To qualified individuals, New York Medicare insurance offers one of the most affordable options for health care coverage. Medicare is a federal program, but the New York state government also offers several other programs to help Medicare beneficiaries in the state.
Medicare’s core coverage can be obtained through Original Medicare, and it’s divided into two parts – Part A and Part B. In most cases, Medicare Part A is free, while Medicare Part B comes with an affordable premium starting at only $134 a month. Both Medicare Part A and Part B may require beneficiaries to pay deductibles, copays, and coinsurance costs as out-of-pocket expenses.
Despite the affordable prices, Original Medicare covers numerous healthcare services. Medicare Part A covers hospital services such as inpatient care and care in skilled nursing facilities. Medicare Part B focuses on medical treatments, outpatient care, durable medical supplies, and preventive services.
Some beneficiaries feel that the coverage of Original Medicare is not comprehensive enough, and to compensate they may obtain Medicare supplemental plans to receive additional benefits. These plans can be purchased from Medicare-approved private insurance companies in the state of New York.
Medicare beneficiaries can pick the supplemental plan that offers the additional benefits they wish to add to their Original Medicare coverage. A common type of supplemental plan covers the cost of Medicare prescription medication, and this type of plan is called Medicare Part D. The plan may cover other services that are not covered by Medicare Part A and Part B, or it can help cover the costs of deductibles, copays, and coinsurance.
These plans do require an additional premium, which is distinct from the premium for Part B that Medicare beneficiaries normally have to pay for.
Instead of obtaining Original Medicare from Medicare and then purchasing supplemental plans from private carriers, some beneficiaries opt to simply obtain Medicare Advantage plans, which are also referred to as Medicare Part C. These plans can be purchased from private carriers who are also authorized by Medicare to offer such plans.
These plans offer a one-stop package, as it offers the benefits of Original Medicare plus whatever benefits the beneficiary may choose to add. Often there is coverage for Medicare prescription drugs, along with coverage for extra healthcare services not included in Medicare Part A and Part B.
As the cost of living can be exorbitant in New York (especially in NYC), a considerable number of Medicare beneficiaries require assistance in covering Medicare expenses. To this end, New York offers several Medicare Savings Programs (MSPs) to help cover some of the costs of Medicare.
Unlike in other MSPs in other states, there are no resource limits for MSPs in New York State. However, there are still income limits for the various programs.
For the Qualified Medicare Beneficiary program (QMB), the income limit for an individual is $1,032 per month. For a married couple, the combined monthly income should be less than $1,392 per month.
This QMB program is undoubtedly the most comprehensive of the MSPs. It covers virtually every expense connected to Medicare, which includes the premiums for both Part A and Part B along with all the deductibles and coinsurance.
The next program is for the Specified Low-Income Medicare Beneficiary (SLMB), which covers the Medicare Part B premium. It is possible for an SLMB to qualify for this program and still benefit from Medicaid programs.
To qualify for the SLMB program, an individual’s income cannot exceed $1,234 per month. A married couple’s combined income must be less than $1,666.
The third MSP is for the Qualified Individuals (QI), which has a monthly income limit of $1,386 for individuals. For married couples, the limit is $1,872 per month. However, The QI beneficiary cannot receive Medicaid benefits while on this MSP.
All of these MSP can qualify beneficiaries for the Extra Help program that covers the premium for Medicare Part D coverage. The income requirements Extra Help (which is also known as the Low-Income Subsidy or LIS) are the same as the QI program. However, this LIS program has asset limits of $13,820 for individuals and $27,600 for married couples.
Each state has to provide a program called the State Health Insurance Program (SHIP) which is designed to provide free and unbiased answers and advice for Medicare applicants and beneficiaries. In New York state, this SHIP is called the New York Health Insurance Information, Counseling, and Assistance Program (HIICAP). To contact HIICAP, New York residents should call 1-800-701-0501.
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