Medicare Advantage Plans in New York
An alternative way to receive your Medicare benefits through private insurance plans approved by Medicare
Explore Medicare Advantage Options
A licensed insurance professional can help you understand the Medicare Advantage plans available in your area.
Important Notice
This information is for general educational purposes only and does not constitute insurance advice or plan recommendations. Medicare Advantage plans vary by carrier, plan type, and service area. Actual benefits, costs, and coverage are subject to the terms of the plan as issued. Contact a licensed insurance professional to discuss plan options available in your area.
What Is Medicare Advantage (Part C)?
Medicare Advantage (also known as Medicare Part C) is an alternative to Original Medicare offered by private insurance companies that are approved by and contract with Medicare. When you join a Medicare Advantage plan, you still have Medicare, but you receive your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage through the plan rather than through Original Medicare.
Medicare Advantage plans must cover all the services that Original Medicare covers, but they may do so with different costs and restrictions, such as requiring you to use network providers. Many Medicare Advantage plans also offer additional benefits not available through Original Medicare, which may include prescription drug coverage, dental, vision, hearing, and wellness programs.
One key difference is that Medicare Advantage plans are required to have an annual out-of-pocket maximum for covered services, which Original Medicare does not have. This means there is a limit on the total amount you may pay out of pocket in a given year for covered services received from in-network providers.
Original Medicare vs. Medicare Advantage
Understanding how Medicare Advantage compares to Original Medicare can help you evaluate which option may fit your situation:
| Feature | Original Medicare | Medicare Advantage (Part C) |
|---|---|---|
| Coverage | Part A (Hospital) and Part B (Medical) | Part A and Part B, often including Part D (Prescription Drugs) |
| Provider Choice | Any doctor or hospital that accepts Medicare nationwide | Typically requires network providers (varies by plan type) |
| Out-of-Pocket Maximum | No annual out-of-pocket maximum | Required annual out-of-pocket maximum for in-network services |
| Prescription Drugs | Requires separate Part D plan | Often included in the plan (MA-PD) |
| Extra Benefits | Does not include dental, vision, or hearing coverage | May include dental, vision, hearing, fitness, and other benefits |
| Referrals | No referral needed to see a specialist | May require referrals (HMO plans typically do; PPO plans typically do not) |
| Supplemental Insurance | Can add a Medigap (Medicare Supplement) policy | Cannot use a Medigap policy with a Medicare Advantage plan |
Plan features vary by carrier, plan type, and service area. This comparison represents general characteristics. Always review specific plan documents for details.
Types of Medicare Advantage Plans
Medicare Advantage plans come in several types, each with different rules for how you access care. The most common types include:
HMO (Health Maintenance Organization)
- ✓Generally requires you to use doctors and hospitals in the plan's network
- ✓May require a referral from your primary care doctor to see a specialist
- ✓Out-of-network care is typically not covered except in emergencies
PPO (Preferred Provider Organization)
- ✓Allows you to see both in-network and out-of-network providers
- ✓Out-of-network care is covered but typically at a higher cost
- ✓Generally does not require referrals to see specialists
PFFS (Private Fee-for-Service)
- ✓Determines how much it will pay providers and how much you pay when you receive care
- ✓You may go to any Medicare-approved provider that accepts the plan's terms
- ✓Providers may choose whether to accept the plan's terms on a case-by-case basis
SNP (Special Needs Plan)
- ✓Designed for people with specific diseases or characteristics
- ✓May serve those who are eligible for both Medicare and Medicaid (dual eligible)
- ✓May serve those who live in certain institutions (such as nursing homes)
Not all plan types are available in all areas. Plan availability varies by county and year. Contact us to learn which plan types are offered in your service area.
What Medicare Advantage Plans May Cover
All Medicare Advantage plans must cover the same services as Original Medicare (Parts A and B). Many plans also offer additional benefits that Original Medicare does not cover:
Hospital & Medical (Required)
- Inpatient hospital stays (Part A)
- Doctor and outpatient services (Part B)
- Preventive services and screenings
- Skilled nursing facility care
- Home health services
- Hospice care (covered by Original Medicare)
Prescription Drugs (Many Plans)
- Part D prescription drug coverage
- Plan-specific drug formulary (list of covered drugs)
- Pharmacy network with preferred pharmacies
- Coverage through the different drug cost phases
Dental, Vision & Hearing (Some Plans)
- Routine dental exams and cleanings
- Eye exams and eyewear allowance
- Hearing exams and hearing aid coverage
- Coverage levels vary widely by plan
Fitness & Wellness (Some Plans)
- Gym membership or fitness programs
- Wellness and health education programs
- Telehealth and virtual visit services
- Nurse advice hotlines
Transportation & Other (Some Plans)
- Transportation to medical appointments
- Over-the-counter health product allowances
- Meal delivery after hospital discharge
- Personal emergency response systems
Chronic Condition Support (Some Plans)
- Chronic condition management programs
- Care coordination services
- Expanded mental health coverage
- Home-based palliative care
Additional benefits vary significantly by plan and carrier. Not all plans offer all benefits listed above. Always review the specific plan's Evidence of Coverage document for details on covered services.
Medicare Advantage Enrollment Periods
There are specific times of year when you can enroll in, switch, or drop a Medicare Advantage plan. Understanding these enrollment periods is important for making timely coverage decisions:
Initial Enrollment Period (IEP)
This is a 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after. This is typically the first opportunity to enroll in a Medicare Advantage plan. If you qualify for Medicare due to disability, your IEP works similarly based on your Medicare eligibility date.
Annual Enrollment Period (AEP)
October 15 through December 7 each year. During this period, you can:
- Switch from Original Medicare to a Medicare Advantage plan
- Switch from one Medicare Advantage plan to another
- Switch from a Medicare Advantage plan back to Original Medicare
- Join, switch, or drop a Part D drug plan
Changes made during the AEP take effect January 1 of the following year.
Medicare Advantage Open Enrollment Period (MA OEP)
January 1 through March 31 each year. If you are already enrolled in a Medicare Advantage plan, during this period you can:
- Switch to a different Medicare Advantage plan
- Drop your Medicare Advantage plan and return to Original Medicare (and optionally join a Part D plan)
Special Enrollment Periods (SEP)
You may qualify for a Special Enrollment Period if you experience certain life events, such as moving to a new area, losing employer coverage, qualifying for Medicaid, or experiencing other qualifying circumstances. SEPs allow you to make plan changes outside of the regular enrollment periods.
Planning Tip: Review your current coverage each year during the Annual Enrollment Period. Plans can change their benefits, costs, and provider networks from year to year. A licensed insurance professional can help you compare options.
Need Help Understanding Your Medicare Options?
Let us help you compare Medicare Advantage plans available in your area and understand how they work with your healthcare needs.
Factors to Consider When Evaluating Medicare Advantage Plans
Provider Network
Check whether your current doctors, hospitals, and specialists participate in the plan's network. If maintaining your existing provider relationships is important, a PPO plan may offer more flexibility.
Prescription Drug Coverage
If the plan includes Part D, review the formulary to verify your medications are covered. Check which tier your drugs fall into and which pharmacies are preferred, as this affects your out-of-pocket costs.
Out-of-Pocket Maximum
Compare the annual out-of-pocket maximum across plans. A lower maximum means your financial exposure is more limited if you need significant care during the year.
Additional Benefits
Evaluate the value of extra benefits like dental, vision, hearing, and fitness programs. These benefits vary widely between plans and may be important depending on your needs.
Star Ratings
Medicare rates plans on a 1-5 star scale based on quality and performance. Higher-rated plans may offer additional benefits. You can review ratings on Medicare Plan Finder.
Travel Considerations
If you travel frequently or spend part of the year in another state, consider how the plan's network works outside your home area. PPO plans typically offer more out-of-area coverage than HMO plans.
Protect Your New Medicare Card
When you receive your new Medicare card, bring it to our office to have it laminated free of charge. You can also bring your old Medicare card to have it shredded securely. Protecting your Medicare number helps prevent fraud and identity theft.
Frequently Asked Questions About Medicare Advantage
What is a Medicare Advantage plan?
A Medicare Advantage plan (also called Part C) is an alternative way to receive your Medicare benefits. These plans are offered by private insurance companies approved by Medicare and must cover everything Original Medicare covers (Part A and Part B). Many plans also include additional benefits such as prescription drug coverage, dental, vision, and hearing services.
Do I still have Medicare if I join a Medicare Advantage plan?
Yes. When you join a Medicare Advantage plan, you still have Medicare. You must continue to pay your Part B premium (and Part A premium if applicable). Your Medicare Advantage plan provides your Part A and Part B coverage instead of Original Medicare.
Can I see any doctor with a Medicare Advantage plan?
It depends on the plan type. HMO plans generally require you to use network providers except in emergencies. PPO plans allow you to see out-of-network providers, though typically at a higher cost. PFFS plans may allow you to see any Medicare-accepting provider who agrees to the plan's terms. Always verify provider availability before enrolling.
When can I enroll in a Medicare Advantage plan?
You can enroll during your Initial Enrollment Period (around your 65th birthday), the Annual Enrollment Period (October 15 - December 7 each year), the Medicare Advantage Open Enrollment Period (January 1 - March 31), or during a Special Enrollment Period if you qualify. A licensed insurance professional can help you understand which enrollment periods apply to your situation.
Can I switch back to Original Medicare from a Medicare Advantage plan?
Yes. You can switch back to Original Medicare during the Annual Enrollment Period (October 15 - December 7) or during the Medicare Advantage Open Enrollment Period (January 1 - March 31). If you switch back, you may want to consider joining a standalone Part D prescription drug plan and may also want to explore Medigap (Medicare Supplement) policies, though guaranteed issue rights for Medigap may be limited depending on your circumstances.
Do Medicare Advantage plans cover prescription drugs?
Many Medicare Advantage plans include prescription drug coverage (known as MA-PD plans). If you enroll in a Medicare Advantage plan that does not include drug coverage, you may be able to join a separate Part D plan. If your plan already includes drug coverage, you generally cannot also enroll in a standalone Part D plan.
Related Medicare Coverage Options
Medicare Advantage is one of several ways to receive your Medicare benefits. Explore these related coverage options:
Medicare Overview
Learn about the different parts of Medicare and how to prepare for enrollment meetings with our team.
Medicare Supplement
Medigap policies that work with Original Medicare to help cover out-of-pocket costs like deductibles and coinsurance.
Medicare Part D
Standalone prescription drug plans for those with Original Medicare who need drug coverage not included in their plan.
Enrollment Guide
A helpful guide to Medicare enrollment periods, timelines, and what to expect when signing up for coverage.
Important Information
This information is provided for general educational purposes only and does not constitute insurance advice or policy recommendations. Coverage features described are examples and may not be available in all policies or from all carriers. Actual coverage is subject to the terms, conditions, and exclusions of the policy as issued. Medicare Advantage plan availability, benefits, and costs vary by carrier, plan type, and service area and may change each plan year. Please consult with a licensed insurance professional to discuss your specific coverage needs and options. Stan Steele Agency is licensed in New York State.
Let Us Help You Explore Medicare Advantage Options
Understanding Medicare can feel overwhelming. Our licensed insurance professionals can help you compare plans, understand your options, and assist with the enrollment process.
How We Can Help:
- ✓ Present Medicare Advantage plan options available in your area
- ✓ Help you understand how plans work with your doctors and medications
- ✓ Compare HMO, PPO, and other plan types
- ✓ Assist with the enrollment process
- ✓ Review your coverage during annual enrollment periods
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