Medicare Advantage (MA) plans are a health insurance option for people with Medicare. MA plans are an all-in-one alternative to Original Medicare: They bundle Part A hospital insurance and Part B medical insurance, and typically offer Part D (prescription drug benefits).1 MA plans may also include other coverage, such as dental and vision care.2
A Medicare Advantage plan, also known as Medicare Part C, helps to cover out-of-pocket costs. Medicare-approved private insurance companies offer these plans, and there are many MA plans available in New York.
After you enroll in a plan, you’ll present your plan card instead of your Medicare card when you receive care.
What You Need to Know
Medicare Advantage plans help cover out-of-pocket healthcare costs.
These plans may offer benefits not offered by Medicare, such as vision and dental care and fitness club memberships.
Plan costs in New York depend on where you live and the type of plan you choose. Some have zero premiums.
What Types of Medicare Advantage Plans Are Available?
There are numerous types of MA plans, including:
- HMO (health maintenance organization): Most MA plans are HMOs. This plan type typically requires you to see healthcare providers who belong to a network. You may also need a referral to see a specialist.
- PPO (preferred provider organization): This plan has a network too, but you can also see providers outside the network. You may pay more if you do, though. You typically don’t need a referral to see a specialist.
- SNP (special needs plan): These plans serve people with specific needs. There are three types of SNPs.
- C-SNP (chronic condition special needs plan): These plans serve those with an ongoing health condition like diabetes, end-stage renal disease, cancer or dementia.
- D-SNP (dual eligible special needs plan): These are for people who have both Medicare and Medicaid.
- I-SNP (institutional special needs plan): These plans are for those who live in a nursing home or who need nursing care in their home.
- PFFS (private fee-for-service): With this plan, you can go to any Medicare-approved provider. Some of these plans also have networks, and you can save by going to a network provider.
- MSA (Medicare medical savings account): This plan combines a high-deductible insurance plan with a savings account you can use to pay for medical costs.3
Lots of Choices
The majority of New York counties offer anywhere from 31 to 60 different Medicare Advantage plans.
What Are Prescription Drug Options with Medicare Advantage?
Most MA plans include prescription drug coverage. If a plan doesn’t include it, you can purchase a separate prescription drug plan (also known as a Medicare Part D plan) or opt not to have prescription coverage.4 However, if you opt out of Part D coverage, you may have to pay a late enrollment penalty if you decide you want it later. It may be best to opt for a Part D plan as soon as you’re eligible for Medicare, even if you don’t have many prescriptions.5
How Do You Choose a Medicare Advantage Plan?
The majority of New York counties offer anywhere from 31 to 60 different MA plans.6 To choose the right one for you, consider the plan costs and benefits. First, look at the premium, which is the amount you pay for a plan each month. You’ll find zero-premium plans, which means you don’t pay any additional costs for the plan beyond what you already pay for Medicare Part B. Other plans may charge a monthly premium that varies based on the type of plan, its benefits and other costs.
Other costs to consider include:
- Coinsurance: This is a percentage you pay for covered services. You might pay 20% for a hospital stay, for example.
- Copayment: A copay is a fixed amount you pay for a covered service. You might pay $20 when you see your primary care doctor.
- Deductible: This is the amount you pay for covered services before your plan starts paying. With a $1,000 deductible, you’d pay for the first $1,000 in services. After that, your plan would start coverage, but you may still have to pay coinsurance and copays.
- Maximum out-of-pocket: This is the maximum amount you will pay for covered services. After you’ve paid out that amount, your plan pays the full cost for covered services.7
While all plans help to cover healthcare costs, some plans cover additional benefits. These may include vision, dental and hearing care. Some plans offer telehealth, so you can talk to a doctor without leaving your home. Plans may also offer a fitness club membership and other wellness programs.8
When and How to Enroll in Medicare Advantage?
You can only enroll in or change MA plans at certain times. These are called enrollment periods. During these periods, you can enroll by visiting the New York Health Insurance Marketplace website or the Medicare Plan Finder or by contacting insurance companies directly.9
You can enroll at the following times:
- Initial Enrollment Period: This seven-month period starts three months before the month you turn 65 and ends three months after your birthday month.
- Open Enrollment Period: Also known as the Annual Election Period, this is an annual time in the fall when you can join, switch or leave a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period: From January 1 to March 31 each year, you can switch Advantage plans or leave an Advantage plan.
- General Enrollment Period: If you didn’t start Part B of Medicare during your initial enrollment, you can enroll from January 1 to March 31 each year.10 You can also enroll in a Medicare Advantage plan.
- Special Enrollment Period: You may be entitled to a special enrollment period if you move, have a change in coverage or have a condition that would be better served by a Special Needs Plan.11
How Much Do Medicare Advantage Plans Cost in New York?
MA plan costs vary depending on where you live and the type of plan you choose. New York City residents living in Chelsea, for example, have 52 plans to choose from, not including special needs plans. About half of these plans have zero premiums, and the most expensive plan is $302 per month. Buffalo residents have 48 plans to choose from, not including special needs plans. Eighteen of these plans have zero premiums, and the most expensive plan is $215 per month.
Did You Know?
Nationally, 60% of people with Medicare Advantage plans have a zero-premium plan. Eighteen percent pay at least $50 per month and 6% pay $100 or more.
What If You Want to Change Your Medicare Advantage Plan?
You can change your Medicare Advantage plan during open enrollment, which takes place from October 15 to December 7 each year. You can also change plans during Medicare Advantage open enrollment, which is from January 1 to March 31 each year.
What Are Medicare Resources in New York?
If you need assistance with navigating Medicare and Medicare Advantage plans, use these resources:
- Health Insurance Information, Counseling, and Assistance: HIICAP offers New York residents free, objective information on Medicare and Medicare plans.13
- New York State Department of Financial Services: This department regulates insurance. You can file a complaint here if you’re having an issue with your plan.14
- Medicaid and Medicare Savings Programs: These programs help with your Medicare plans costs. You can find out whether you qualify by contacting your local department of social services.15
If you’re enrolled in Medicare Part A and Part B, your next step is to learn what Medicare Advantage plans are available in your area. Visit the New York Marketplace website or the Medicare Plan Finder and review each plan’s costs and benefits. Choose a plan that offers benefits that are important to you and that fits your budget.