors, their families, or their caregivers to help them find the option that best suits their medical situation.

Contact Information: Website | 800-701-0501

Senior Medical Patrol

Members of the New York Senior Medicare Patrol are volunteers who work with seniors across the state to help detect, prevent, and report Medicare fraud and abuse. It provides education and information to seniors and the people who care for them, so they can choose the best Medicare plan for their needs. You can learn how to ensure that you’re treated with respect and dignity and receive all the benefits and coverage that you’re entitled to under Medicare.

Contact Information: Website | 800-333-4374

Elderly Pharmaceutical Insurance Coverage (EPIC)

The New York Department of Health’s EPIC program assists low- to moderate-income seniors with the financial cost of Part D prescription drug plans. The program assists seniors aged 65 and older who qualify for the program with out-of-pocket costs for prescription drug coverage plans under Part D. There is no asset test and there are two different EPIC plans based on income: one for individuals with financial limits between 35,000-$75,000 a year and one for couples with limits of $50,000-$100,000 a year, subject to deductibles.

Contact Information: Website | 800-332-3742

Learn from our sources