Wondering which plan or company is right for you if you want to sign up for Medicare in New York? Follow Benzinga’s guide so you’ll have the best Medicare options in New York at your fingertips.
The Best Medicare in NY:
- Best Overall in NY: Humana
- Most Affordable in NY: WellCare
- Best For No Deductibles: Fidelis
- Best for Low Drug Costs: Aetna
- Best Customer Service: CDPHP
What is Medicare?
Medicare is a federal health insurance program offered to qualified individuals. You may be eligible for Medicare insurance if you:
- Are 65 or older
- Have a disability
- Suffer from end-stage renal disease
There are 4 parts of Medicare insurance. Each one serves its own unique purpose. You may want to enroll in one or more plans, depending on your insurance needs.
Part A: This part is your hospital insurance, which covers inpatient hospital stays, hospice care, care in a nursing facility and some home health care.
Part B: Part B covers outpatient care, medical supplies, preventive services and other types of service offered at doctors’ offices.
Part C: Part C refers to Medicare Advantage plans. These plans are an alternative to Original Medicare and are offered by private Medicare-approved companies. Medicare Advantage plans bundle the other parts of Medicare into a singular plan.
Part D: Medicare Part D plans are your prescription drug coverage. You can add it as a supplement to your Medicare plan(s).
Legalities of Medicare in New York
It’s important to understand the difference between Medicare and Medicare Advantage. Medicare is a government-controlled health insurance plan, also referred to as Original Medicare. Medicare Advantage plans are offered by private insurance companies. These companies must be Medicare-approved, are not offered by the federal government and may not be held to the same standards.
You can see any doctor you’d like if you have Medicare as long as the doctor accepts Medicare insurance plans. Medicare Advantage providers can restrict the doctors and specialists that are covered by your plan. You may be required to get a referral from a primary care doctor before your Medicare Advantage plan will cover a visit with a specialist.
Medicare Advantage plans can also restrict your prescription drug coverage. Your plan may require you to use generic drug treatments instead of the brand-name options. In some cases, your plan may cover brand-name drug treatments if the generic treatments did not work for you.
You are also prohibited from carrying a Medicare Supplemental Insurance plan with Medicare Advantage. These plans are also referred to as Medigap policies. These supplemental plans are also offered by private insurance companies to fill gaps in your Medicare coverage.
You should also be aware that Medicare Advantage providers reserve the right to change your insurance premiums at their will.
Types of Medicare Advantage Plans
Medicare Advantage providers in New York offer several different types of insurance plans. Here’s a quick overview of the 2 most common options.
HMO
Medicare Advantage health maintenance organization (HMO) plans include both Part A and Part B insurance. This covers both of your hospital and medical insurance needs. These plans also often include Medicare Part D plans, which covers prescription drug coverage. Your HMO plan may also include vision, hearing and dental coverage.
There are requirements involved with Medicare Advantage HMO plans. These plans only cover visits with doctors and hospitals if they are within your plan’s network. The only exception to this rule is if there is an emergency and you must visit a doctor or hospital outside of your network. Your Medicare Advantage HMO plan may also require a referral from an in-network primary care doctor if you wish to receive coverage for a specialist visit.
PPO
Medicare Advantage preferred provider organization (PPO) plans cover both Medicare Part A and Part B insurance. It will also likely include your Part D prescription drug coverage. Your PPO plan may also offer coverage for vision, hearing and dental.
The way PPO plan networks work is a little different than HMO plans. You can visit any doctor or hospital you’d like with a PPO plan. However, the amount you pay for your visit will depend on whether you visited an in-network doctor or hospital. If they are not in-network, you will likely pay more for your visit.
These plans usually do not require a referral to get coverage for a specialist visit.
Become familiar with a few insurance-related terms so you can select the best coverage option for you.
Deductible: Most plans list a deductible. This is a major factor you should consider as you choose your plan. Your deductible is a monetary amount that you must pay out-of-pocket for your medical services. After you have met your deductible, your health insurance company will begin to pitch in for your care.
Coinsurance: Your coinsurance amount is the percentage of your bill that you will be responsible for. You will pay this amount directly to your service provider after you have met your deductible if your plan requires coinsurance. Your insurance company will pay the remaining percentage directly to the doctor’s office or hospital.
Copay: Some insurance companies use copays instead of coinsurance. A copay is a set monetary amount that you will be responsible for paying. Like coinsurance, you will make copayments after you have met your deductible. Your insurance company will cover the remainder of the cost of your services.
How to Sign Up for Medicare in NY
If you are interested in signing up for Original Medicare (Part A and Part B), there are 3 ways to do so:
- Enroll online.
- Call Social Security anytime Monday through Friday from 7 a.m. to 7 p.m. at 1-800-772-1213.
- Visit a Social Security office near you.
If you’d like to explore your options for a Medicare Advantage plan, you can:
- Compare the Medicare health plans available in your area. Be sure to look for plans in the ZIP code where you reside, as plans can vary by county.
- Once you have found a plan that you are interested in, you can visit the company’s website to see if you can enroll in the plan online. If you cannot enroll online, contact the company to ask for a paper enrollment form.
- You can also call 1-800-MEDICARE (1-800-633-4227) to enroll in a Medicare Advantage plan.
Average Cost of Medicare Advantage Plans in NY
The cost of Medicare Advantage plans can vary widely. You’ll want to pay close attention to each plan’s network, deductibles and coinsurance or copays. Here are some examples of Medicare Advantage plans in New York.
| Plan Name | Company | Plan Type | Health and Drug Costs |
|---|---|---|---|
| WellCare Value | WellCare | HMO | $0 |
| MVP WellSelect with Part D | MVP Health Care | PPO | $20.16 |
| Fidelis Medicare $0 Premium | Fidelis Legacy Plan | HMO | $21.72 |
| HumanaChoice H57970-015 | Humana | PPO | $24 |
| BlueShield Freedom Value | BlueCross BlueShield of WNY and BlueShield of NENY | HMO | $61.80 |
Best Medicare Insurance Providers in New York
Consider what each provider can offer you before you decide which Medicare option is right for you. Take a look at customer service, networks and deductibles. Here’s an overview of some of the Medicare Advantage providers in New York.
- Medicare Advantage Plans
1. Best Overall in NY: Humana
Humana has offered Medicare Advantage plans since the program began to build up its network and establish relationships with many valued doctors and hospitals across the country.
You should have access to almost any service provider with a Humana plan. Humana can even offer you in-network doctors and hospitals both in your area and around the country. This can be incredibly helpful if you travel frequently and you want to be sure your coverage extends to your travel destinations.
- Medicare Prescription Drug Plans
2. Most Affordable in NY: WellCare
WellCare is known for its highly-rated price accuracy, appeals process and accessibility. It offers the most affordable Medicare Advantage plans in New York — $0 premiums and $0 drug deductibles.
This provider also offers vision, hearing and dental coverage as well as fitness benefits to its members. You can expect copays as little as $10 for primary doctor visits with this provider.
- Best for Those Who Qualify for Both Medicare and Medicaid
3. Best for No Deductibles: Fidelis
Fidelis offers several Medicare Advantage plan options. It offers 2 different segments of plans that are available to specific New York counties, so it is important to ensure that the plan you are looking at is available in your county.
Each plan comes with its own benefits. For example, some plans come with a $400 flex benefit to help you pay for health-related items. Other plans may have no premiums. Many Fidelis plans feature $0 deductibles, which is helpful if you want to start taking advantage of your coverage immediately.
Remember, even if you have a $0 deductible, you will likely need to pay a small copay or coinsurance payment for any medical service you receive.
- Member support
4. Best for Low Drug Costs: Aetna
Aetna is one of the largest health insurance providers in the world. It offers both HMO and PPO plans with $0 or low-cost premiums. Its plans also come with annual wellness visits, hearing and vision check-ups and prescription drug coverage. If you want to receive discounts on fitness center memberships, it can offer you a plan with that option as well.
Aetna also has access to a large network of pharmacies so it’s more convenient for you to pick up your prescriptions. Most preferred generic drugs cost as little as $1 with an Aetna plan.
5. Best for Customer Service: CDPHP
CDPHP offers a smaller, more personal insurance company. It offers $0 physicals and preventive screenings and low-cost prescription coverage on its Medicare Advantage plans. It also offers low, predictable copays for services including dental and vision. Its plans can also cover you worldwide.
CDPHP also offers unlimited free access to over 14,000 gyms across the country. Its online tools make it easy to search for doctors to ensure they’re within the CDPHP network. Best of all, CDPHP offers excellent customer service.
Most CDPHP members rave about how easy it is to access a customer service representative at CDPHP and how helpful the representatives are.
Which Medicare Plan is Right for You?
There are several options when it comes to Medicare in New York. Original Medicare certainly has its advantages, but may end up becoming more expensive in the long run. Medicare Advantage plans are not regulated by the federal government but allow you to bundle your coverage and add additional benefits to your health insurance plans.
Ultimately, only you can decide which health insurance plan is the right option for you. Be sure to carefully study and compare the plans available to you to find out which one can give you the best coverage for your health needs.
Frequently Asked Questions
1) Q: What are the different parts of Medicare?
Medicare has 4 parts named Parts A, B, C, and D. Part A provides hospitalization coverage while Part B provides outpatient coverage, like doctor visits. Parts A and B make up Medicare’s core coverages. Part C is provides private-market Medicare plans, called Medicare Advantage Plans. Part C coverage often includes additional benefits. Medicare Part D provides coverage for prescription drugs. Get a Medicare Insurance Quote through the top providers here.
2) Q: Is Medicare free?
Because there are 4 parts to Medicare, there can be different cost structures. Most people won’t have to pay for Medicare Part A (hospitalization). Eligibility for premium-free Part A is based on your work history during which you paid Medicare taxes. Many people do pay a monthly premium for Medicare Part B, however, which covers outpatient medical services, like doctor visits. Deductibles also apply to services covered under Medicare Parts A and B, so you’ll pay a part of the annual cost.
Medicare Parts C and D are optional coverages and have premium costs of their own. Medicare Part C refers to Medicare Advantage Plans that offer additional coverage in exchange for a monthly premium. Part D, the prescription plan, reduces the cost of medications but also requires a monthly premium. Subsidies may be available for low income households to help reduce overall Medicare costs.
3) Q: Do I need to sign up for Medicare?
If you signed up for Social Security before age 65, you were enrolled in Medicare automatically but benefits will begin at age 65. In most cases, there are penalties for not enrolling at age 65, so it pays to sign up on time. Click here to get a medicare quote in minutes from the best providers.
If you have employer coverage, you may be able to delay Medicare coverage while your work plan is still in force. However, the size of the employer determines whether you’ll pay a penalty for not enrolling at age 65. Employees (and their spouses) of companies that offer group health insurance to 20 or more people are usually exempt from late sign-up penalties if they are covered by the employer’s plan.
About Ashley Hart
Ashley Hart is a personal finance writer passionate about helping people feel empowered to take control of their finances. She has more than eight years of writing experience, focused on insurance.