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Information for Medicare Beneficiaries

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Important Protections For Medicare Beneficiaries Residing In New York State

Medicare Advantage Plans | Supplement InsurersRates TablesOutline of Medicare Supplement Coverage

Medigap Information For New York State Residents Being Terminated By Medicare Managed Care Plans (New!)

If you receive notification this Fall from your Medicare Managed Care Plan that it will not be providing coverage in your area after December 31, 2014, you will need to decide to either enroll in another one of the Medicare Managed Care Plans, if one is available in your county, or return to the Original Medicare Plan.

If you are considering returning to the Original Medicare Plan, you are probably also contemplating the purchase of a Medigap policy to help defray some of the costs not covered by Medicare including the Medicare deductibles and co-insurance. Your application for Medigap coverage must be accepted at any time throughout the year and as long as you are enrolled in both Part A and Part B of Original Medicare, you are guaranteed the right to purchase any of the standardized Medigap policies "A" through "N".

Insurers may not deny you a Medigap policy or make any premium rate distinctions because of your health status, claims experience, medical condition or whether you are receiving health care services. However, Medigap policies may contain up to a six-month waiting period before pre-existing conditions are covered. Medigap insurers are required to reduce the waiting period by the number of days that you were covered under certain types of health insurance, including Medicare Managed Care Plan coverage, if you enroll within 63 calendar days of losing coverage.

If you disenroll from the Medicare Managed Care Plan due to any of the reasons described below, you may obtain a Medigap policy without a waiting period for pre-existing conditions even if you were enrolled in the Medicare Managed Care Plan for less than six months. The issuer of a Medigap policy may not impose a pre-existing condition limitation under the policy if you seek to enroll under a Medigap policy within the time limits described below.

If your Medicare Managed Care Plan coverage terminates under either of the situations described above, the Managed Care Plan must provide you with written notification of your right to purchase any Medigap policy on an open enrollment basis without a waiting period for pre-existing conditions. You should not wait until your Managed Care Plan coverage has terminated before applying for a Medigap policy. In order to prevent a gap in coverage, you should apply for a Medigap policy while you are still enrolled in your Managed Care Plan and request that the Medigap coverage begin the same day as your Original Medicare Plan coverage. If you fail to enroll in a Medigap policy within the time limits described above, you may still purchase any of the standardized Medigap plans, however, you may have to satisfy a pre-existing condition waiting period if more than 63 days has passed since enrollment in your Medicare Managed Care Plan has terminated.

Remember, to purchase a Medigap policy, you must contact a private insurance company that sells Medigap policies and request an application. Neither your existing Medicare Managed Care Plan nor the Original Medicare Plan can do this for you. A list of the insurance companies that sell Medigap policies in New York State and the current premium rates appear below. Also appearing below is a list of the Medicare Managed Care Plans that are available in New York State. Note that such Medicare Managed Care Plans may not be available in all counties throughout the state.

The Department will be available to offer assistance through its toll-free telephone number 1-800-342-3736.

Improvements to Medicare's Preventative Care Coverage

As of January 1, 2011, Medicare covers more preventative services. Medicare beneficiaries pay nothing for most preventive services if the services are received from a doctor or other health care provider who participates with Medicare (also known as accepting assignment). For some preventive services, the Medicare beneficiary pays nothing for the service, but may have to pay coinsurance for the office visit to receive these services.

Medicare covers two types of physical exams; one when you're new to Medicare and one each year after that. The Welcome to Medicare physical exam is a one-time review of your health, education and counseling about preventive services, and referrals for other care if needed. Medicare will cover this exam if you get it within the first 12 months of enrolling in Part B. You will pay nothing for the exam if the doctor accepts assignment. When you make your appointment, let your doctor's office know that you would like to schedule your Welcome to Medicare physical exam. Keep in mind, you don't need to get the Welcome to Medicare physical exam before getting a yearly Wellness exam. If you have had Medicare Part B for longer than 12 months, you can get a yearly wellness visit to develop or update a personalized prevention plan based on your current health and risk factors. Again, you will pay nothing for this exam if the doctor accepts assignment. This exam is covered once every 12 months.

General Information About Medicare Supplement Insurance

Medicare Supplement (Medigap) insurance is health insurance that is sold by private insurance companies to cover some of the "gaps" in expenses that are not covered by Medicare. For policies sold before June 01, 2010, there are fourteen standardized plans A through L. For policies sold on or after June 01, 2010, there are 11 standardized plans A through N. Each standardized Medigap policy must provide the same basic core benefits such as covering the cost of some Medicare copayments and deductibles. Some of the standardized Medigap policies also provide additional benefits such as skilled nursing facility coinsurance and foreign travel emergency care. However, in order to be eligible for Medigap coverage, you must be enrolled in both Part A and Part B of Medicare.

As of June 1, 2010, changes to Medigap resulted in modifications to the previously standardized plans offered by insurers. Medigap plans H, I, and J, which contained prescription drug benefits prior to the Medicare Modernization Act, were eliminated. Plan E was also eliminated as it is identical to an already available plan. Two new plan options were added and are now available to beneficiaries, which have higher cost-sharing responsibility and lower estimated premiums:

Certain Medigap benefits were also be modernized. The At-Home Recovery benefit, which was previously offered in only Plans D, G, I, and J was eliminated. In its place, a new Hospice Care benefit was created and was added as a basic benefit available in every Medigap plan. The under-utilized Preventive Care Benefit, which was previously only offered in Plans E and J, was eliminated. The 80 percent Medicare Part B Excess benefit, available in Plan G, was changed to a 100 percent coverage benefit. Insurers are also now required to offer Plans A and B, as well as either Plan C or Plan F. Previously insurers only had to offer Plans A and B.

Individuals enrolled in plans with an effective date prior to June 01, 2010 have the right to keep their existing policies in force. Medicare supplement insurance is guaranteed renewable.

Medicare Supplement (Medigap) insurance is health insurance that is sold by private insurance companies to cover some of the "gaps" in expenses that are not covered by Medicare. For policies sold before June 01, 2010, there are fourteen standardized plans A through L. For policies sold on or after June 01, 2010, there are 11 standardized plans A through N. Each standardized Medigap policy must provide the same basic core benefits such as covering the cost of some Medicare copayments and deductibles. Some of the standardized Medigap policies also provide additional benefits such as skilled nursing facility coinsurance and foreign travel emergency care. However, in order to be eligible for Medigap coverage, you must be enrolled in both Part A and Part B of Medicare.

Open Enrollment

New York State law and regulation require that any insurer writing Medigap insurance must accept a Medicare enrollee’s application for coverage at any time throughout the year. Insurers may not deny the applicant a Medigap policy or make any premium rate distinctions because of health status, claims experience, medical condition or whether the applicant is receiving health care services. However, eligibility for policies offered on a group basis is limited to those individuals who are members of the group to which the policy is issued.

A list of insurers offering Medigap insurance along with the premium rates for each plan are provided below. Note that while every Medigap insurer offers both Plan A and B for policies sold before June 01, 2010, and Plans A, B and either C or F for policies sold on or after June 01, 2010, not every company offers all standardized plans.

Portability

Medigap policies may contain up to a six (6) month waiting period before pre-existing conditions are covered. A pre-existing condition is a condition for which medical advice was given or treatment was recommended or received from a physician within six months before the effective date of coverage. However, under New York State regulation, the waiting period may be either reduced or waived entirely, depending upon your individual circumstances. Medigap insurers are required to reduce the waiting period by the number of days that you were covered under some form of "creditable" coverage so long as there were no breaks in coverage of more than 63 calendar days. Coverage is considered "creditable" if it is one of the following types of coverage:

  1. A group health plan;
  2. Health insurance coverage;
  3. Medicare*;
  4. Medicaid;
  5. CHAMPUS AND TRICARE health care programs for the uniformed military services;
  6. A medical care program of the Indian Health Service or of a tribal organization;
  7. A State health benefits risk pool;
  8. Federal Employees Health Benefits Program;
  9. A public health plan**;
  10. A health benefit plan issued under the Peace Corps Act; and
  11. Medicare supplement insurance, Medicare select coverage or Medicare Advantage plan (Medicare HMO Plan).

*Credit for the time that a person was previously covered under Medicare shall be required only if the applicant submits an application for Medigap insurance prior to or during the six month period beginning with the first day of the first month in which an individual is both 65 years of age or older and is enrolled for benefits under Medicare Part B.

**Any plan established or maintained by a state, the U.S. government, a foreign country, or any political subdivision of a state, the U.S. government, or a foreign country that provides health coverage to individuals who are enrolled in the plan.

NOTE: New York's Open Enrollment and Portability provisions protect you whether you are Medicare eligible by reason of age or disability. The provisions also apply to Medicare beneficiaries with end stage renal disease.

Medicare Select

Medicare Select is a type of Medigap policy that requires insureds to use specific hospitals and in some cases specific doctors (except in an emergency) in order to be eligible for full benefits. Other than the limitation on hospitals and providers, Medicare Select policies must meet all the requirements that apply to a Medigap policy. Medicare Select policies may have lower premiums because of this requirement.

When you use the Medicare Select network hospitals and providers, Medicare pays its share of approved charges and the insurance company is responsible for all supplemental benefits in the Medicare Select policy. In general, Medicare Select policies are not required to pay any benefits if you do not use a network provider for non-emergency services. However, Medicare will still pay its share of approved charges no matter what provider you use.

Currently no insurers are offering Medicare Select insurance in New York State.


Insurers Offering Medicare Supplement Insurance in New York State

Protections | Medicare Advantage Plans | Rates Tables | Outline of Medicare Supplement Coverage (PDF Format)

Insurance Carriers With Approved Standardized Medicare Supplement Benefit Plans (as of December 1, 2014).

Medicare Supplement Insurance Carrier

For carrier contact information, select this link

Pre-Ex Wait (months)

Benefit Plan Offered

ABCDFF+GKLMN

Aetna Life Insurance Company
(Individual)

6XXX 

American Progressive Life & Health Insurance Company of New York
(Individual)

6XXXXX X 

Bankers Conseco Life Insurance Company
(Individual)

6XX  XXXXXXX

CDPHP Universal Benefits, Inc. (CDPHP)
(Individual)

0XX  X     X

Excellus Health Plan, Inc.
(doing business as Excellus BlueCross BlueShield)
(Individual & Group)

6XXXXX  

Excellus Health Plan, Inc.
(doing business as Univera Healthcare)
(Individual & Group)

6XXXXX  

First United American Life Insurance Company
(Individual & Group)

2XXXXXXXXXX

Group Health Incorporated (GHI)
(Individual)

6XXXX

Hartford Life Insurance Company
(Group)

6XXXXX X 

HealthNow New York Inc.
(doing business as BlueShield of Northeastern New York)
(Individual)

6XXXXX 

HealthNow New York Inc.
(doing business as BlueCross BlueShield of Western New York)
(Individual)

6XXXXX 

HealthNow New York Inc.(Individual)

6XXXXX 

Humana Insurance Company of New York
(Individual)

3XXXXX XX

Mutual of Omaha Insurance Company
(Individual)

6XXXXX X X 

State Farm Mutual Automobile Insurance Company
(Individual)

0XXXX 

Sterling Life Insurance Company
(Individual)

0XXXX X

Transamerica Financial Life Insurance Company
(Group)

6XXXXX XXXXX

UnitedHealthCare Insurance Company of New York
(American Association of Retired Persons)
(Group Association)

6XXX X XX X

Medicare Supplement Insurance Carrier

Pre-Ex Wait
(months)
ABCDFF+GKLMN
Benefit Plan Offered


Medicare Supplement Insurance Premium Tables

Protections | Medicare Advantage PlansMedicare Supplement Insurers

Select from the 'Plan...' links below to view Insurance Premium Comparison Tables of the Different Plans:

December 2014 Medicare Supplement Premium Comparison Tables:

The December 2014 Premium Comparison Tables are also available in PDF format (8 pages).

NEW! Preview of the January 2015 Premium Comparison Tables in PDF format (8 pages).


Medicare Supplement Carriers and Premiums By Zip Code


Medicare Advantage Plans Offered in New York State

Protections | Medicare Supplement InsurersRates Tables

Medicare Advantage Plans are approved and regulated by the federal government's Centers for Medicare and Medicaid Services (CMS). For information regarding which Plans are available and the Plan's benefits and premium rates, please contact CMS directly or visit CMS’s Medicare web site. Click here for their Medicare and You guide.


Medicare Open Enrollment

Protections | Medicare Supplement InsurersRates Tables

In 2014, the federal Medicare Open Enrollment period will run from October 15th through December 7th. 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.

People with Medicare, their families and other trusted representatives can review and compare current plan coverage with new Medicare Advantage and Medicare Part D plan offerings. The following is a listing of resources that may be helpful in comparing plan offerings:


Medicare Prescription Drug Coverage (Part D)

Medicare Part D is prescription drug coverage that is partially subsidized by the federal government. To be eligible, you must be entitled to benefits under Medicare Part A and/or enrolled under Part B. You must choose a plan, enroll, and pay a monthly premium to get the coverage. If you have limited income and resources, you may get this coverage for little or no cost by applying for the Low Income Subsidy.

To take advantage of this coverage, you may join a Medicare Prescription Drug Plan that covers prescription drugs only and keep Original Medicare (Medicare Part A and B) or you can join a Medicare Advantage Plan that also offers prescription drug coverage.

Important:

For more information about Medicare prescription drug coverage, see the federal Centers for Medicare and Medicaid Services (CMS) publication Medicare & You Handbook (PDF Format). For more information about the Medicare Advantage Plans or Medicare Prescription Drug Plans available in your area, visit the federal Medicare Web site or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

* Disclaimer: The inclusion of these links does not imply our endorsement of, nor responsibility for, these web sites or their content, but has been included herein solely as a convenience to our Web site visitors.

Updated 12/01/2014

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