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New York Medicare Plans

From Central Park, the Statue of Liberty, to the Empire State Building, it’s hard to ignore New York’s impact on America. As a gateway for immigration, it has proven to be a real melting pot of culture and Broadway. It is no surprise that as one of the most diverse states in the country, New York also has some of the most unique rules for Medicare plans. It is important to understand everything about Medicare in New York, from enrollment to state-specific laws. Comparing plans and rates will help you make the best decision for your health!

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What are Medicare Options in New York?

New York, like many states, offers the standard Medicare Supplement plans, also known as Medigap plans. If you are a resident, you can choose from the following plans: A, B, C, D, F, G, H, K, L, M, N, high-deductible Plan F, and high-deductible Plan G. You’re able to enroll during the year, but if you want your coverage to be guaranteed, you want to enroll during your open enrollment period in New York.

When is the Open Enrollment Period in New York?

Year-Round Open Enrollment in New York

New York is one of few states that offers what is considered year-round open enrollment for MediGap plans. Typically in most states, you must enroll in a Medicare Supplement plan within 6 months of your Medicare Part B enrollment in order to avoid any medical underwriting and health questions. This is not the case in New York. In the state of New York, there is never any medical underwriting for Medicare Supplement plans. This means that you can not be denied coverage for your health history or pre-existing conditions, and you are given guaranteed acceptance for these plans. This is extremely beneficial in ensuring your access to coverage, as well as ability to maintain the best available premium rate on your Medicare Supplement plan.

Although you are guaranteed acceptance into Medicare Supplement plans at any point in New York, you do not wait to delay your coverage. Insurance carriers often have the ability to impose pre-existing conditions limitations for periods of 3-6 months, where there is limited coverage initially if you are not coming from another form of creditable insurance (another Medicare Supplement, Medicare Advantage Plan, or employer-sponsored insurance).

 

Can I Change Medicare Supplement Plans in New York?

You can apply to change your Medicare Supplement during any month of the year in New York without undergoing any medical underwriting. Due to New York’s year-round open enrollment, Medicare beneficiaries are guaranteed acceptance into Medicare Supplement plans without question regarding health history or pre-existing conditions.   

What are the Most Popular Medicare Supplement Plans in New York?

Medigap Plan F in New York

Medicare Supplement Plan F has been a very popular plan with Medicare beneficiaries over time. The reason for the popularity of Plan F, is that it covers the gaps left by Medicare with no deductibles or copayments. This means that Medicare Part A and B costs are covered with no additional out-of-pocket. However, if you became Medicare eligible after January 1st 2020, you are not eligible to enroll in MediGap Plan F. Luckily, there are other great Medicare Supplement plan options available.

Medigap Plan G in New York

Medicare Supplement Plan G is a very comprehensive Medicare Supplement plan with very little out-of-pocket expense. Once you have met your Part B annual deductible, MediGap Plan G becomes a full coverage plan, covering all of the gaps left by Original Medicare, with no additional out-of-pocket expenses. Plan G typically has a higher premium in states like New York due to the year-round open enrollment, so it is very important to assess the other options available as well.

New York does things a bit different than most other states. I give a great overview in the video at the beginning of this page.
Keith Armbrecht
Medicare on Video

Medigap Plan N in New York

Medicare Supplement Plan N is also a great, comprehensive MediGap plan available in New York. This plan has slightly more out-of-pocket cost than MediGap Plan G, but also comes with a lower monthly premium. As with Plan G, you are still responsible for the Medicare part B annual deductible. Once you have met this deductible, your Original Medicare coverage kicks in, but you still have some cost-share. With MediGap Plan N, you will pay copayments up to $20 for office visits, and up to $50 for ER visits that do not result in an inpatient admission. 

In most states, Plan N also has the possibility of an excess charges (up to 15% above the Medicare-approved amount) if you use a doctor or healthcare provider that does not accept Medicare Assignment. In New York, however, excess charges are not permitted, and providers are prohibited from charging Medicare beneficiaries over the Medicare-allowed amount for services.  This means that you will not have to worry about encountering an excess charge if using a doctor or healthcare provider in the state of New York. If you do travel to another state, however, you will want to confirm that the doctor you are seeing does accept Medicare Assignment to avoid a possible excess charge. 

Medigap Plan GHD in New York

Medicare Supplement Plan GHD is rising in popularity as a MediGap choice in New York. Plan GHD is short for Plan G High-Deductible. This plan offers the same benefits as a standard Plan G, but with one catch. In order to reach the benefit level of the standard Plan G, you must first meet the annual deductible of the Plan GHD. Initially this plan, like Plan G, requires enrollees to meet the annual Part B deductible before Medicare coverage begins. Once the Part B deductible is met, the Plan GHD beneficiary then enters an 80/20 split with Medicare, where the beneficiary is responsible for 20% of costs, until the high deductible is met. In 2021, the high deductible on Plan GHD is $2,370. This plan gives enrollees the freedom to remain on Original Medicare, while having a stop to their annual out-of-pocket costs, accompanied by a much lower premium than other plans in New York, such as Plan N or Plan G. 

What is the Cost of a Medicare Supplement Plan in New York?

Monthly premiums for Medicare Supplement plans are based on three main factors- age, gender, and location. There are other things that may impact your premium such as tobacco use. The premium amounts will vary based on these factors, so it is important to receive a quote based on your specific demographic information.

Medicare Plans in New York for Those Under 65

When it comes to Medicare in New York for those under 65, there is also year-round open enrollment for Medicare Supplement plans. This means that there is no medical underwriting for any MediGap plans, even if the Medicare beneficiary is under 65 on Medicare disability. Although there is no medical underwriting for these plans, often times the premiums can be much higher than average, so it is best to assess all options.

Medicare Advantage in New York

New York also offers options for Medicare Advantage plans. In these plans you must live in your plan’s service area and enroll during an appropriate election period.  Medicare Advantage plans do not required medical underwriting if enrolling during an election period, but are also significantly different plans than Medicare Supplement plans.

Medicare and Medicaid in New York

It is possible to qualify for both Medicare and Medicaid in the state of New York. These two programs, however, are separate and have different qualifications you must meet in order to receive benefits. To qualify for Medicaid, you must meet  state income requirements. To qualify for Medicare, you must be either over the age of 65, or under 65 but receiving Social Security Disability Insurance for a minimum of 24 months before applying for Medicare. 

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In his book “Medicare Made Clear” the #1 authority on Medicare, Keith Armbrecht outlines all you need to know when starting medicare. Easy to follow with videos included.  Download Now for Free!