Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
Medicare Advantage policies provide the same benefits as Medicare Parts A and B and are an alternative to Original Medicare coverage. Eligible people can buy Medicare Advantage policies from approved private insurance companies. Unlike Original Medicare, many Medicare Advantage Plans cover prescription medications (Part D) and other benefits, such as vision and hearing care. Although insurers must offer Medicare Advantage enrollees at least the same benefits as Original Medicare, additional coverage varies significantly between providers.
Key differences exist between Medicare Advantage policies and Original Medicare. Original Medicare offers coverage across the entire United States, while Medicare Advantage usually requires network providers. While some plans cover out-of-network services, these can be more expensive. Out-of-pocket costs in Medicare Advantage vary, potentially higher or lower than Original Medicare, but Advantage Plans cap annual costs, unlike Original Medicare’s unlimited out-of-pocket expenses.
Between 2022 and 2023, the number of people enrolled in Medicare Advantage Plans in New York rose by 7.27%. Therefore, the increase in enrollees was lower than the national average of 9.75%. Increases in Medicare Advantage eligibility were also lower in New York than in the United States as a whole. Eligibility in New York rose by 2.2%, compared to an increase of 2.66% across the U.S. 4.96% more of the people eligible for Medicare Advantage purchased a plan in 2023 than in 2022.
This guide on Medicare Advantage Plans in New York state provides individuals with valuable information about the diverse range of plans accessible. It outlines the benefits offered by these plans and clarifies the eligibility criteria for coverage. Additionally, the guide presents useful information regarding the application procedure for Medicare Advantage in New York, offering seniors a clear, comprehensive resource to make informed decisions.
The Top 10 Medicare Advantage Plans in New York
Many companies offer Medicare Advantage Plans in New York. Therefore, Medicare-eligible seniors have plenty of options when selecting a Medicare Advantage policy. The table below shows the state’s 22 most popular Medicare Advantage insurers by the number of people enrolled. Most insurance companies selling Medicare Advantage Plans in New York offer multiple policy types, so the list displays costs as a range. Furthermore, the table lists enrollment numbers as a total across all Medicare Advantage Plans for each provider as of July 2023. Medicare.gov provides up-to-date information on New York enrollment figures and Medicare Advantage options.
Name
Enrollment
Medicare Star Rating
Monthly Cost Range
Plan Types
Healthfirst Medicare Plan
255556
3
$0 – $30
PPO, HMO
Humana
224980
4
$0 – $114
PPO, HMO
UnitedHealthcare
220437
3.5
$0 – $82
PPO, HMO
Aetna Medicare
220377
3.5
$0 – $97
PPO, HMO
Wellcare
98398
2.5
$0 – $155
PPO, PFFS
Highmark Inc.
89816
5
$0 – $208
HMO
EmblemHealth Medicare HMO
75006
3
$0 – $254
HMO
Empire BlueCross BlueShield
73693
2.5
$0 – $91
PPO, HMO
Independent Health
65798
5
$0 – $225
PPO, HMO
Blue Cross Blue Shield of Michigan
56523
3
$0 – $17
HMO
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.
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?
Preventive Screenings
Yes
Yes
Hospital Care
Yes
Yes
Durable Medical Equipment
Yes
Yes
Prescription Drugs
No
Yes**
Vision Care
No
Yes*
Dental Care
No
Yes*
Hearing Aids
No
Yes*
*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.
Start Date
End Date
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
October 15th
December 7th
Medicare Advantage Open Enrollment Period
January 1st
March 31st
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.
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.
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.
Contact Info
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 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 [email protected]. To find out more information on chapters and events, interested parties should visit the regional section of StateWide’s website.
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.
