What Are Some Of The Benefits Of Medicare Advantage
One benefit of Medicare Advantage plans is that many plans also cover extra benefits such as routine dental and vision care, hearing, or wellness programs. Some plans, known as Medicare Advantage Prescription Drug plans, also include prescription drug coverage. In other words, these plans cover all of your Medicare medical and prescription drug benefits through a single plan.
Another important benefit that Medicare Advantage plans offer is that these plans are required to include a maximum out-of-pocket spending limit, which can vary from plan to plan. Once your out-of-pocket expenses have reached this amount , the Medicare Advantage plan pays 100% of covered health-care costs for the rest of the year. Notably, Original Medicare doesnât include an annual spending limit, so thereâs no cap on how much you could spend on health care in a given year. If you have chronic conditions that require a lot of ongoing care or if you have a medical emergency, your out-of-pocket costs could quickly skyrocket.
Want to learn more about Medicare Advantage? Hereâs an informative video on types of Medicare Advantage plans that may be available in New York and other states.
Sign Up: Within 8 Months After You Or Your Spouse Stop Working
- Most people dont have to pay a premium for Part A . So, you may want to sign up for Part A when you turn 65, even if you or your spouse are still working.
- Youll pay a monthly premium for Part B , so you may want to wait to sign up for Part B.
Avoid the penalty & gap in coverageIf you miss this 8-month Special Enrollment Period, youll have to wait to sign up and go months without coverage. You might also pay a monthly penalty for as long as you have Part B. The penalty goes up the longer you wait to sign up. How much is the Part B late enrollment penalty?
Medicare In New York Medicare Advantage
You may opt to enroll in a Medicare Advantage plan in New York as an alternative way to get your Original Medicare benefits. Medicare Advantage plans are offered by private insurance companies that contract with CMS. Also known as Medicare Part C, these plans must provide at least the same level of Medicare coverage as Original Medicare, Part A and Part B, with the exception of hospice care.
To be eligible for Medicare Part C, you must be entitled to Medicare Part A, be enrolled in Medicare Part B, and live in the Medicare Advantage planâs service area. You also canât have end-stage renal disease . Youâll need to keep paying your Medicare Part B premium, in addition to any premium required by your Medicare Advantage plan. Medicare Advantage members pay the equivalent of their Medicare premium and may also pay an additional premium directly to their plans.
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Who Is Eligible For Medicare In New York
You may have Medicare eligibility in New York if youre a U.S. citizen or a permanent legal resident who has lived in the U.S. for more than five years and one or more of the following applies to you:3
- You are 65 or older.
- You have been on Social Security Disability Insurance for two years.
- You have end-stage renal disease or Lou Gehrigs disease.
The Parts Of Medicare
Social Security enrolls you in Original Medicare .
- Medicare Part A helps pay for inpatient care in a hospital or limited time at a skilled nursing facility . Part A also pays for some home health care and hospice care.
- Medicare Part B helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services.
Other parts of Medicare are run by private insurance companies that follow rules set by Medicare.
- Supplemental policies help pay Medicare out-of-pocket copayments, coinsurance, and deductible expenses.
- Medicare Advantage Plan includes all benefits and services covered under Part A and Part B prescription drugs and additional benefits such as vision, hearing, and dental bundled together in one plan.
- Medicare Part D helps cover the cost of prescription drugs.
Most people age 65 or older are eligible for free Medicare hospital insurance if they have worked and paid Medicare taxes long enough. You can sign up for Medicare medical insurance by paying a monthly premium. Some beneficiaries with higher incomes will pay a higher monthly Part B premium. To learn more, read .
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Can I Get Medicare At Age 55
Like those who retire at 62, those who retire at age 55 are not eligible for Medicare. While you may be eligible for Social Security benefits, this is not the same as Medicare healthcare coverage.
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The only time you qualify for Medicare before age 65 is if you have been diagnosed with specific conditions or have been receiving Social Security disability benefits for 24 months.
What If Your Medicare Card Didnt Arrive
If youre expecting to receive a Medicare card but havent yet received one three months before your 65th birthday, the first thing to do is to not worry. Medicare sends out hundreds of thousands of cards per year without issue. Its possible for the card to be delayed or for there to be an error. To confirm whether a Medicare card is heading your way, check with your local Social Security office to make sure that youre enrolled.
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More Answers: Changing From The Marketplace To Medicare
- Can I get help paying for Medicare?
If you need help with your Part A and B costs, you can apply for a Medicare Savings Program.
You may also qualify for Extra Help to pay for your Medicare prescription drug coverage if you meet certain income and resource limits.
- What if Im eligible for Medicare, but my spouse isnt and wants to stay covered under our current Marketplace plan?
If someone gets Medicare but the rest of the people on the application want to keep their Marketplace coverage, you can end coverage for just some people on the Marketplace plan, like a spouse or dependents.
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Another type of Medicaid program is Early and Periodic Screening, Diagnostic, and Treatment . This program is available to individuals under the age of 21 who live in households that meet certain financial criteria. This type of Medicaid also has an age restriction and could therefore also be considered age-based.
ABD and EPSDT are required by federal law to be included in all state Medicaid programs. But as long as certain federal requirements are met, state Medicaid programs are free to offer their own Medicaid benefits and eligibility guidelines to people who might not otherwise be eligible for these two programs. Age may or may not play a role, depending on where you live.
For example, Medicaid in North Carolina is only available to those age 65 and over or 21 and under unless you are pregnant, are responsible for a child age 18 and under, disabled or require long-term care.
But in North Dakota, Medicaid is available to all low-income adults, regardless of age.
It could be said that Medicaid is age-based in some states and for some programs, but it is not universally age-based.
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Other Ways To Get Medicare Coverage At Age 65
If you dont qualify for premium-free Medicare Part A coverage, you may be eligible to buy coverage. However, you must still be a U.S. citizen or a permanent resident for at least five years to qualify.
Other Medicare Eligibility Options
- You can pay premiums for Medicare Part A hospital insurance. Premium costs vary based on how long you have worked and paid into Medicare.
- You can pay monthly premiums for Medicare Part B medical services insurance. Youll pay the same premiums as anyone else enrolled in Part B.
- You can pay monthly premiums for Medicare Part D prescription drug coverage. Your premium will be the standard rate and would depend upon the plan you choose.
How Does Medicare Work In New York
If youve established that you are eligible for Medicare, its time to review your choices. You can opt for the governments Original Medicare or choose an all-in-one plan from a private insurance company.
There are four parts of Medicare:
- Part A, which covers inpatient hospital care)
- Part B, which covers outpatient services like doctor visits
- Part C or Medicare Advantage, which combines Parts A and B
- Part D, which covers prescription drugs
Medicare Parts A and B are Original Medicare. With this option, you can add to your coverage with a separate Part D prescription drug plan and a Medicare Supplement plan, both of which are sold by insurance companies.
Over 1.5 million New Yorkers are enrolled in a Medicare Advantage plan,2 which means their Medicare benefits are provided by a private insurance company. Medicare Advantage bundles Parts A & B into a single plan and often includes additional coverage such as prescription drugs, dental, and vision.
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Some Ways To Get Medicare Before Age 65
Anyone with a disability may qualify for Medicare before age 65. Most people younger than 65 who receive Social Security Disability Insurance benefits can get Medicare 24 months after they become eligible for disability benefits.
How Could Lowering The Medicare Age Affect Out
What is current policy? The Medicare Savings Program is a Medicaid pathway that helps to cover Medicares premiums and/or cost-sharing requirements for current Medicare enrollees with low income and limited assets. This is an important consideration because Medicares premiums and cost-sharing are higher than those under Medicaid, which limits the populations who can be subject to premiums and has nominal cost-sharing. Box 1 summarizes current Medicare out-of-pocket costs and the assistance available through MSP.
Box 1: Medicare Out-of-Pocket Costs and the Medicare Savings Program
Medicare Part A, which covers inpatient hospital services, has an annual deductible of $1,484 in 2021. Medicare Part A also requires co-insurance for hospital stays over 60 days. Most Medicare beneficiaries qualify for Part A without a premium, based on their work history. Medicare Part B, which covers outpatient services, requires a monthly premium of $148.50 for most beneficiaries in 2021. Part B also requires an annual deductible of $203 in 2021 and co-insurance of 20% of the Medicare-approved cost of services after the deductible is met.
To help low-income enrollees afford Medicares out-of-pocket costs, state Medicaid programs must offer three MSP pathways:
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Tips For Enrolling In Medicare In New York
When deciding which type of plan works best for you, consider the following:
- Out-of-pocket costs. Monthly plan premiums arent the only cost to consider as you compare plans. Youll also pay coinsurance, copayments, and deductibles until you meet your plans annual out-of-pocket limit.
- Services covered. All Medicare Advantage plans cover Medicare parts A and B services, but other covered services may vary. Make a list of services youd like your plan to cover, and keep your wish list in mind as you shop around.
- Doctor choice. Medicare plans generally have a network of doctors and other healthcare providers. Before you choose a plan, make sure your current doctors are in the network.
- Star ratings. The Centers for Medicare & Medicaid Services Five-Star Rating System can help you find high-quality plans. CMS ratings are based on customer service, care coordination, healthcare quality and other factors that affect you.
- Healthcare needs. If you have a chronic health condition, such as diabetes or HIV, you may want to look for a Special Needs Plan. These plans offer tailored coverage for people with specific health conditions.
What Is Open Enrollment For Medicare
During the federal Open Enrollment period, current or newly eligible Medicare beneficiaries, including people with Original Medicare, can review current health and prescription drug coverage, compare health and drug plan options available in their area, and choose coverage that best meets their needs. This is the time when Medicare eligible individuals can enroll in Medicare Advantage and Medicare Part D prescription drug plans.
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Other Ways To Get Medicare Coverage
If you do not qualify on your own or through your spouses work record but are a U.S. citizen or have been a legal resident for at least five years, you can get full Medicare benefits at age 65 or older. You just have to buy into them by:
- Paying premiums for Part A, the hospital insurance. How much you would have to pay for Part A depends on how long youve worked. The longer you work, the more work credits you will earn. Work credits are earned based on your income the amount of income it takes to earn a credit changes each year. In 2022 you earn one work credit for every $1,510 in earnings, up to a maximum of four credits per year. If you have accrued fewer than 30 work credits, you pay the maximum premium $499 in 2022. If you have 30 to 39 credits, you pay less $274 a month in 2022. If you continue working until you gain 40 credits, you will no longer pay these premiums.
- Paying the same monthly premiums for Part B, which covers doctor visits and other outpatient services, as other enrollees pay. In 2022 the amount is $170.10 for individuals with a yearly income of $91,000 or less or those filing a joint tax return with $182,000 in income or less. Rates are higher for people with higher incomes.
- Paying the same monthly premium for Part D prescription drug coverage as others enrolled in the drug plan you choose.
You can enroll in Part B without buying Part A. But if you buy Part A, you also must enroll in Part B.
You can get Part D if youre enrolled in either A or B.
Medicare Advantage In New York
Medicare Advantage plans are another option. These bundled plans must cover everything in original Medicare, and they often include prescription drug coverage, too. Depending on the plan, you could also get other types of coverage, such as dental care, vision care, or even gym memberships.
When you start shopping for Medicare plans in New York, youll notice there are plenty of options. Here are some of the insurance companies that sell Medicare Advantage plans in New York for 2022:
In total, you have 12 different types of Medigap plans that are available to choose from this year if you live in New York.
In New York State, youre eligible for Medicare if you fall into one of the programs eligibility groups:
- youre age 65 or older
- youre under age 65 and have received Social Security Disability Insurance for 24 months
- you have end stage renal disease or amyotrophic lateral sclerosis
If you qualify for Medicare based on your age, your first chance to apply is during your initial enrollment period. This period starts 3 months before the month you turn 65 and ends 3 months after your birthday month. You can sign up for Medicare at any time during this 7-month period.
If you miss your initial enrollment period, you can sign up for Medicare during the General Enrollment Period. This runs from every year. Note that if you sign up late, you may need to pay higher monthly premiums for your coverage.
Medicare Resources In New York
New York State Office for the Aging â The New York State Office for the Aging is one of the most comprehensive resources for information about Medicare. The office provides information and services to seniors to help them live independently well into their retirement years. The state office features a local branch in every county. The Medicare services provided by this office include the following three programs:
- Health Insurance Information Counseling and Assistance Program â This program, also referred to as HIICAP, offers free counseling to New York Medicare beneficiaries. Since the office is not affiliated with any specific insurance companies, counseling services are unbiased.
- NY Connects: Choices for Long-Term Care â When beneficiaries require long-term care, this program provides information about the options available. In addition, local offices in each county ensure that beneficiaries have easy access to personalized counseling services.
- Senior Medicare Patrol â These programs are created to help New York Medicare beneficiaries protect themselves from fraud through education, detection, and prevention. The program also educates beneficiaries about what to do in the event of an error on their billing claim.
For information about the specific plan options available in your community, use the eHealth plan finder tool on this page and enter your zip code.