Seniors who live in New York are able to get health insurance known as a Medicare Advantage plan. These Advantage plans provide excellent coverage of medical services and include the Original Medicare, which you will need to have. When you become 65, you are able to get Medicare and a Medicare Advantage plan. If you are still unsure of what you need to do to get this health insurance in New York, please don’t hesitate to contact us and we can help you find a plan that will be suitable for you.

Medicare only pays 80% of your medical bills and the remaining 20% will have to come out of your own pocket and seniors are looking for a way to have that portion taken care of. A Medicare Advantage plan will help with those remaining costs. It will take care of your basic services and even some extra ones you wouldn’t think would be paid for. There are several Advantage plans and you will need to check out each one to find the plan that will take care of the most important medical services that you would need and not put a burden on your budget.

Medicare Part A and Part B costs will be included in an Advantage plan, as well as, emergency care, and all urgent care when needed. Hospice care will not be covered, but that is taken care of by your Original Medicare, which you have to have for your Advantage plan to be complete.

Some New York Medicare advantage plans will also include Medicare Part D. Part D is the plan that will cover your prescription drugs like your generic ones and pay some of the name brand ones. Generic drugs will always be covered by the plan and payment for the name brand ones will depend on the Advantage plan you chose. Part D will have all the medical coverage we already stated and this can be very beneficial for seniors.

Other coverage you can get with an Advantage plan would be your regular physicals at your physician, specialists, dentists, optometrists and audiologists. Your dental cleanings and checkups, x-rays and medical tests will also be taken care of. Some seniors will like the fact that hearing aids and prescription eye glasses will also be covered. This can be a great savings for seniors that live on a fixed income.

You might be wondering just how much medical coverage do you want or need. It would be a good idea to talk with your physician about your medical issues and what type of health insurance coverage you might need in the future. We never know what can happen from day to day and what medical issues may come about, so you will want to keep your Advantage plan current. In the future you may need to change your plan according to your health issues and this can be done during the enrollment period.

All Medicare Advantage plans work with a network. This network include physicians, hospitals, pharmacies and medical clinics that contract with your particular Advantage policy and will always accept your plan. These facilities are in network and those who are not on your Advantage plans are out of network. If you use aNew York of the doctors in your plans’ network, they will accept and you will get payment for the services. If you needed to see a doctor that is not in this network, your medical bills will not be paid by the insurance plan and most likely you will have to pay them yourself.

The basic Medicare Advantage plan is called a HMO. This has all the coverage we discussed and full payment is rendered for medical services as long as you stay within the network.

If you find you want a facility to be your main provider and they are not within the network, you can get an Advantage plan called a PPO. New York residents can get this plan and will get full coverage of services while in network and partial payment when they need to go outside of the network. You do need to remember that that entire medical bill will only be partially paid for. Another consideration for this particular Advantage plan is the monthly premiums will also be higher.

Sometimes a person will need a medical service out of the network and the PFFS plan will pay a set price for that service. It will still pay completely within the network, but will pay a fee for service amount and no more. The rest of the bill will be your responsibility. For instance, if you needed surgery at a hospital out of the network, the cost of that surgery will already be predetermined and your policy will only pay that amount.

Another Advantage plan is known as the Special Needs plan for those that have Medicare and Medicaid. These plans have low rates and a senior will have qualify to get this plan. If you aren’t sure if this plan might be for you, feel free to call us and we can help you find the right Advantage plan for your needs.

The overall cost of MA hinges on a particular plan. The total amount you pay will depend on the individual plan you purchase.

But there are particular expenses that you need to pay attention to. Listed below are the basics of monthly premiums, yearly deducible, coinsurance, and copays, as well as the maximum out-of-pocket limit.

You may be wondering what insurance companies are selling these Medicare Advantage plans and how do you go about getting one. We found a few of what we consider very good companies that offer a great amount of coverage for their Advantage plans and you will probably find one that suits you. We decided on these companies because the plans have good coverage and the prices are reasonable. They also have outstanding reputations in the insurance industry.

Health maintenance organization (HMO) is a health plan that requires you to go to an in-network provider to obtain full coverage. If you go outside of the network, your health plan will not cover the medical costs, except in medical emergencies.

Another thing to remember when you choose HMO is that you need to pick a primary care physician (PCP). This is your doctor who will supervise your medical care. All your medical care will go through your PCP. Thus, if you need to see a specialist, you must ask your PCP to give you a referral to that specialist.

HMO has several subsets. One of them is the point-of-service plan. This type of plan lets you obtain medical services out-of-network. But it entails a higher coinsurance or copayment.

When you choose a preferred provider organization (PPO) plan, you get more flexibility than when you pick an HMO plan. The reason for this is that your health plan will cover medical costs through an out-of-network provider. The monthly cost for this is quite higher than HMO. Furthermore, the healthcare costs are higher than if you stay within the network.

But there is no need for you to pick a primary care physician who will manage your healthcare. Because of that, you can see a specialist at any time without getting a referral.

A private fee-for-service plan lets you visit any healthcare providers that accept Medicare. But the provider must agree to treat you first.

Some PFFS policies have a network of providers. If you choose a PFFS plan with a network of providers, you can still get treated through out-of-network providers. But they must agree to treat you. However, if you choose to undergo treatment outside of your plan’s network, then you need to bear the higher cost.

Despite the higher costs, some seniors would choose PFFS plans because of the flexibility that they offer when receiving care. But you must remember that some providers don’t accept your health plan when you visit. Even if you frequently go to the providers, they can still deny you treatment, unless it is an emergency.

In that case, with this plan, you will still have a more difficult time looking for a healthcare provider to treat you, depending on where you live. Thus, before you purchase a PFFS plan, make sure that your current healthcare provider can accept you as a patient.

The health insurance provider will have more control over the amount you pay to get medical care when you choose a PFFS plan. The other health plans will need to follow the prices set by medicare.

Compared to HMOs and PPOs, PFFS has higher out-of-pocket expenses. Thus, you must ensure that you have read the terms and conditions of PFFS before you choose it.

Special needs plan (SNP) is a type of plan that can only be accessed by some people with specific conditions. This type of plan targets specific consumers. The health insurance provider that sells it tailors the benefits, list of medications, and available providers.

Health conditions that this plan will cover would include end-stage renal disease (ESRD), diabetes, dementia, chronic heart failure, and HIV/AIDS. All SNPs have prescription medication coverage.

Most SNPs require that you choose a primary care physician. And if you need to visit a specialist, you need to get a referral. Although some SNPs can cover your visits to providers that are not part of your plans’ network, not all SNPs do. Make sure to check your plan’s details to know more about the limits and inclusions.

A medical savings account (MSA) plan is a different type of health plan. It works like a high-deductible health plan and a bank account.

Your MSA plan will deposit money to your account for your healthcare expenses. Use the fund to pay for your medical cost.

With the MSA plan, the out-of-pocket costs are high until you meet the deductible. Once you hit your deductible, your plan will cover 100% of the healthcare cost, as long as the medical service is a Medicare-approved.

The deductibles will depend on the individual plan. It can go up to thousands of dollars. As mentioned, you can spend the fund in your account to pay for your medical expenses.

Now, if you maxed out the fund, you will have to pay for your medical expenses using your own money. Your health plan will start to cover you if you have reached the deductible.

But even if you reach the deductible, your health plan will not cover your healthcare costs 100%. In that case, we recommend that you consider the high deductible associated with this plan. You may end up paying more if you choose an MSA than if you opt for other health plans.

Before you can sign up for a Medicare Part C plan, you will need to have an active Original Medicare, which includes Part A and Part B. You are not allowed to sign up for Part C without the traditional Medicare.

If you are receiving federal retirement benefits, though, you are enrolled in Medicare automatically when you turn 65. You are also automatically signed up for Original Medicare if you have federal disability payments for the past 24 months.

Now, if you have not received federal retirement benefits yet but you’re already 65, then you need to enroll for Original Medicare manually. You can do so by going to a local Social Security office. You may also call the office at 1-800-772-1213. Or fill out an online application through the ssa.gov.

After you have successfully enrolled in Original Medicare, you can start shopping for Medicare Advantage plan. Use Medicare’s official website to find plans. But you can only sign up within the specified period per year.

If you are a new subscriber, you have seven months to purchase coverage. The period starts three months before you turn 65. Then, another three months after turn 65. This is your first enrollment period.

Outside of this initial enrollment, you can still purchase or change your plan during open enrollment. It happens from October 15 to December 7 every year. This is known as the yearly election period.

On the other hand, if you are experiencing a qualifying moment, like moving to a new state or losing your health coverage, you can still apply through special enrollment.

If you don’t like your MA plan, you can still drop it and go back to Original Medicare. You can do so during the dis-enrollment period, which starts from January 1 to February 14 every year.

Medicare Advantage plans have more benefits compared to the standard Medicare. Because of the high costs, they are not the best option for low-income seniors as they can just apply for Medicare savings programs. To help you decide, here are some of the pros and cons of having Part C.

Pros

• Offers coverage for medical services that Original Medicare does not cover.

• Includes prescription drug plan

• Maximum out-of-pocket expenses

Cons 

• You’ll pay two premiums, for part B and the Advantage plan.

• Each type of MA plan has its own rules regarding coverage and the cost of using an out-of-network provider.

• Not all in-network providers can accept new patients

• Not compatible with the employer-sponsored health plan and Medigap or Medicare Supplements.