Medicare Supplement Plans in New York
Medicare Supplement Insurance, also known as Medigap, is private health insurance designed to work with Original Medicare — Part A and Part B.
A Medicare Supplement policy can help pay some of the out-of-pocket costs that Original Medicare does not pay, such as certain deductibles, copayments, and coinsurance.
Medicare Supplement coverage is different from Medicare Advantage. A Medigap policy supplements Original Medicare; it does not replace it. In general, you must be enrolled in both Medicare Part A and Part B to purchase a Medicare Supplement policy.
Medicare Supplement plans are standardized under federal law. The standardized plan letters are A, B, C, D, F, G, K, L, M, and N.
This means that the basic benefits of a particular plan letter are the same regardless of which insurance company sells the policy. For example, the standardized benefits of one company’s Plan G are the same as the standardized benefits of another company’s Plan G. However, premiums can differ among insurance companies, and not every company offers every standardized plan.
A high-deductible version of Plan G may also be available from certain insurers. Plan availability varies by company and location.
Some items are not covered by any Medicare Supplement plan:
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- Routine dental, hearing, and vision exams
- Glasses or contacts
- Hearing aids
- Retail prescription drugs
- Long-term care or custodial care
New York Has Year-Round Medigap Enrollment Protections
New York provides Medicare Supplement enrollment protections that are broader than the federal minimum requirements.
Under New York State law and regulation, an insurance company that writes Medicare Supplement coverage in New York State must accept an eligible Medicare enrollee’s application at any time throughout the year.
An insurer may not deny an applicant a Medicare Supplement policy or make premium distinctions because of:
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- Health status
- Claims experience
- Medical condition
- Whether the applicant is currently receiving health care services
This is an important difference between New York State and many other states.
Pre-Existing Conditions in New York State
Although New York insurers generally cannot reject an eligible Medicare Supplement applicant because of health status, a Medigap policy may, in certain circumstances, contain a waiting period of up to six months before coverage for a pre-existing condition begins.
Under New York rules, that waiting period may be reduced or eliminated based on prior creditable health coverage and the circumstances of the applicant’s previous coverage. Generally, prior creditable coverage is taken into account when there has not been a break in coverage of more than 63 days. This is different from being denied a Medicare Supplement policy because of a medical condition.
Get Help Comparing New York Medicare Supplement Plans
Medicare Supplement rules can be confusing, especially because New York’s Medigap enrollment protections differ from the rules that apply in many other states.
Jack Siegel, Licensed Medicare Supplement Insurance Agent, can help New York Medicare beneficiaries understand Medicare Supplement coverage and compare available Medicare Supplement plan options. There is no obligation to enroll.
Schedule a free consultation to discuss your Medicare Supplement questions and the options available to you in New York.
Jack SiegelLicensed Insurance Broker
- To speak with a licensed insurance agent, call (646) 630-7049
(TTY 711 M-F, 9am-5pm)
- New York License #LA-792311
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