New York State Medicare plan primer – understanding your options
As a Medicare beneficiary you have some choices to make. Determining which type of Medicare plan you will have is one of the most important health decisions you will make.
Very few people enroll in Medicare without at least adding Part D coverage and most people also choose a Medicare supplement or a Medicare Advantage plan.
This article will highlight the different options you have available when considering New York State Medicare plan choices. We’ll also learn why some New Yorkers have more Medicare plan options than others.
It all starts with original Medicare but does not often end there
Medicare does not offer complete health coverage. There are out-of-pocket costs in the form of deductibles and coinsurance. In addition, Medicare does not cover many services that are more readily required as we age. Many people on Medicare have been disappointed by the lack of dental, vision and hearing benefits.
Understanding your plan options and aligning them with your needs and budget can allow you to bridge some of the gaps. Here are the types of Medicare plans available in New York State:
- Stand-alone Medicare Part D
- Medigap also known as a Medicare supplement
- Medicare Advantage plan with Part D included (MAPD)
- Medicare Advantage plan with medical benefits only (MA)
Original Medicare and Part D
This option is chosen less than other available plan options. The reason it is less popular is because you are still exposed to the gaps in original Medicare. You will be responsible for the Part A deductible should you require hospitalization ($1184 for 2013) and will incur additional costs if your hospital stay lasts longer than 60 days.
Cost for outpatient services can add up quickly. You will be responsible for the Part B deductible ($147 for 2013) and 20% of all Medicare approved expenses.
Medigap and Part D
Medigap is insurance offered by a private insurance company designed to fill the gaps or to varying degrees pay your share of the costs. Medigap works in conjunction with original Medicare but does not include Part D drug coverage. You will be required to purchase a stand-alone Part D plan.
Medigap policies are standardized so coverage for the same plan will be identical from company to company. This make it very easy to shop for a Medigap policy. Medicare supplement Plan F is the most comprehensive.
There are 28 2013 Part D plans to choose from in New York. Part D plans are State specific although are available for use nationwide.
Medigap policies are readily available from several insurance companies but you should be aware that companies are not required to offer all available plans. As an example, Mutual of Omaha indicated that they would no longer offer Medicare supplement Plan N which happens to be a good alternative to a Medicare Advantage plan.
Medicare Advantage plans
Medicare Advantage plans offered by private insurance companies approved by CMS give you another way to receive your Medicare benefits. Advantage plans are also know as Medicare Part C and some people refer to them as Medicare replacement plans.
Unlike a Medigap policy original Medicare benefits are not supplemented but rather you receive your benefits from the plan. Premiums are normally lower than a Medigap policy and in some cases premiums are $0 per month.
You will be responsible for some cost sharing in the form of deductibles, copays and coinsurance but unlike original Medicare will have a cap on costs in the form of an annual Maximum out-of-pocket amount $6700 for 2013).
Most Advantage plans have a network of providers and it is important to know the rules of the plan. Most plans include Part D coverage and plans will often include some additional benefits such as dental, vision, hearing and other health and wellness programs.
Medicare Advantage plans are offered on a County-by-County basis and what plans you may have available may not be available in a neighboring County.
Rural Counties will generally seem to get the short end of the stick while more populated Counties will generally have plan options in the double digits. Visit the Medicare website to see all available plans in your County.
As a resident of New York State you will generally have ample Medicare plan choices to find a plan that will need your specific health needs and budget.
If you are under 65 and need health insurance, check out this New York Health Insurance Exchange resource.