How Do Medicare Advantage Plans Work In New York?

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How Do Medicare Advantage Plans Work in New York?

Not all that long ago, there was only one way to go when it came to Medicare coverage. First one would acquire Medicare coverage. They would then supplement the coverage by purchasing a Medicare Supplement plan. This is because a stand-alone Medicare plan contains "gaps" in coverage that could lead to significant out-of-pocket costs for certain medical occurrences. There are a variety of supplement plan options that provide different levels of supplement protection. The various plan types are designated by letters of the alphabet (A-N). Generally, the more comprehensive the coverage, the higher the cost of the supplement plan.

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courtesy of Parents.com

In New York, Medicare Advantage Plans are an "all in one" alternative to the Original Medicare / Supplement plan arrangement. These plans are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. These "all in one" plans include Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and usually Medicare prescription drug (Part D).

Medicare Advantage Plans cover all services covered by original Medicare. In addition, Advantage plans are required to offer at least the same level of coverage as the Original Medicare Part A and Part B coverage. In almost every case, Advantage plans feature several attractive additional benefits that are not covered by original Medicare. Dependent upon which New York advantage plan you choose, these benefits may include coverage for vision care, hearing aids, dental care, prescription drug coverage, transportation to and from medical facilities, and even fitness center membership. The end result is a very comprehensive medical insurance plan.

If you enroll in a Medicare Advantage plan, you continue to pay your Medicare Part B premium. The private insurer determines what the Medicare Advantage plan premium will be. This premium amount will vary from one plan style to another.

Medicare Advantage plans tend to be significantly less expensive than Medicare Supplement coverage. Some Medicare Advantage plans may have premiums as low as $0.

Copay costs may also be less with a Medicare Advantage plan. For, example, if you visit a primary care physician under a Medicare Advantage plan, you may pay a copayment of $10. However, if you visit a primary care physician under Original Medicare, you may have a coinsurance of 20%, which could be significantly more than $10.

A Medicare Advantage plan will limit your maximum out-of-pocket expense. Once you have spent that maximum, you pay nothing for covered medical services for the remainder of the year.

Good to know: If your family is healthy and doesn't visit the doctor often, a high-deductible health plan could save you hundreds of dollars in lower monthly premiums. In addition, most high deductible health insurance plans are HSA eligible. An HSA eligible plan qualifies you to open a health savings account (HSA). A health savings account is designed to work in concert with a your high deductible health insurance plan. You can save money in your HSA account before taxes and use the funds to pay for eligible health care expenses. Additionally, unused HSA funds continue to grow tax-deferred, year after year.

Medicare Advantage Rules and Guidelines

Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans. In turn, these companies must follow rules set by Medicare.

Each Medicare Advantage Plan can charge different Out-of-pocket costs. They can also have different rules for how you get services – for example:

Whether you need a referral to see a specialist.
What shared medical costs you are responsible for.

Which Medicare Avantage Plan Carriers Are Available in New York?

Following is a list of some of the insurance companies that offer Medicare Advantage plans in New York:

Bright Advantage - New York. (Several plan variations)
Health Pointe Direct Complete Plan H1722-001 - New York. (HMO,SNP)
Integra Harmony Plan H1205-001 - New York. (Several plan variations)
Kalos Health Gold Plus H3227-001 - New York. (HMO,SNP)
Longevity Health Plan H8457-001- New York. (HMO SNP)
Nascentia Health Dual H9066-003 - New York. (Several plan variations)
Sunrise Advantage Plan - New York. (Several plan variations)
Aetna Medicare. (Several plan variations)
HumanaChoice. (Several plan variations)
WellCare Access - New York. (Several plan variations)
UnitedHealthcare. (Several plan variations)
AARP. (Several plan variations)

Good to know: Just because your doctor writes you a prescription doesn't mean you can fill it. Expensive medications for treatment of certain cancers, diabetes, liver disease, and a host of other maladies can cost patients tens to hundreds of thousands of dollars if the insurer does not cover the drugs. But even if the drugs are covered, insurers have been known to try to stall, just to see if the patient will come up with the money to pay for the drugs rather than wait on the insurer's approval. What can we say? It happens.

For more information concerning Medicare Advantage, Medicare Supplement or Medicare Prescription Drug Plans, please give us a call.

Other articles:
Medicare Supplement Insurance Rates in New York.
Medicare Supplement Vs Medicare Advantage Plans.
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