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Who Qualifies for Medicare Advantage?
To be eligible for one of the Medicare Advantage health plan choices, an individual must be eligible for both Part A (Hospital Insurance) and Part B (Medical Insurance). Someone enrolled in a Medicare Advantage Plan (also referred to as Part C) receives the same category of benefits offered by Parts A & B (also referred to as Original Medicare), but their plan may apply different rules, costs, and restrictions, which can affect how and when participants receive care.
A plan cannot reject an individual because of their age or health status and cannot delay coverage for preexisting conditions. Some choose to participate in Part C plans to save on the cost of monthly premiums but must beware that the deductibles, co-insurance, and co-pays may result in higher out of pocket costs in the end.
What are the Medicare Advantage Plans in New York?
The Medicare Advantage plans available depends on the county in which an individual resides. In 2025, Nassau County and New York City residents will have four (4) fewer Medicare Advantage Plans to choose from than they did in 2024. Queens and Brooklyn residents will have eight (8) fewer plans to choose from. And unlike many other counties, Suffolk residents will have the same amount of Medicare Advantage Plans to choose from in 2025 as they did in 2024.
What Happens if Your Medicare Advantage Plan is Cancelled in 2025?
A small number of participants whose plan has been terminated for 2025 will not be automatically assigned to a new plan. People in this group will be able to enroll in another Medicare Advantage plan, if one is available, or choose Original Medicare. If they choose Original Medicare, they will qualify for a special enrollment period for Medigap with guaranteed issue rights, meaning they can switch to Original Medicare and will not be denied a Medigap policy due to a preexisting health condition.
In other cases, a new plan will be assigned under the same insurance provider automatically if the contract includes another plan of the same type (i.e., HMO or PPO) in the same county. Others will have to make an active choice to enroll in another Medicare Advantage plan.
What is Medigap?
Those that participate in Original Medicare often purchase a Medicare Supplemental or Medigap insurance policy. The Medigap helps to fill in the “gaps” in Original Medicare. Medigap policies may cover co-insurance, co-payments, and deductibles, as well as extra benefits such as foreign travel emergency coverage. There are twelve (12) Medigap insurance plans to choose from in New York. Normally, prices for this kind of policy vary based on your age, sex, and health status. However, if someone’s Medicare Advantage Plan is cancelled for 2025, one may enroll in a Medigap insurance policy regardless of preexisting health conditions that might have previously disqualified them from coverage.
When is Open Enrollment for Medicare 2025?
Finding affordable healthcare coverage is often overwhelming, but vital to living a healthy, full life. Regardless of your circumstances, it is never too early to consider how changes in New York’s Medicare offerings will affect you. Whether you participate in Original Medicare or a Medicare Advantage plan, open enrollment is now! Open enrollment for 2025 insurance coverage is from October 15 to December 7. Take this opportunity to review your plan to ensure you have the coverage you need for the new year!
Authors: Britt Burner, Esq. is a Partner at Burner Prudenti Law, P.C. focusing her practice areas on Estate Planning and Elder Law. Erin Cullen is a graduate of the Maurice A. Dean School of Law at Hofstra University.
Burner Prudenti Law, P.C. serves clients from New York City to the east end of Long Island with offices located in East Setauket, Westhampton Beach, Manhattan and East Hampton.
