Medicare Supplement Insurance has been a go-to, trusted tool for lowering out of pocket spending on healthcare for decades. It is relied upon by millions of people, and is a product you should consider as part of your overall plan to take full advantage of your Medicare benefits. Read this article to learn all about how Medicare Supplement Plans in New York work, and why you should consider enrolling in one.
You might wonder if you need to add any additional coverage to your Medicare benefits. After all, Part A and Part B combine to provide comprehensive and affordable coverage. This is a foundational fact to remember about Original Medicare, though: it leaves you exposed to out of pocket costs. By design, Medicare requires you to pay for part of the cost for your care. These costs are:
With the exception of the Part A deductible, which is $1,600 for 2023, none of these costs are particularly large. The problem is that these costs are all uncapped. There is no limit on how much you can spend with basic Part A and Part B coverage.
Besides the Part A deductible, Part B co-insurance can really add up throughout the year. Once you pay the small Part B deductible ($226 for 2023), you will be responsible for paying 20% of the cost for all of your Part B services for the rest of the year. When you consider that major treatments like chemotherapy are covered under Part B of Medicare, you can get a feeling for how high these costs can be.
Since costs can be potentially unlimited, people frequently turn to Medicare Supplement Insurance to protect against unbearably high medical expenses.
Medicare Supplement Insurance was created specifically to help with these costs. These plans are designed to integrate with your Original Medicare coverage. As supplemental policies, they pay only what Medicare doesn’t pay; they don’t provide any actual coverage on their own.
Medicare Supplement Plans, which are regularly called Medigap Plans, are standardized in 47 states and Washington, D.C. New York is one of the standardized states. In these states, the benefits for Medigap plans have been codified into ten standardized plans, plus two high deductible options. These Medigap plans are known by letter: A, B, C, D, F, G, K, L, M, and N. Each one of these plans covers a unique number of costs. Since there is a spectrum of coverage available, you can choose the level you’re comfortable with. That way you don’t pay for more coverage than you need. The benefits are exactly the same in all of the standardized states. This means that the benefits and coverage provided by Plan D in New York is exactly the same as Plan D in Florida, or any of the other standardized states. This is true regardless of which insurance company you use.
Medigap plans are simply an enhancement of your Original Medicare coverage. They do not impose any network or referral restrictions on you. You retain total freedom when it comes to choosing medical providers.As long as a provider accepts Medicare patients, you can see them.
It is very simple to use your Medigap plan coverage. When you see a medical provider, you’ll give them both your Medigap and Original Medicare card. Your provider will bill Original Medicare as the primary payer. As long as you’ve met your deductible for Part B, Medicare will pay 80% of the cost for your care. Your provider will also bill your Plan for the remaining 20%. Depending on which standardized plan you’ve chosen, your plan will pay most, or all, of your share of cost. This will continue for the entire year, so you can see how limited your out of pocket costs can be with Medigap coverage.
To give you an idea of how different the benefits are for each of the standardized plans, we will compare the benefits for the most basic plan (Plan A) and the most comprehensive plan (Plan G).
Plan A is the most basic, least comprehensive plan available; it covers the fewest expenses, and is also the least expensive. Plan A will cover:
Plan A doesn’t provide any help with:
This is the most robust plan available to people who become eligible for Medicare after December 31, 2019. Plan G will provide 100% coverage for all of your expenses except for the Part B deductible. You pay the Part B deductible once during the year and then Plan G will cover all of your expenses for the rest of the year. Plan G also provides international emergency coverage. For this reason, it is usually the most expensive Plan available.
To enroll in a Medicare Supplement Plan, you have to be fully enrolled in Original Medicare. This means that both your Part A and Part B coverage needs to be in effect. Traditionally, this happens when you turn 65 years old. When you turn 65, you enter your Initial Election Period (IEP) for Medicare. This seven month window is your opportunity to enroll in Parts A and B. If you’re already receiving Social Security retirement income, you’ll be automatically enrolled. If you’re not yet receiving Social Security, you’ll have to manually enroll in Medicare. Once your Part A and B coverage is active, you can enroll in a Medigap plan.
In many states, it can be difficult or impossible to enroll in Medigap if you enter Medicare before age 65. However, Medicare Supplement Plans in New York are required to accept people under age 65. They are also prohibited from charging higher premiums for people under 65.
No. In New York, Medigap plans are prohibited from setting premiums based on your age.
Yes. New York allows you to enroll in any Medigap plan available at any time of year on a guaranteed issue basis.
No. You need a separate Part D drug plan to cover your medications.
No. They don’t cover routine dental, vision, or hearing. Consider adding standalone dental, vision, and hearing coverage.
Yes. You can do this once per year, during the Medicare Annual Election Period (AEP).
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Participating sales agencies do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1–800–MEDICARE to get information on all of your options.
Participating sales agencies represent Medicare Advantage [HMO, PPO, PFFS, and PDP]organizations that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.
Enrollment in the described plan type may be limited to certain times of the year unless you qualify for a special enrollment period.
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