New Yorkers have access to dozens of five-star Medicare Advantage plans, whether they live in New York City or a more rural area upstate.
There are many healthcare coverage options for Medicare beneficiaries, depending on your healthcare needs. If you need a robust formulary to cover your medications, there’s a plan that’s right for you. Are you in a nursing home? A special needs plan may be what you’re looking for to keep your out-of- pocket costs low.
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There are hundreds of Medicare Advantage plans in New York, many with five- star ratings. But which one is the best? That all depends on what you need in a plan.
If you’re not on any prescription drugs, then the cost of those may not be as crucial as preventive care and wellness programs. But if you are using medications long-term, you need to find a plan that covers your prescriptions.
1. CDPHP Vital Rx (PPO) - Score: 78.01
2. CDPHP Flex Rx (PPO) - Score: 78.01
3. BlueShield Freedom Nation (PPO) - Score: 75.93
4. BlueCross BlueShield Freedom Nation (PPO) - Score: 75.93
5. CDPHP Basic RX (HMO) - Score: 74.68
6. CDPHP $0 Medicare Rx (HMO) - Score: 74.68
7. Univera SeniorChoice Basic (HMO) - Score: 72.59
8. Univera SeniorChoice Advanced (HMO-POS) - Score: 72.59
These plans rank high in terms of the overall cost compared to the benefits they offer. Below, you’ll find the plan’s monthly premium and unique features of these top New York Medicare Advantage plans.
Monthly Premium: $0
Deductible: $350
Out-of-pocket Maximum: $7,500
The second premium-free plan on this list, this one offers prescription drug coverage and may give you extra benefits that lower your costs if you are diagnosed with certain health issues.
Eye exams are $20 with free frames and lenses. Also covered are medical equipment, diabetes supplies, and foot care. Seeing your primary care doctor costs $0, and seeing a specialist is $50 per visit.
Monthly Premium: $41.80
Deductible: $0
Out-of-pocket Maximum: $5,500
If you’re looking for a low monthly premium, no deductible, and a low out-of-pocket maximum, this might be the one for you. Additionally, this plan offers affordable co-pays and coinsurance. Doctor visits are $0, while specialist visits are $40.
Lab work, diagnostic testing, and X-rays cost between $0 and $40. Transportation is free, and you can get a dental exam and a cleaning for just $25. This plan has additional benefits that can reduce the cost-sharing for beneficiaries with certain health conditions.
Monthly Premium: $0
Deductible: $375
Out-of-pocket Maximum: $7,550
As the first premium-free plan on the list, this one offers low co-pays and coinsurance on medical care. Your primary care doctor visits cost $0 to $5, and specialists cost $45. Diagnostic testing, lab work, and X-rays each have a co-pay of $50 or less.
Basic dental is $15 for an exam and cleaning. Vision and hearing checkups, skilled nursing care, diabetes supplies, and Medicare Part B drugs are also covered.
Monthly Premium: $25
Deductible: $300
Out-of-pocket Maximum: $7,550
While this plan has a lower monthly premium than the previous two, it does have a deductible. The co-pay for doctor visits ranges from $0 to $15 and seeing a specialist costs $35. Inpatient hospital stays are more expensive than the other BlueCross BlueShield plans. Days one through five are $370 per night. The remaining days, up to 90, are fully covered.
One area where this plan shines is in the basic dental and vision coverage. A trip to the dentist will cost you $10 for the cleaning, $10 for the exam, and $10 for X-rays. Vision exams are $25, and your frames, lenses, and contacts are free.
Monthly Premium: $31
Deductible: $0
Out-of-pocket Maximum: $6,700
This plan covers the basics at low or no-cost copays. Prescriptions, specialists visits, urgent care, and diagnostic services all have affordable rates. Plus you pay nothing for a standard primary care or preventive visit.
Add to that hearing, vision, and dental coverage. Even restorative dental services are covered.
Monthly Premium: $0
Deductible: $300
Out-of-pocket Maximum: $7,500
Here’s a plan with many affordable copay costs. You’ll get $0 visits to your primary care doctor or for preventive visits. Plus basic dental, vision, and hearing is covered affordably. Even hearing aids. And if you need non-emergency transportation services, you’ll be covered at no additional cost.
Plus, your prescriptions come with affordable copays for Tier 1 and 2 drugs. Couple that with a robust wellness program, and you can see why co many seniors choose this plan.
Monthly Premium: $0
Deductible: $360
Out-of-pocket Maximum: $7,550
This plan may not offer the cheapest copays around, but it does offer a solid plan for people looking for basic coverage. Plus, your health plan has a $0 deductible, while prescriptions are set at a $150 deductible.
Basic hearing and dental are also covered at affordable rates. Though you’ll need to buy a stand-alone vision plan. All in all, a basic plan at reasonable rates.
Monthly Premium: $33
Deductible: $150
Out-of-pocket Maximum: $7,200
The advantages of this plan is the flexibility it offers you. Not only do you get affordable in-network coverage, you’ll also get partially-covered access to out-of-network services. For some, this flexibility is what matters most. And this a great plan to use for that reason.
In addition to out-of-network flexibility, you’ll also get basic hearing, vision, and dental coverage. Plus benefits for wellness programs.
Ready for Medicare to work for you? Use the Insurify Medicare comparison tool to check out Medicare Advantage plans in New York. Start with your ZIP code, and you’ll be comparing options in less than two minutes. Try it today!
Medicare Advantage costs vary from person to person, but the average price for a plan is $25 per month. Remember, plans can range from $0 to $100 or more per month. Your cost will depend on the features of the plan you choose.
Low- or no- deductible plans are typically more expensive than those with a higher deductible. Things that impact the cost of your Medicare coverage include:
Monthly premiums
Deductibles
Co-pays and coinsurance
Prescription drug costs
Whether or not you receive Extra Help benefits
Medicare Advantage ( Medicare Part C ) is an alternative to Original Medicare. It is not a Medicare Supplement or Medigap plan. Rather than using Medicare Part A, Part B, and Part D for your healthcare needs, you get an all-in-one Medicare Advantage plan.
These plans are offered by private insurance companies and meet government standards. Each plan is different, and you have many plans from which to choose. Consider each plan carefully; you may find that the plan that’s best for you is not the one that’s best for your spouse.
New York Medicare beneficiaries have 249 Medicare Advantage plans from which to choose. Here’s a brief intro to the five types of plans that are offered in New York:
Health Maintenance Organization ( HMO ): HMO plans typically require you to stay within their provider network, choose a primary care physician ( PCP ), and get a referral to see a specialist. For more flexibility, look for an HMO-POS plan, which allows you to go out-of-network.
Preferred Provider Organization (PPO): PPO plans offer more options but cost a bit more. You can choose to stay in-network or go out-of-network for your care. Plan members don’t need to have a PCP or get referrals to see specialists.
Private Fee-for-Service ( PFFS ): These plans look attractive because you can see any provider who accepts the health insurance company ‘s payment terms. But sometimes, this is easier said than done; not all healthcare providers will work with PFFS plans.
Special Needs Plan ( SNP ): Each SNP is tailor-made for individuals with a particular medical condition or need. This ranges from people suffering from end-stage renal disease to individuals who receive long-term care in a private nursing facility.
Medical Savings Account ( MSA ): These are high- deductible insurance plans that feature a savings account component. You can pay for medical expenses with money in the tax-advantaged account.
All the Medicare Advantage (MA) plans listed above give you prescription drug coverage, so there’s no need to add Part D coverage to those. Certain MA plans, PFFS and MSA, do not offer prescription drug coverage, so you can add a stand-alone Part D plan to those. When in doubt about your coverage, call your plan provider to determine what you can and cannot do without jeopardizing enrollment in your current plan.
Most people can join Medicare when they turn 65. Some people are dual-eligible for Medicare and Medicaid and start receiving benefits earlier.
If you have any questions about eligibility, you can contact your local Social Security office, visit Medicare.gov, or call 1 (800) 633-4227. TTY users can call 1 (877) 486-2048.
You can change it! You have to wait until the designated time, but you have the opportunity to do so once a year. You can switch between Original Medicare and Medicare Advantage during the Open Enrollment Period, which runs from October 15 to December 7.
If you want to switch from one MA plan to another, you can do so during the Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31.
Don’t waste time poring over plan options on insurance company websites or talking to an insurance agent. You can find the essential details of Medicare Advantage plans in one place, thereby seeing how they stack up against one another.
Remember that not everyone is going to need the same features in their health plan. Some may want a premium-free plan, others might wish for no deductible, and others may want to be sure they can get their diabetes medications and supplies at no extra cost. Consider what is most important to you, your health, and your budget as you compare plans.
And don’t forget to compare New York Medicare Advantage plans with the Insurify Medicare comparison tool. Uncover plan options in your area at no cost to you. Try it today!
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