5 Important Things to Look at When Selecting a Medicare Advantage Plan in New York City

5 Important Things to Look at When Selecting a Medicare Advantage Plan in New York City
Nowadays, there are so many Medicare Advantage Plans to select from in New York City, that finding the right one can take become a long and gruesome process.

Nowadays, there are so many Medicare Advantage Plans to select from in New York City, that finding the right one can take become a long and gruesome process. Every insurance has their perks, therefore, here are a few highlighted items to look for when selecting your Medicare Advantage Plan, which can guide you in selecting the plan that will ultimately work for you. Seniors and Retirees Are Flooded With so Many Medicare Advantage flyers and mailers almost every quarter. During the Open Enrollment Period, which is from October 15- December 7th of each year in New York, during Medicare OEP from January 1st- March 31st and throughout the year- retirees keep getting bombarded with TV commercials, mailers, and unexpected phone calls from Brokers, Agents, and tele sales from various insurance plans.

In New York City Alone, There Are Over 15+ Medicare Advantage Plans , And Each Year New Plans Appear. Here’s a List of Some of The Common Plans in New York:

  • Elderplan
  • Health First
  • Wellcare
  • Emblem
  • United Health Care
  • Aetna
  • Empire
  • Humana
  • Bright Health
  • Village Care
  • Fidelis
  • Metroplus
  • Senior Whole Health
  • Age Well
  • Centers Plan

With So Many Options to Choose From, Seeking Help From a Medicare Health Advisor Who Will Review All The Options For You May Be a Good Option

5 Important Things to Look at When Selecting a Medicare Advantage Plan in New York City

When speaking with insurance brokers, you should note that they may not be contracted with all the plans…

so the options your broker or agent may offer you may be limited to plans the are contracted with, or in some cases, plans that pay out a higher commission. This is a common issue with Brokers in NYC. If seeking help from an agent who works directly for a Medicare Advantage Plan, they may give you a biased opinion and try to sell the current plan they work for – its just part of their job!

Seeking Guidance From a Medicare Health Advisor Plays a Vital Role

Here are some questions to ask yourself in determining if a  Medicare Health Specialist would be right for helping you select the coverage you need.

  • Is the Medicare Advisor experienced in all available plan options?
  • Are they licensed to sell Medicare plans in various States?
  • Do they understand union and group coverage plans and how the work? Especially if your Union or Group coverage is terminated after you retire?
  • Are they certified with the New York State Marketplace?
  • Do the understand how New York State Assistance Programs like Extra Help, Medicare Savings Program (MSP), EPIC Work?
  • Do they work with organizations that can help sponsor specialty medications ( organiztions like Accredo or Public Health Solutions) ?

Once you check off all the questions above with the advisor of your choice, they would be the  right person to get advice from, and a wealth of knowledge you can benefit from greatly. Medicare Health Advisors  who possess the knowledge in the matrix above play essential for you in getting the right guidance and help in select the right coverage for you.

Now That We Have a Better Understanding in How to Select The Right Advisor For You, Lets Get into The Nitty Gritty as to How Medicare Advantage Plans Work: provides a concise explanation as to the nature of Medicare Advantage Plans and how they work.  So how to Medicare Advantage Plans work? Medicare Advantage Plans, are also known as MA Plans, or MAPD Plans or are considered as Part C of Medicare. People who have Medicare A and Medicare Part B, with both parts effective, have the option to select a Medicare Advantage Plan given the fact they have a special election.  Medicare Advantage plans coordinate the Hospital and Medical benefits, and are usually integrated with prescription drug coverage ( part D).  They are offered by private insurance plans approved by Medicare. Once joining a plan, they provide additional benefits not offered by Original Medicare, and offer a bundle of benefits that can help you save money on your health care costs.

What Are Some Covered Services Offered My Medicare Advantage Plans in New York?

Most Medicare Advantage Plans provide coverage for vision, hearing, dental gym membership. Certain plans even provide coverage for non-emergent transportation to your doctors, and over the counter ( OTC) benefits which allow you to purchase health related products live vitamins, minerals, creams, oral products, and Medicare Part B Give back benefits, and more.

The Nature of Medicare Advantage Plans

Certain Medicare Advantage Plans do have a premium for part C + Part D. Usually the offer 0 or low monthly premiums, that is of course dependent on the types of plans. In many cases, Medicare Advantage Plans have a network for participating providers you can see. If a provider is not in network, you would have to incur paying for the visit. Seeking in-network providers is important. Certain Medicare Advantage plans can offer out of network benefits, and they are commonly referred to as PPO plans, or POS plans.  Selecting a plan that offers out of network benefits comes at a cost, but can be beneficial at times, especially if you like to travel in the United States and see providers in different states and not being confined in seeing providers only in the New York City Downstate Region.

Drug Coverage in Medicare Advantage Plans:

Most Medicare Advantage Plans are integrated with prescription drug coverage. Each plan has it’s own formulary of medications that they cover. Checking to see if they cover your medication, and the co-pay amounts is important. Each Medicare Plan can have a different prescription drug deductible ( the amount you have to spend out of pocket, before the insurance picks up some of the cost), which can apply in different prescription drug tiers. It’s important to review each plans formulary, deductible responsibility, and other intricate details. For people who have Union coverage after the retire, keep in your union may allow you to join a Medicare Advantage Plan (if they grant permission), but you must go through your union administrator.

Now That we have a Better Understanding as the Nature of Medicare Advantage Plans & How They Work, Here Are The 5 Important Benefits to Consider Looking Into  When Selecting a Medicare Advantage Plan:


5 Important Things to Look at When Selecting a Medicare Advantage Plan in New York City

According to a new national pool most older Americans over 65  prefer to have insurance coverage that provides dental benefits

Most Medicare Advantage plans provide dental coverage,  but with yearly limits. When reviewing the dental benefits offered by Medicare Advantage Plans, it’s important to check whether the dental includes comprehensive and preventative dental coverage, and whether limits apply. Comprehensive dental includes coverage for dentures, extractions, root canals, fillings, crowns and more. Preventative dental provides coverage for cleaning, x-ray and checkups.  Knowing the yearly limits on the dental is important. For instance, if your plan offers comprehensive dental benefits, but the yearly limit is 500, although you have comprehensive dental coverage, what will it cover if the limit for the year is 500? This means that if you need a root canal, and the cost of the root canal is 1,000, with your yearly plan limit, the insurance will only pay up to 500 dollars for the year, once the procedure gets approved.  There are Medicare Advantage Plans that don’t have yearly limits, and selecting a plan which offers comprehensive and preventative dental overage with no yearly limits and 0 or low copays for various procedures can save you a lot of money.


5 Important Things to Look at When Selecting a Medicare Advantage Plan in New York City

Getting vision coverage is important, especially for the yearly Glaucoma and Cataract checkups

It’s important to review the details of the vision benefits. Most Medicare Advantage plans offer a certain amount annually, or bi-annually for lenses, frames, contacts, or upgrades. For instance, some insurances give any where from 100-500 dollars once a year, or once every 2 years. Also, making sure your have medical coverage for your eyes is important, especially if you need eye treatment, and cataract surgery.

Over the Counter:

5 Important Things to Look at When Selecting a Medicare Advantage Plan in New York City

Many Medicare Advantage Plans in New York provide OTC benefits

OTC benefits help you get health products like Tylenol, Dayquil, Motrin, Aspirin, Vitamins, Minerals, Sanitation Wipes, Alcohol Rup, Tiger Balm and more. There are thousands of products you can get on the OTC card, and this can help you save a lot of money throughout the year. It’s important to check the actual amount offered on the OTC card, and whether that benefit comes on the first of every month, or quarterly.  For instance, the Medicare Advantage of your choice provides OTC benefits of 45 dollars. Is the 45 dollars provided every month or quarterly, and does the OTC amount roll over? It’s important to ask these questions. Each Medicare Advantage Plan has a list of approved items you can get, and as of 2021, certain plans allow you to get food products as well.  This helps money on items not covered by your prescription drug plan and help you get health items that may serve you a good purpose.


5 Important Things to Look at When Selecting a Medicare Advantage Plan in New York City

Some Medicare Advantage Plans offer transportation to and from your providers office

Having access to transportation at no cost definitely a good benefit, especially if you need to see a doctor in New York City who’s far from home. The transportation benefits are non-emergent, have to be ordered 2-3 days in advance, cover private taxi or ambulette service, and can be used the same day if you have an emergency and need to go to the urgent care or hospital. You can have 1 person accommodate you as well in your travels, and wheelchair accessible vehicles are also available upon request. This helps you have on your transportation costs.

World Wide Emergency Coverage:

5 Important Things to Look at When Selecting a Medicare Advantage Plan in New York City

You can set your mind at ease if your planning to travel internationally or cross borders

Having emergency coverage not only in your home state is a great benefit to have, especially if your traveling to another state or country. This benefit offers coverage for emergencies only, and most Medicare Advantage plans will provide full coverage upon the receipt of the hospital bill. This benefit is good to have and will help you have on your emergency needs.


5 Important Things to Look at When Selecting a Medicare Advantage Plan in New York City

There are many Medicare Advantage Plans in New York which offer out of network benefits

The two that are most common plans which offer out of network benefits in New York City are known as PPO Medicare Advantage plans or POS Medicare Advantage plans.

PPO plans, or preferred provider organization, have a network of providers and hospitals, and they allow you to go out of network for a greater cost. In other words, you pay more if you use doctors, hospitals, and doctors outside of the network. The health insurer has pre negotiated contracts with PPO network providers. You don’t have to select a Primary Care Doctor, don’t need a referral to see specialists, and don’t need to get prior authorization for services covered out side of the network. The deductible amounts you pay for your in network and out of network are combined.

POS plans are not that different. They are both types of health plans which allow you to see doctors and go to hospitals outside of your network for a greater cost. With PPS plans, you need to select a primary care doctor. You don’t need a referral to see a specialist, but you do need to get prior authorization before you get certain service. POS plans may have separate deductibles in regards the care you receive in-network, and providers you receive care from out of network. These deductibles can not be combined.

The 5 important benefits to consider as described above are just a few highlighted areas that can help you select the right Medicare Advantage Plan in New York City, but are not limited to other important things you must review before making your final selection. For greater help or assistance, follow the five question matrix we provided earlier to ensure you get the right help from a professional Medicare Health Advisor who you can determine to be the right fit for you.



Nowadays, there are so many Medicare Advantage Plans to select from in New York City, that finding the right one can take become a long and gruesome process.

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