There were more than 1.3 million people in the state of New York
with a Medicare Advantage plan in 2017, the third-most of any state.¹
There are several major types of Medicare Advantage plans. In
the state of New York, there are 162 different plans available as of 2018,
which is also the third-highest number in the U.S.² Not every plan is available
in each county, so it's important to find out which ones are offered where you
live.
Seven out of 10 people with a Medicare Advantage plan in New
York were enrolled in an HMO plan in 2017, while most of the remaining beneficiaries
were split between local or regional PPO plans. The major types of Medicare
Advantage plans include:
HMO
A Health Maintenance Organization usually
requires patients to use health care providers and pharmacies that are part of
the plan’s network (except in the case of emergencies) while also typically
requiring a referral from a primary care doctor in order to see a specialist.
PPO
Medicare Advantage beneficiaries in a Preferred Provider
Organization are able to see providers outside of their plan’s network, often
at a higher cost. Beneficiaries in this type of plan typically pay less out of
pocket if they choose to receive medical services from providers within their
plan’s network. PPO plans typically do not require patients to acquire a
referral before visiting with a specialist.
PFFS
A Private Fee-For-Service plan determines how much it will pay
to health care providers and how much the patient will pay when care is
received. With a PFFS plan, you can typically receive care from any doctor,
hospital or health care provider that accepts your plan’s terms. Not all
providers will accept these terms, however.
SNP
A Special Needs Plan is a type of Medicare Advantage plan
limited to people with certain chronic conditions and other specific
characteristics. Typically, you must receive care from health care providers
and hospitals within your SNP network, except for in cases when you need emergency
or urgent care and when someone who has End-Stage Renal Disease (ESRD) needs
out-of-area kidney dialysis.
Medicare Cost Plans, Medical Savings Accounts (MSA) and HMO
Point-of-Service (HMO POS) plans are 3 additional types of Medicare Advantage
plans that are less popular in most states. Enrollment in these plans makes up
fewer than 2 percent of all Medicare Advantage plan enrollment in New York.
Total number of Medicare Advantage enrollees in New York: 1,325,900 as
of 2017¹
New York's Medicare Advantage enrollees by plan type:
Plan type
|
Percentage of New York enrollees (2017)
|
HMO
|
70%
|
Local PPO
|
18%
|
Regional PPO
|
10%
|
PPFS
|
2%
|
Cost Plans
|
<1%
|
Other Plans
|
<1%
|
Data reflects Medicare Advantage enrollment in the state of New
York as of 2017, as obtained from the Kaiser Family Foundation Medicare
Advantage 2017 Spotlight: Enrollment Market Update¹
New York’s Health Insurance Information, Counseling and
Assistance Program (HIICAP)
The state of New York has a program called the Health Insurance
Information, Counseling and Assistance Program that provides
education surrounding Medicare, Medicare Advantage and other types of public
health health insurance. The goal is to help the state’s insurance
beneficiaries better understand their coverage and obtain the proper care. This
free program may be reached at 1-800-701-0501.
You can also explore more information about the insurance
industry in New York by visiting the state’s Department
of Financial Services website.
¹Kaiser Family Foundation. Medicare Advantage 2017
Spotlight: Enrollment Market Update. Retrieved from
https://www.kff.org/report-section/medicare-advantage-2017-spotlight-enrollment-market-update-appendices.
²Kaiser Family Foundation. State Health Facts: Medicare
Advantage Plans. Retrieved from
https://www.kff.org/medicare/state-indicator/plans/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.
https://www.medicareadvantage.com/plans-by-state/new-york?q_criteria=404|388874&SRC=tz_ma_goog_srch&cid=00001&afid=362403&tfn=ODAwLTYxMC05Mzc1&q_publisher=google&q_network=g&q_creative=283994232855&q_keyword=%2Bmedicare%20%2Bplans%20%2Bin%20%2Bnew%20%2Byork&q_placement=&q_matchtype=b&q_adposition=1t2&q_device=c&q_devicemodel=&q_targetid=aud-450892538046:kwd-467082841644&q_campaignid=1458195961&q_adgroupid=57000461499&q_accountid=7441853351&k_clickid=b1276b29-25d9-4b68-9439-acb2a5ff5d12&gclid=CjwKCAjwtIXbBRBhEiwAWV-5nvdrDdxc_HM1DcMPsYYQMPsDiaP1PWaurYLG9YnTP3cE3l0L3GDsHxoC8o4QAvD_BwE
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