Thanks to expanding benefits and plan options, the Medicare Advantage (MA) program grows more popular every year. In 2023, over half of eligible Medicare beneficiaries were enrolled in an Advantage plan. This page describes Medicare Advantage plans in New York and how to compare your options.
What is Medicare Advantage in New York?
Also known as Medicare Part C, every Medicare Advantage plan must provide same benefits as Original Medicare. This includes Medicare Part A, hospital insurance, and Medicare Part B, medical insurance. Prescription drug coverage, however, is not included. For that, you need Medicare Part D.
While Medicare Advantage plans must provide the same coverage as Parts A and B, they are not limited to those benefits. In fact, around 90% provide prescription drug coverage, routine vision services, fitness benefits, and more.
New York Medicare Advantage plans with prescription drug coverage
Medicare Advantage Prescription Drug plans (MA-PD) combine your Parts A, B, and D benefits. These all-in-one plans often save beneficiaries money, since there's no need to buy a standalone Medicare Part D plan when you join an MA-PD.
Who is eligible for Medicare Advantage in New York?
You become eligible for Medicare Advantage in New York as soon as you sign up for Medicare Parts A and B.
American citizens and permanent legal residents age 65 or older qualify for Medicare. You are only automatically enrolled if you begin collecting Social Security at least 4 months before your 65th birthday.
You may also be eligible if you collect Railroad Retirement Board (RRB) or Social Security disability benefits for 24 months. If you qualify for Medicare due to a disability, enrollment occurs automatically during month 25.
When can you join a Medicare Advantage plan in New York?
The five Medicare Advantage enrollment periods are:
- Initial Enrollment Period: Your IEP lasts for 7 months and begins 3 months before your Medicare eligibility month. So, if your 65th birthday or 25th month of disability is in July, your IEP runs from April 1 through October 31.
- General Enrollment Period: If you did not sign up for Medicare Part A and/or Part B during your IEP, you may do so from January 1 through March 31. You may then join a Medicare Advantage plan between April 1 and June 30.
- Annual Enrollment Period: You can sign up for an MA plan any time during AEP, which runs from October 7 through December 15.
- Medicare Advantage Open Enrollment Period: If you already belong to an Advantage plan, you may either change to a new one or return to Original Medicare during Open Enrollment. It runs from January 1 through March 31.
Medicare also offers Special Enrollment Periods for people who experience certain life changes, like moving or losing your current coverage. The full list of qualifying special circumstances is available on Medicare.gov.
Types of Medicare Advantage plans in New York
The four most common types of Medicare Advantage plans in New York are:
- Health maintenance organizations: HMO plan requirements include a provider network, choosing a primary care doctor, and obtaining a referral before seeing a specialist. Most HMO plans do not cover out-of-network services.
- Preferred provider organizations: PPO plans have provider networks but members can visit an out-of-network provider for a higher copay. There is no requirement to choose a primary doctor or get a referral to see a specialist.
- Private fee-for-service: PFFS plans set cost limits for all covered services. Most have a provider network but allow plan members to go out-of-network for a higher cost. You don't need for a primary doctor or a referral to see a specialist with a PFFS plan.
- Special needs plans: SNPs are limited to people who meet one of the following guidelines: live in a nursing home/require home healthcare, have a chronic condition, or qualify for both Medicare and Medicaid (dual eligible). All services covered by an SNP are geared toward whichever population that plan serves.
How to choose a Medicare Advantage plan in New York
Compare your options carefully before joining a Medicare Advantage plan in New York. Consider the following:
- Coverage (including the drug formulary for an MA-PD plan)
Comparing New York Medicare Advantage plans is easy with our Find a Plan tool. Just enter your location information and coverage start date to review Medicare plans in your area.
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