New York State Protections
Medicare is a national health insurance program in the United States administered by the Centers for Medicare and Medicaid Services. You are first eligible to sign up for Medicare 3 months before you turn 65. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease). Visit the Medicare.gov to learn about Medicare, how to sign up, and your coverage options.
No matter how you get Medicare, you have certain rights and protections designed to protect you when you get health care, make sure you get the health care services the law says you can get, protect you against unethical practices, and protect your privacy.
New York State regulations provide additional protections to New Yorkers.
Medicare Preventative Care
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. For some preventive services, you may have to pay coinsurance for the office visit to receive services.
Medicare covers two types of physical exams, one exam when you are 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.
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. You pay nothing for this exam if the doctor accepts assignment and this exam is covered once every 12 months.
Medigap Protections and Modernizations
Medicare supplement insurance in New York State is solely regulated by the Department of Financial Services.
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 that have higher cost-sharing responsibility and lower estimated premiums:
- Plan M includes 50 percent coverage of the Medicare Part A deductible and does not cover the Part B deductible.
- Plan N does not cover the Part B deductible and adds a new co-payment structure of $20 for each physician visit and $50 for an emergency room visit (this is waived upon admission to hospital).
Certain Medigap benefits were modernized in 2010.
- 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.
As of January 1, 2020, the Medicare Access and CHIP Reauthorization Act (MACRA), which the federal government enacted in 2015, resulted in modifications to the availability of certain Medigap plans. On or after January 1, 2020, insurers may not offer plans C, F, or high-deductible plan F to newly eligible Medicare beneficiaries. “Newly eligible” is defined as those individuals who first become eligible for Medicare due to age, disability, or end-stage renal disease, on or after January 1, 2020.
Existing insureds covered under plans C, F, or high-deductible plan F prior to January 1, 2020 may continue to renew their coverage due to guaranteed renewability. All three of these Medigap plans cover the Medicare Part B (medical insurance) deductible. On or after January 1, 2020, insurers are required to offer either Plan D or G in addition to A and B. The MACRA changes also created a new high-deductible Plan G that may be offered starting January 1, 2020.
Standard Medicare Benefits
This chart shows the benefits included in each of the standard Medicare supplement plans sold on or after January 1, 2010 Including revisions effective January 1, 2020. Every company must make Plans A & B and either D or G available.
|Medicare Part A coinsurance and hospital coverage
(up to an additional 365 days after Medicare benefits are used up)
|Medicare Part B coinsurance or
|Blood (first 3 pints)||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes||Yes||Yes|
|Part A hospice care coinsurance of copayment||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes||Yes||Yes|
|Skilled nursing facility coinsurance||Yes||Yes||50%||75%||Yes||Yes||Yes||Yes|
|Medicare Part A deductible||Yes||Yes||Yes||50%||75%||50%||Yes||Yes||Yes|
|Medicare Part B deductible||Yes||Yes|
|Medicare Part B deductible||Yes||Yes|
|Foreign travel emergency (up to plan limits)||Yes||Yes||Yes||Yes||Yes||Yes|
|Out-of-Pocket limit in 2019 2||$5,560||$2,780|
1 Only applicants who were first eligible for Medicare before January 1, 2020 may purchase Plans C, F, and high deductible F+. Plans F and G also have a high deductible option which require first paying a $2300 deductible of before the plan begins to pay. Once the plan deductible is met, the plan pays 100% of covered services for the rest of the calendar year. High deductible plan G is only available on or after January 1, 2020, and does not cover the Medicare Part B deductible. However, high deductible plans F and G count payment of the Medicare Part B deductible toward meeting the plan deductible.
2 Plans K and L pay 100% of covered services for the rest of the calendar year once you meet the out-of-pocket yearly limit.
3 Plan N pays 100% of the Part B coinsurance, except for a co-payment of up to $20 for some office visits and up to a $50 co-payment for emergency room visits that do not result in an inpatient admission.
Medicare supplemental insurance, also known as "Medigap" insurance is health insurance sold by a private insurance company to cover some of the "gaps" in expenses not covered by Medicare.
To be eligible for Medigap coverage, you must be enrolled in both Part A and Part B of Medicare.
Each policy is standardized and lettered. This means that all policies labeled with the same letter have the same benefits, no matter which company provides them. 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.
- For policies sold before June 01, 2010, there are 14 standardized plans A through L.
- For policies sold on or after June 01, 2010, there are 11 standardized plans A through N.
Medicare supplement insurance is guaranteed renewable.
Premium Comparison Tables
The following Tables show the regions of New York and Monthly Premiums for November 1, 2021 based on zip code. They also provide the insurer names.
If a premium is shown within a region, that premium may be offered in a part or all of the region. For more details on your exact premium, contact the company or use the Medicare Supplement Rate Look-up Application below.
The above rate tables for each plan are also available for this year and next year in the following PDF documents:
Medigap Plan and Rate Search
Insurers Offering Medigap in New York
|Company||DBA/FKA||Address||Mailing Address||TTY/TDD||Phone Number||Phone Number|
|Aetna Life Insurance Company||151 Farmington Avenue, Hartford, CT 06156||P.O. Box 14088, Lexington, KY 40512||(844) 795-3428||www.aetna.com|
|Bankers Conseco Life Insurance Company||111 E. Wacker Drive
Suite 2100, 60601
|EmblemHealth Plan, Inc.||Formerly Group Health Incorporated (GHI)||55 Water Street, New York, NY 10041||(646) 447-5000||
|Empire HealthChoice Assurance||DBA Empire BC in Albany region & Empire BC/BS in all other regions)||11 W. 42nd St
New York, NY 10036
|(212) 476-1000||(855) 731-1090||www.empireblue.com|
|Excellus Health Plan, Inc.||DBA Excellus BlueCross BlueShield in central New York: Medicare Supplement products,
Excellus BlueCross BlueShield
|P.O. Box 22999
Rochester, New York 14692
|(800) 633-6066||(877) 883-9577||www.excellusbcbs.com|
|Excellus Health Plan, Inc.||DBA UniveraHealthCare: Medicare Select products, Western New York Region||Western New York Region
205 Park Club Lane
Buffalo, New York 14221
|(800) 659-1986||(877) 883-9577||www.univerahealthcare.com|
|Globe Life Insurance Company of New York||Post Office Box 3125, Syracuse, New York 13220-3125||(315) 451-2544||(800) 331-2512||www.globelifeofnewyork.com|
|HealthNow New York Inc.||DBA BlueCross BlueShield of Western New York||Physical Address: 257 West Genesee Street, Buffalo, NY 14202||Mailing Address: PO Box 80, Buffalo, NY 14240||(TTD): (877) 286-5710||(888) 587-2583||(800) 329-2792||www.bcbswny.com|
|HealthNow New York Inc.||Physical Address: 257 West Genesee St., Buffalo, NY 142202||Mailing Address: P.O. Box 15013, Albany, NY 12212||(TTY): (877) 513-1470||(888) 989-9905||(888) 787-2390||www.healthnowny.com|
|Highmark Western & Northeastern NY Inc.||DBA BlueShield of NNY||Physical Address: 40 Century Hill Drive, Latham, NY 12110||Mailing Address: P.O. Box 15013, Albany, New York 12212||(TTD): (877) 513-1470||(800) 329-2792||(877) 258-7453||www.bsneny.com|
|Humana Insurance Company of New York||500 West Main Street
Louisville, KY 40202
|(800) 486-2620||(800) 833-6917||www.humana.com|
|Mutual of Omaha Insurance Company||3300 Mutual of Omaha Plaza
Omaha, Nebraska 68175
|Talcott Resolution Life Insurance Company
||16 International Way,
Warwick, RI 02886
|Transamerica Financial Life Insurance Company||520 Park Avenue
Baltimore, Maryland 21201
|UnitedHealthCare Insurance Company of New York, AARP Health Care Options||P.O. Box 1017
Montgomeryville, Pennsylvania 18936
|(800) 523-5800||(800) 871-2023||www.aarpmedicaresupplement.com|
Open Enrollment & Portability
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.
While every Medigap insurer offers both plan A and B for policies sold before June 01, 2010, plans A, B and either C or F for policies sold on or after June 01, 2010, and plans A, B and either D or G for policies sold on or after January 1, 2020, not every company offers all standardized plans.
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 on the CMS website.
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:
- A group health plan
- Health insurance coverage
- Medicare (Credit for the time a person was previously covered under Medicare is required only if 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.)
- CHAMPUS AND TRICARE health care programs for the uniformed military services
- A medical care program of the Indian Health Service or of a tribal organization
- A State health benefits risk pool
- Federal Employees Health Benefits Program
- A public health plan (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
- A health benefit plan issued under the Peace Corps Act
- Medicare supplement insurance, Medicare select coverage or Medicare Advantage plan (Medicare HMO Plan)
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 & Advantage
Medicare Select is a type of Medigap policy that requires you to use specific hospitals and, in some cases, specific doctors (except in an emergency) to be eligible for full benefits. Other than the limitation on hospitals and providers, Medicare Select policies must meet all 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 the 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 offer Medicare Select insurance in New York State.
Medicare Advantage Plans Offered in New York State
Medicare Advantage Plans are approved and regulated by the federal government Centers for Medicare and Medicaid Services (CMS). For information regarding plans, benefits and premium rates, contact CMS directly or visit CMS Medicare web site.
Medicare Prescription Drug Coverage (Part D)
Medicare Part D is prescription drug coverage that is partially subsidized by the federal government.
To be eligible for Medicare Part D, 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.
For a listing of available Medicare Part D Plans, please use the Medicare Plan Finder available on the CMS website.
If you have prescription drug coverage through an employer or union, check with your benefits administrator to discuss your options. The prescription drug coverage under your employer/union plan may be equal to or better than Medicare prescription drug coverage and you may not need to enroll in Medicare Part D.
If you have prescription drug coverage under the Elderly Pharmaceutical Insurance Coverage (EPIC) Program, contact EPIC for more information about your options.
If you have a Medicare supplement insurance plan with prescription drug coverage (Plans H, I, or J), you will receive a letter from your carrier describing your prescription drug options. If you need additional assistance contact the Health Insurance Information Counseling & Assistance Program (HIICAP) at (800) 701-0501.
For more information about Medicare prescription drug coverage, see the federal Centers for Medicare and Medicaid Services (CMS) publication Medicare and You Handbook.
For more information about the Medicare Advantage Plans or Medicare Prescription Drug Plans available in your area, visit the federal Medicare website or call (800) MEDICARE (800) 633-4227. TTY users should call (877) 486-2048.