New York Medicare Supplement Plans (Medigap)
New York Medicare Supplement plans were created to work alongside with Medicare to provide additional benefits to the Traditional Medicare coverage. These benefits were created to provide coverage for what’s not covered by your Original Medicare.
This includes out of pocket expenses such as deductibles, copayments and coinsurance. Medigap insurance is the same as a Medicare Supplement plan. These plans are sold by private insurance companies. New York Medicare options are broken down into parts and plans.
New York Medicare Benefits Broken Down
Original Medicare, Part A and Part B: Federal Medicare coverage. Medicare Part A(hospital insurance) and Part B (medical insurance) is what’s known as “Original Medicare.”
Medicare Advantage, Part C: Refers to plans offered by private health insurance companies approved by Medicare. These plans are required to cover the same as Part A and Part B of Original Medicare. They may also include additional benefits such as dental, vision and prescription drug coverage.
Medicare Part D or Prescription Drug Plans: Are also Medicare-approved plans. Their sole purpose is to provide prescription drug coverage and work in conjunction with Medicare Part A and/or Part B insurance.
Medicare Supplement Plans: Are slightly different in that they cover the remainder of what Original Medicare does not. Generally, this type of insurance helps cover premiums, deductibles, and copayments. It covers the 20% “gap” that Medicare leaves up the the beneficiary to pay. It also has additional benefits such as foreign travel emergency care.
What Benefits does Medicare Cover in New York
Going back to Original Medicare, Plan A is hospital coverage. Meaning this plan covers:
- hospital stays
- any imaging or diagnostic testing performed
- medications and medical supplies used all while being an inpatient
- skilled nursing facilities
- some home health care
- Hospice care
Part B is medical insurance that covers:
- doctor visits
- clinic services
- lab work
- preventive care services
- physical and occupational therapy
- care you receive as an outpatient in the ER or an ambulatory service center
- any imaging or diagnostic testing required
- home health care
- durable medical equipment
All of these services are covered at 80%, which leaves the remaining 20% up to the beneficiary to pay. Additionally, any out of pocket cost will be required by the patient. Therefore, it’s important to have a Supplement Plan, to cover these, “gaps”.
Requirements for New York Medicare Supplement Plans
A Medicare beneficiary already enrolled in Medicare Part B may enroll in a Supplement plan in New York at any time after age 65. Normally, the best time to do so is during your six-month Medigap Open Enrollment Period (OEP). This time period begins on the first day of the month that you are both age 65 or older and enrolled in Medicare Part B. During this timeframe you are eligible to enroll in any plan of your choosing, without an increase in monthly premium or exclusion of coverage.
However, New York has year round Open Enrollment. Well discuss this further below. Also, it’s important to sign up for Part B as soon as eligible to avoid the Part B late penalty.
Medicare Eligibility in New York for the Disabled, Under 65
Those who get disability benefits from Social Security or certain disability benefitsfrom the Railroad Retirement Benefits for 24 months, automatically qualify for Medicare Part A and Part B.
Many, but not all carriers, offer Medicare Supplement plans for the disabled under 65 in some states. The Federal Law in the U.S. actually does not require insurance carriers to offer this type of plan, however, some state laws do. New York is one of those states to REQUIRE insurance providers to offer a Medigap Plan to those disabled under 65 and/or in end-stage renal disease.
How to Apply for Medicare Supplement/Medigap in New York in 2018
In New York it’s Open Enrollment year round, meaning, the beneficiary can enroll at anytime all year long with guaranteed issuance. Seniors cannot be denied or charged any more for health status, claims experience, medical condition(s) or whether the applicant is currently undergoing healthcare treatment. The only exception, or Guaranteed Issue (GI) is pre- existing limitation which may apply for up to six months.
Medigap Premiums in New York
Each individual insurance company offering a supplement plan will determine its own monthly premium. Many factors go into this determination including age, sex and location. What you are quoted in Rochester, NY may very well differ compared to if you lived in Buffalo, NY. You’ll want to compare all Medicare Supplement plans that are available to you and make a decision based on your finances and individual healthcare needs.
The Best Medicare Supplement Plans in New York
There are ten letter plans for Medicare Supplement plans, A-N. Regardless of which carrier you choose to sign up with go with, the plan benefits will be the same. The only difference between the plans is the cost the carrier chooses to charge for their Supplement Plan.
One important fact to keep in mind is that New York is one of the few states that prohibit doctors from charging excess charges. We’ll go into this more below. Out of all the Supplement plans the top, most popular plans are F, G and N.
Plan F in New York
This is the most popular plan as it leaves beneficiaries with the least amount of out-of-pocket expenses. Supplement Plan F covers 100% of your Medicare Part A and Medicare Part B deductibles.
Additionally, it pays most of the remaining hospital and physician’s costs not covered by Medicare.
These costs include:
- any coinsurance or copayments that fall under Part B
- the first 3 pints of blood needed for a medical procedure
- coverage for any foreign travel emergency up to plan limits
Plan G in New York
The only difference between Plan F and Plan G is that Plan G does NOT cover your Medicare Part B deductible. Which as of 2018 is $183. Remember, Medicare Part B only pays 80% of the total approved charges. Thus, leaving the beneficiary responsible for the remaining 20% as well as additional out of pocket costs. Your supplement plan will cover that 20% and most, if not all, your OOP expenses.
Plan N in New York
The difference between Plan N vs Plan G is that Plan N pays 100% of the Part B coinsurance, minus a copayment of $20 for some office visits and a copayment of $50 for emergency room visits that don’t end with an inpatient admission. This plan is considered one of the “cost-sharing” plans due to the above required copays.
No Part B Excess Charges in New York
New York is one of the few states that does not allow excess charges, which is important to keep in mind when choosing your Supplemental Plan. For New Yorkers, you may want to go with Supplement Plan F or Plan N, rather than Plan G which primarily covers those exact charges. You can also go with a High Deductible Plan F Supplemental Insurance which is outlined here:
Regardless of which carrier you decide go with for your supplemental insurance, the letter plan benefits will all be the same. The only difference is the cost chosen by the carrier. This is another example regarding the cost being dependent on where you live in New York. The same letter plan in Saratoga Springs can cost more or less when compared to the same letter plan in New York City.
New York Medicare Advantage Plans
Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private insurance companies. They’ve been approved by Medicare and are usually an HMO or PPO plan. Whichever insurance carrier you chose will then take over as your primary coverage. You’ll be required to forfeit your Original Medicare Plans A and B. This means, you’ll still get your hospital and medical coverage. However, it will be in the form of your Medicare Advantage Plan.
The downside of having a Medicare Advantage plan are the limitations which include:
- Having to choose a hospital or healthcare provider within your network which can be challenging as it’s always changing.
- Your Max-Out-Of-Pocket cost is typically higher than that of a Medicare Supplement Plan.
- If you are hospitalized having a Medicare Advantage Plan, there are many daily out of pocket expenses during the first week(s) of hospitalization. As well as many other expenses you were unaware of, which can be difficult to afford once discharged.
- While the premiums may be lower, the out of pocket expenses will end up offsetting the original savings. In turn, it’ll end up costing you more.
It’s important to consider all the factors when choosing a plan to fit your needs. Furthermore, it’s important to do research on both Medicare Advantage Plans and Medicare Supplement Plans before deciding. With supplemental Medicare insurance, you may spend less money and for better coverage in the long run.
New York Prescription Drug Plans for Medicare
Prescription Drug Plans, or Medicare Part D, is just that. It covers your medications. Original Medicare Part A and Part B does not cover any prescription benefits. Therefore, it’s important to consider a Prescription Drug Plan as medications can become quite costly and sometimes just downright unaffordable.
There’s a late enrollment penalty for going without a Part D Plan. Your late penalty fee will be applied to your monthly premium after going 63 consecutive days or more without prescription drug coverage after your Initial Enrollment Period has passed.
New York Medicare Supplement plans can help Medicare beneficiaries pay for out-of-pocket expenses associated with Original Medicare. This includes deductibles, copayments and coinsurance.
Remember there are 10 types of standardized Supplement Plans in New York. Keep in mind, there’s differences in costs based on where you reside and also which carrier you chose. Be smart and compare all Medicare Supplement plans available in your area. This will help you choose a plan to fit your individual budget and healthcare needs.
At MedicareFAQ, we would be more than happy to help guide you to find the best Supplemental Plan suitable for all your individual needs. Click or call today, our agents are here to help and our services are 100% free. You can also compare rates here.
Extra Help for Those in New York with Medicare
If you’re on a fixed income, disabled or are a part of a low income working family, you may be eligible for financial assistance. There are a few options for those who qualify, including a Medicare Savings Program. Furthermore, every state offers Extra Help and there are 4 type of programs, each customized for your individual circumstances.
Additionally, there is a National program called State Health Insurance Assistance program or SHIP. They provide local help for people with Medicare, Medicare Advantage, Medicare Supplement Plans and Prescription Drug Coverage Plans. Each state has their own individual programs. They’re provided for free and designed to help those in need of financial help.
New York State FAQs:
- Where do I get information on Medicare in New York State? Contact us if you’re looking for a Medicare Supplement Plan or general information on all your Medicare options.
- Does Medicare cover hospice in New York? It does. However, you must meet Medicare’s requirements, including a doctor’s certification of terminal illness. Also, you’ll be required for the limited copayment/ coinsurance for outpatient drugs and inpatient respite care. A Medigap plan will pay for these out of pocket costs associated with Hospice that Medicare will not cover.
- What does New York Part B cover? It covers medically necessary procedures, preventative and palliative care. This includes doctor’s visits, imaging, diagnostic testing, lab work, outpatient surgery and procedures as well as durable medical equipment, or DME. Again, a Medicare Supplement Plan will help with the remaining out-of-pocket costs not covered by Original Medicare.
- How to Apply for Medicare in Syracuse, NY? If you’re trying to enroll in Original Medicare, please visit Medicare.gov. If you’re looking for information on Medigap or other supplement Medicare options, please contact us at the number above!