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.

Good to know: Discuss health plans options with your doctor. Go over your insurance company's list of covered prescription medications with your doctor. Some medicines will cost you more than others. If your doctor knows what's on your insurer's list, he can select the best medication for you at the lowest price. Also, if your plan requires you to get a referral to a specialist, take your insurance plan's preferred-provider list to your primary-care appointment. Your doctor can easily pick out the best specialist who participates in your plan.

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: When it comes to medical services, shop around for a better deals. Patients often think that medical fees are set, but just like any other business, costs for goods and services can vary widely. Shop the cost of exams, tests, procedures, medications, nursing facilities, and imaging centers before non-emergency events. The price of an MRI on one side of Main Street can be $500, and $2,500 on the other. Healthcare pricing, as a rule, is arbitrary. Even the pharmacy you choose can be the difference in hundred of dollars annually.

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: Want to really know the particulars concerning a health care plan? Request the "evidence of coverage" document associated with the plan. The evidence of coverage document is what you need if you want to understand in perfect detail, exactly what a health care plan covers. You will find a thorough explanation of benefits, exceptions, and exclusions. The evidence of coverage document provides details that may not be listed in that glossy plan brochure, or any online verbiage detailing plan benefits. In most circumstances, this document is legally required to be associated with most any health plan policy. It is available to consumers. You need only to ask.

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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