Medicare Advantage in New York

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New York Medicare Advantage enrollment by the numbers

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.

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TZ Insurance Solutions LLC and the licensed sales agents that may call you are not connected with or endorsed by the U.S. Government or the federal Medicare program. This website does not contain a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call (877) 486-2048), 24 hours a day / 7 days a week or consult www.medicare.gov.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.

Medicare has neither reviewed nor endorsed this information.

Last Updated: 4/24/2018