Information for Medicare Beneficiaries

Updated! Medigap Information For New York State Residents Being Terminated By Medicare Managed Care Plans
Important Protections For Medicare Beneficiaries
Medicare and You guide
(Link to the CMS Web site; opens in a new window; includes descriptions of Medigap plans A thru L)
Medicare Supplement Insurers Information
Medicare Supplement Insurance Rates Tables
Medicare Advantage Plans Offered in New York State
Medicare Prescription Drug Coverage (Part D)
Outline of Medicare Supplement Coverage (Plans A thru L)
(Link to Regulation 62, Section 52.63; opens in a new window; includes descriptions of Medigap plans A thru L in PDF format)
HIICAP
(Link to the Health Insurance Information Counseling and Assistance Program Offered by the NYS Office for the Aging; opens in a new window)

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

Medicare Advantage Plans | Supplement Insurers | Rates Tables | Outline of Medicare Supplement Coverage

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, 2009, 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 "L".

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 has notified you that it is terminating its Medicare participation or ceasing to provide Medicare services in the area in which you reside and you decide to stay enrolled in the Plan until the contract ends, your coverage under the Plan will end on December 31, 2009. You will automatically be enrolled in the Original Medicare Plan on January 1, 2010. You must apply for a Medigap policy no later than 63 calendar days after your coverage ends under the Plan. This means that you must apply for a Medigap policy no later than March 4, 2010. However, remember that the Medigap policy will not actually begin covering claims until its stated effective date. Therefore, by waiting until March 4, 2010 to apply, you may incur a gap in coverage.
If your Medicare Managed Care Plan has notified you that it is terminating its Medicare participation or ceasing to provide Medicare services in the area in which you reside and you decide to leave your Medicare Managed Care Plan before December 31, 2009 and return to the Original Medicare Plan, you must apply for a Medigap policy no later than 63 days after the effective date of disenrollment from the Medicare Managed Care Plan.

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.

Important Protections For Medicare Beneficiaries Residing In New York State

Medicare Advantage Plans | Supplement Insurers | Rates Tables | Outline of Medicare Supplement Coverage

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. There are fourteen standardized plans "A" through L", which includes two high deductible plans. 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 at-home recovery care 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 Plan B, 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:

A group health plan;
Health insurance coverage;
Medicare*;
Medicaid;
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;
A health benefit plan issued under the Peace Corps Act; and
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.

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.

The availability of Medicare Select coverage is limited to the geographic areas of the state serviced by the particular policy’s network of hospitals and doctors.

A list of insurers offering Medicare Select insurance is provided below.

Insurers Offering Medicare Supplement Insurance in New York State

Protections | Medicare Advantage Plans | Rates Tables | Outline of Medicare Supplement Coverage

Insurance Carriers With Approved Standardized Medicare Supplement Benefit Plans
(as of February 1, 2010)

Medicare Supplement Insurance Carrier For carrier contact information, select this link	Pre-Ex Wait (months)	Benefit Plan Offered
	Pre-Ex Wait (months)	A	B	C	D	E	F	F+	G	H	I	J	J+	K	L
Aetna Life Insurance Company	0	X	X				X
Amalgamated Life Insurance Company (group coverage only)	6	X	X	X	X		X
American Progressive Life & Health Insurance Company of New York	6	X	X	X	X	X	X	X	X
Bankers Conseco Life Insurance Company	0	X	X	X	X	X	X	X	X			X		X	X
Empire HealthChoice Assurance, Inc. (doing business as Empire Blue Cross and Blue Shield)	6	X	X	X			X			X				X	X
Excellus Health Plan, Inc. (doing business as Excellus BlueCross BlueShield)	6	X	X	X			X	X		X
Excellus Health Plan, Inc. (doing business as Univera Healthcare)	6	X	X	X			X	X		X
First United American Life Insurance Company	2	X	X	X	X		X	X	X					X	X
Group Health Incorporated (GHI)	6	X	X	X
Hartford Life Insurance Company (group coverage only)	6	X	X	X	X		X		X
HealthNow New York Inc. (doing business as BlueShield of Northeastern New York)	6	X	X	X						X
HealthNow New York Inc. (doing business as BlueCross BlueShield of Western New York)	6	X	X	X						X
Humana Insurance Company of New York	6	X	X	X			X	X						X	X
Mutual of Omaha Insurance Company	6	X	X				X		X
State Farm Mutual Automobile Insurance Company	0	X	X	X			X
Sterling Life Insurance Company	0	X	X											X
Transamerica Financial Life Insurance Company (group coverage only)	6	X	X	X	X	X	X		X	X	X	X
United HealthCare Insurance Company of New York (American Association of Retired Persons)	6	X	X	X	X	X	X		X	X	X	X		X	X
Medicare Supplement Insurance Carrier	Pre-Ex Wait (months)	A	B	C	D	E	F	F+	G	H	I	J	J+	K	L
Medicare Supplement Insurance Carrier	Pre-Ex Wait (months)	Benefit Plan Offered

Insurance Carrier With Approved Medicare Select Benefit Plans:

Amalgamated Life Insurance Company (group coverage only)

Select Plan B
Select Plan C
Select Plan D
Select Plan F

The above listed group Select Plans are available in Bronx, Kings, Nassau, New York, Queens, and Richmond counties in their entireties and in portions of Suffolk county represented by the following zip codes.

Suffolk County: 11701, 11703, 11704, 11706, 11717, 11718, 11721, 11722, 11724, 11725, 11726, 11729, 11730, 11731, 11735, 11740, 11743, 11746, 11747, 11749, 11751, 11752, 11754, 11757, 11780, 11787, 11788, 11795, 11797, 11798

Medicare Supplement and Medicare Select Insurance Premium Tables

Protections | Medicare Advantage Plans | Medicare Supplement Insurers

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

February 2010 Medicare Supplement Premium Comparison Tables:

The February 2010 Premium Comparison Tables in PDF format (7 pages) are also available.

Medicare Advantage Plans Offered in New York State

Protections | Medicare Supplement Insurers | Rates 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 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:

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 1-800-701-0501.

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.

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