New York Medigap Rules You Need to Know

New York Medigap plans have a unique model for enrollment that is different than most states. While the same standardized A-N plans are available in New York as in the majority of states, Medigap enrollment in the Empire State is somewhat of a free-for-all. There are both pros and cons to NY’s unique Medicare Supplement model. We will review this dichotomy in the article below.

What is New York Medigap’s Open Enrollment Rule?

New York Open Enrollment falls under the “pros” category. Every single person with Medicare Part A and B is eligible for Medigap Open Enrollment year-round. Due to a special New York law, you can’t be denied or charged more based on your health history no matter when you enroll. Below are some key features:

New York Open Enrollment features:

• Can enroll anytime
• Cannot be denied coverage based on medical history
• Cannot be charged more based on medical history
• Must be enrolled in BOTH Medicare Part A and B
• May have a 6-month waiting period covering preexisting conditions (see below)

Waiting Periods with New York Medigap

Medigap plans may require a six-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.” The waiting period may be either reduced or waived entirely if you were covered under some form of “creditable” coverage so long as there were no breaks in coverage of more than 63 calendar days. The following are types of credible coverage:

-A group health plan
-Health insurance coverage
-Medicare (Credit for the time a person was previously covered under Medicare is required only if 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.)
-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 (any plan established or maintained by a state, the U.S. government, a foreign country, or any political subdivision of a state, the U.S. government, or a foreign country that provides health coverage to individuals who are enrolled in the plan
-A health benefit plan issued under the Peace Corps Act
-Medicare supplement insurance, Medicare select coverage or Medicare Advantage plan (Medicare HMO Plan)

NOTE: New York’s Open Enrollment and Portability provisions protect you whether you are Medicare eligible because of age or disability. The provisions also apply to Medicare beneficiaries with end-stage renal disease. (Source)

How much do NY Medigap plans cost?

Medigap price falls under the “con” category. New York Medigap plans are pricey. Remember we said that there was a dichotomy with New York’s rules? Well, here it is. Due to New York’s generous guaranteed-issued enrollment law, Medigap providers charge more for plans to help offset the cost associated with members with pre-existing conditions enrolling year-round.

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New York Medigap premiums increase with age?: Community Rating

Here is another for the pro column. In New York, all Medigap plans are community-rated. This rule means that no matter your age, you’ll pay exactly the same rate as those older or younger than you. This includes those on Medicare who are under 65 due to a disability or End Stage Renal Disease.

The tradeoff: this community rating law comes with a con. NY Medicare Supplement plan rates are fairly good compared to most states when you’re under 65 or very old but relatively expensive for those just turning 65. You’ll likely pay significantly more for a NY Medigap plan when you’re 65 than you would for the identical plan in many other states, such as a Medigap plan in California.

Comparing New York Medigap Plans

Plans available if you qualified for Medicare after January 1, 2020:

**Medigap Plan G High Deductible is identical coverage with a high deductible of $2,800.

If you were Part B eligible before January 1, 2020, you may be able to enroll in Medigap Plan F.

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What is New York’s Medicare Part B Excess Charges limit?

Here is one more for the pro side! In New York, Part B Excess Charges (extra cost that doctors and medical suppliers sometimes charge you which is above the Medicare-approved amount), are limited to 5% above the Medicare-approved rate.*** In most other states, Part B Excess Charges can be as high as 15% above the Medicare assignment.

***Exceptions when NY provider’s excess charges can exceed 5%:

• Opt-out provider: a physician who chooses not to work with Medicare is not limited to how much they can charge
• DMEPOS: durable medical equipment, prosthetics, orthotics, and supplies can be billed at the ENTIRE difference between what Medicare pays and the supplier’s typical charge

New Yorkers who don’t choose a Medigap plan that covers Part B Excess Charges, like Medigap plan G, must be vigilant in order to keep their excess physician charges at 5%. Read more in our “Medicare Part B Excess Charges: Ultimate Guide

Which NY Medigap lettered plans cover Part B Excess Charges?

If you were eligible for Medicare after January 1, 2020, there is now only one plan available that covers New Yorkers’ Part B Excess Charges: Medigap Plan G. If you scroll up to the chart, you’ll see that Plan G ticks the Excess Charges box. In fact, Plan G covers all Medigap benefits available except for the one-time annual Part B deductible of ($240). Click here to get your New York Plan G Medigap quote.

Does NY Medigap charge a different rate by gender?

No! Here’s another good thing, well, at least for male New Yorkers. In many other states, males are often charged more than females for the same Medigap policy.

How much are New York’s Medigap plans?

It depends on a few things. The three main factors that vary your NY Medigap premium costs are your chosen lettered plan, insurance provider, and zip code. Hit the button below to compare Medigap plans in your area.

One trick is to look at Medigap plan G’s high deductible in New York. While it does have a $2,800 deductible, high deductible plan G is considerably less than standard Medigap Plan G. The majority of Senior65.com clients in NY select Medigap high deductible G. Learn more about High Deductible Medigap Plan G here.

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Switching New York Medigap Plans: Birthday Rule?

New York doesn’t have a Birthday Rule, but it is one of the few states that allow Medicare Supplement (Medigap) enrollees to switch plans at any time. In most states, you have to go through medical underwriting and answer health questions to be approved to switch to a new Medigap plan.That isn’t how the story goes in the Empire State. Learn more in our article “New York Allows Medigap Members To Switch Plans At Any Time“.

What happens to my New York Medigap plan if I move?

Most likely you will be able to keep your plan even if you move out of state! New York Medigap plans match the majority of states’ standardized A-N lettered plans so they are portable. An exception to this rule would be if you move to a state that doesn’t have the traditional standardized plans.

If you do move to another state you will likely lose your New York year-round Medigap Open Enrollment and could see your Part B Excess Charges increase to 15%.

New York Medigap Discounts

The following Medigap discounts may be available to New Yorkers:

• Autopay discount: Some insurance providers offer a discount of $2+ a month
• Household discount: Some insurance providers will cut your monthly bill by 5% a month or more if someone else lives in the house and (usually) has the same policy. This is called the Medigap Household Discount and each provider handles it differently so give us a call to discuss if you qualify.
• New York Medigap Roommate Discount: is a simple way to save money on your Medigap plan. Check out our article for more details: “What is the Medigap Roommate Discount and How do I get it?“.

Next Steps for New York Medigap

Now that you know just about everything there is to know about New York Medigap plans, it’s time to review New York Medigap plan pricing. If you have any further questions, give one of our licensed agents a call at 800-930-7956.

Remember, our Senior65.com agents will NOT charge you a fee for our services!