Medicare Advantage is a newer approach to organizing Medicare benefits for seniors and other eligible individuals. Also known as Medicare Part C, these plans combine all coverage normally included under Original Medicare Parts A and B in a single monthly premium. Unlike Original Medicare, private insurance companies issue Part C plans and have agreed to meet all of the same coverage minimums of Medicare, except for hospice care, which Part A continues to cover. In addition to these minimums, many Part C plans also include prescription coverage, along with some extras Medicare doesn’t typically cover, such as dental, hearing and vision benefits. Many Medicare Advantage plans also have annual out-of-pocket limits, which Original Medicare does not.
Because Part C benefits are generally more expensive than Original Medicare, seniors who participate in these plans rarely need a traditional Medicare supplement, which reduces what seniors pay for health insurance every month. Issuers can organize Medicare Advantage plans like any other private insurance policy, with managed care packages with their own rules about referrals, network providers and specialist visits. The greater flexibility and potential cost savings make Part C plans attractive to many New York seniors, where over 1.5 million of the 3.6 million Medicare-eligible seniors choose this health coverage path, based on data from 2020. The 41% of the state’s Medicare beneficiaries covered by a Part C plan comes very close to the national average of 42%.
This guide to Medicare Advantage plans in New York state includes information about the plans available, what benefits they offer and who is eligible for coverage. It also provides helpful information about how to apply for Medicare Advantage in New York.
The Top 10 Medicare Advantage Plans in New York
Multiple insurance companies offer a variety of Medicare Advantage plans in New York. As a result, Medicare-eligible seniors have substantial choices when shopping for a plan. The table below lists the 10 most popular Medicare Advantage plans available in the Empire State, as judged by their enrollment figures. Because most Part C providers offer more than one plan, the list shows their rates as a range rather than a single average figure. The list also includes the number of current enrollees as of April 2022. For up-to-date information about the number of people enrolled in each plan, refer to the figures provided through Medicare.gov.
Healthfirst Medicare Plan
Excellus Health Plan, Inc
HMO, PPO, PFFS
EmblemHealth Medicare HMO
Empire BlueCross BlueShield
Highmark Blue Cross Blue Shield of Western New Yo
How Medicare Advantage Plans Work in New York
It’s important to understand how a Medicare Advantage plan works before enrolling. The companies offering plans typically organize their packages into a few different structures to deliver care. These include health maintenance organizations (HMOs), preferred provider organizations (PPOs) and special needs plans (SNPs). Each plan has its own rules about specialist care, condition-specific treatment and whether or not enrollees need to pick a primary care physician. The four most common plans are listed below.
Medicare Advantage Plan Types Graphic
What Medicare Advantage Plans Cover in New York
Medicare Advantage plans must include all of the same benefits that Original Medicare Parts A and B usually include, except for hospice care, which remains a Part A benefit. Services included in all Part C plans include screenings, lab tests, X-rays ordered by a doctor and the care provided during a stay in the hospital. Most Medicare Advantage plans also offer coverage for services that go beyond Original Medicare. This may include vision, dental and assistance with getting hearing aids.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Durable Medical Equipment
*Select plans offer this coverage
** Most plans offer this coverage
Eligibility for Medicare Advantage in New York
To qualify for a Medicare Advantage plan, seniors must already be eligible for Original Medicare Parts A and B, as well as meet all of the other eligibility requirements for Medicare participation. It is unnecessary to have a Part D prescription drug plan to sign up for Medicare Advantage. Medicare Advantage providers are not normally allowed to charge extra or deny coverage for applicants with preexisting conditions, though it is important to apply within one of the designated open enrollment windows to preserve this advantage. Medicare may decline or charge a special penalty rate for applications made outside of the enrollment windows.
Read over the list below for information about open enrollment periods and when applicants in New York are allowed to make changes to their Medicare Advantage plan coverage.
Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.
Initial Coverage Election
3 Months Before One’s
65th Birth Month
3 Months After One’s
65th Birth Month
Annual Election Period
Medicare Advantage Open
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
How to Find & Choose a Medicare Advantage Plan in New York
Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.
First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.
Choose a Medicare Advantage Plan
State-Wide Medicare Advantage Resources
Health Insurance Information Counseling and Assistance Program
The Health Insurance Information Counseling and Assistance Program (HIICAP) helps seniors navigate New York’s many medical insurance options. The program employs more than 500 counselors in offices throughout the state, who work directly with Medicare beneficiaries or individuals who are eligible to apply for state programs. These trained representatives provide information and education about Medicare, Medicare Advantage, Medicaid, prescription drug plans and other health insurance options. Counselors can answer questions about coverage, give access to CMS and help seniors resolve complaints with insurers. Counseling is available in person at county offices or via telephone through a toll-free hotline. The program also offers helpful online resources, including the HIICAP Notebook, where seniors can access additional information about Medicare and Medicare Advantage.
To access HIICAP’s toll-free benefits hotline, call 1-800-701-0501. At the prompt, callers must state their county of residence so their inquiry can be directed to the appropriate Area Agency on Aging office or a participating community organization.
Community Health Advocates
Community Health Advocates (CHA) provides confidential one-on-one counseling free of charge to help New Yorkers understand their health insurance options and choose the plan that’s right for their unique medical needs. CHA gives community presentations designed to guide consumers through the complexity of the health care system. The presentations focus on a variety of health care topics and serve to educate individuals on insurance options and how changes in health care laws may affect individuals in the state. The program’s outreach services help high-need communities and offer help in more than 170 languages.
New York State residents can connect with CHA through its centralized helpline by dialing 1-888-614-5400 during weekdays from 9 a.m to 4 p.m. Seniors can also schedule a call by filling out the online form. A list of CHA affiliated organizations with staff who are qualified to assist consumers with health insurance questions and enrollment issues can be found online at CHA’s website.
New York State Attorney General’s Health Care Bureau
The New York State Attorney General’s Health Care Bureau provides information and assistance to help New Yorkers connect with public and private insurers so they can get affordable medical coverage regardless of age. The bureau educates consumers about their health care rights under the Managed Care Bill of Rights and has outreach programs that serve high-need communities. Through the bureau’s toll-free helpline, consumers can connect with trained intake specialists and advocates who can help individuals understand available benefits and how to secure coverage. The hotline also helps consumers resolve complaints concerning health plan denials, wrongful practices and prescription drug coverage.
Consumers can speak with a trained advocate or intake specialist at the New York State Attorney General’s Health Care Bureau through its toll-free helpline by dialing 1-800-428-9071. Additional information, including tips and brochures, is available through the Health Care Bureau’s website.
Local Medicare Advantage Resources
NYC Health provides in-person assistance at no cost to seniors who need help navigating health care enrollment and coverage-related issues. Certified health insurance enrollment counselors are available at locations in all five boroughs to help consumers explore plan options that are available to them. The counselors can also assist with complex enrollment or the renewal process for public and private insurance, including Medicare Advantage. NYC Health can help local immigrants secure quality health care regardless of their immigration status, and the agency provides assistance in a multitude of languages. Telephone enrollment appointments are also available.
New Yorkers aged 65 and older who need help with health care enrollment can find a counselor in their borough of residence by searching the NYC Health Map. They can also set up an in-person or telephone appointment by calling 311 or texting “CoveredNYC” to 877-877. A list of locations broken down by borough is also available by visiting NYC Health’s website.
New York StateWide Senior Action Council
New York StateWide Senior Action Council is a group that provides health care advocacy and support to New York elders. The organization runs a confidential health and prescription medication coverage helpline, where certified counselors provide information on Medicare Advantage benefits and prescription drug coverage, answer consumer questions and assist with plan enrollment free of charge. New York StateWide Senior Action Council also connects seniors with essential resources at the local, state and federal levels. The council has offices throughout the state and hosts regional chapter meetings, presentations focusing on senior-friendly topics and telephone teach-ins on various subjects. It also sponsors a Senior Medicare Patrol, which empowers seniors and their families to detect, prevent and report potential Medicare fraud.
New York StateWide Senior Action Council’s Medicare and prescription drug coverage hotline is available free of cost by calling 1-800-333-4374. Seniors can also connect with a certified counselor by emailing firstname.lastname@example.org. To find out more information on chapters and events, interested parties should visit the regional section of StateWide’s website.
Jewish Association Serving the Aging (JASA)
The Jewish Association Serving the Aging is a nonprofit organization that provides a multitude of no-cost services for seniors of all races and religions residing in Long Island and New York City’s five boroughs. JASA’s Sally and Henry Pearce Help Center employs bilingual social workers trained to conduct comprehensive assessments to determine an individual’s health care needs and eligibility. Representatives can also help seniors navigate the health care enrollment process and secure benefits under programs such as Medicare and Medicaid.
Regardless of religion, race or economic background, seniors can connect with trained social workers through JASA’s bilingual Sally and Henry Pearce Help Center by calling 212-273-5272 or filling out a brief online form. Seniors or their family members who are looking for more information on Medicare and other health care benefits can search for association locations throughout the Bronx, Brooklyn, Queens, Manhattan and Long Island by visiting JASA’s website.