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Medicare in NYC

Are you eligible for Medicare this year? If you are turning 65 years old soon then you will soon receive a packet from Medicare explaining your benefits and will need to make a few decisions, but donıt panic. Although Medicare in NYC can look a little complicated but is really quite simple if you break it down into manageable parts.

When you first receive your Medicare paperwork at around three months prior to your 65th birthday you will need to make a couple of choices. These choices may look difficult but they are really easy once you know what they are and have the information to make an informed choice.

The first choice that you will need to make is whether to keep Original Medicare and purchase a Medigap plan or to opt for a Medicare Advantage plan instead. Previously in our article titled," Medicare NY: Medigap" we discussed Medigap coverage. This article will take a closer look at Medicare Advantage.

Medicare Advantage Plans

  • Eligibility

    To purchase a Medicare Advantage plan you will need to have Medicare Parts A and B and live within the service area of the policy you choose.

  • Cost

    No matter what your age, gender or health you will pay the same premiums as every other member for your plan. Most Medicare Advantage plans charge a co-payment for services and have a maximum out of pocket limit.

  • Providers

    With Medicare Advantage plans providers depend on the type of policy you choose.

    • HMO: You will need to choose a primary care doctor and stay within the insurance companyıs provider network for any care you need. You will also need to get a referral for any specialist care that you may need.

      PPO: Under a PPO plan you will have the option of going outside of a provider network although staying in network is less expensive. You will not need a primary care doctor or a referral to see a specialist.

      PFFS: Private fee for service plans do not have a provider network but you will need to find a doctor who accepts Medicare coverage.

Prescription Drugs


Although the benefits of the plan may change you are normally allowed to renew but it is not guaranteed. It is advised that you check your coverage every year to make sure that it still fits your needs.


Some health plans offer extras such as dental and vision care.

Who should choose a Medicare Advantage Plan?

Those who do not need to see a doctor often may save money with a Medicare Advantage plan.

How to sign up

Signing up for a Medicare Advantage plan is not as easy as a Medigap policy. You will need to do the research to find the right plan for you. It may be a good idea to ask an expert for help.

Do you have questions about Medicare in NYC ? Just give us a call on our toll free number and our experts will be glad to speak with you about your situation and options to help you get the best plan for your needs, lifestyle and budget.