Tag: Schenectady NY

Part C Medicare Advantage

What is Medicare Advantage?

Post author By Dan
Post date August 27, 2026

Medicare Part C is also known as Medicare Advantage (MA)
MA plans are approved by Medicare and run by private insurance companies as an alternative to Original Medicare.
CMS (Medicare) pays these private insurers to manage your Medicare Parts A and B benefits and pay your claims on behalf of CMS.
MA plans must have the same or better benefits than Original Medicare.
Some plans may include additional supplemental benefits such as dental, eyewear, fitness and wellness coverage that go beyond what what Original Medicare offers. These additional benefits vary so please refer to the plan’s Summary of Benefits for details.
Many MA plans also include Part D prescription drug benefits. These are MAPD plans.
All MA plans contract with a network of providers, hospitals and vendors. Generally, your copay and cost sharing responsibility is lower when using an “in-network” provider when compared to one not contracted with your plan.

Tags Aetna Medicare, Albany NY, Buffalo NY, cdphp, Devoted Health, Humana Medicare, Medicare Advantage, New York, Saratoga NY, Schenectady NY, Syracuse NY, Troy

Part C Medicare Advantage Part D Prescription Drug

About the Medicare GLP-1 Bridge Program

Post author By Dan
Post date June 7, 2026

Beginning July 1, 2026, a new federal initiative called the Medicare GLP-1 Bridge Program will allow individuals enrolled in a Part D plan to access certain highly sought-after weight-loss drugs for a flat copay of $50 a month.

According to the Centers for Medicare & Medicaid Services (CMS), this temporary demonstration program will run through December 31, 2027. The goal is to make these treatments more affordable while the government evaluates long-term coverage models.

Here are the essential details you need to know about who qualifies, what is covered, and how to get started.

1. Who Is Eligible?

You must be enrolled in a standalone Medicare Part D prescription drug plan or a Medicare Advantage plan that includes drug coverage. (This excludes the MA-Only plans that do not include drug coverage.) However, because this is a medical demonstration, you cannot simply request the $50 rate at the pharmacy counter. Your doctor must submit a Prior Authorization showing you meet specific medical categories based on your Body Mass Index (BMI):

Tier 1: A BMI of 35 or higher (no other health conditions required).
Tier 2: A BMI of 30 to 34.9 plus at least one of these conditions: heart failure, uncontrolled high blood pressure, or chronic kidney disease.
Tier 3: A BMI of 27 to 29.9 plus at least one of these conditions: pre-diabetes, a history of a heart attack, a history of a stroke, or peripheral artery disease.

Note: The program specifically excludes patients who have Type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease, as those individuals are typically already eligible for GLP-1 coverage directly through standard Part D plans.

2. Which Medications Are Included?

The $50 monthly price is the result of a negotiated agreement between the federal government and certain drug manufacturers. The program strictly covers specific brand-name formulations prescribed specifically for weight management:

Wegovy® (both the standard injectable and the newer oral tablet versions).
Zepbound® (strictly limited to the KwikPen® formulation; standard single-dose vials or pens are not covered).
Foundayo® (Eli Lilly’s newly approved oral pill).

Medications like Ozempic® and Mounjaro® are not part of this $50 weight-loss program because they are FDA-approved to treat Type 2 diabetes and are already handled under standard Medicare Part D formularies.

3. The “Fine Print” Seniors Need to Know

Because the Bridge program operates entirely outside of the traditional Medicare Part D design, there are a few unique rules to keep in mind:

Out-of-Pocket Limits: The $50 monthly copay does not count toward your standard Part D deductible or your annual $2,100 out-of-pocket maximum.
Extra Help: Because the program includes a flat $50 copay for everyone who qualifies, the federal Low Income Subsidy (Extra Help) and New York State EPIC cost-sharing protections do not apply to this program.
Supply Limits: The program will only cover 28-day or 30-day supplies at a time.

How to Take Action

You do not need to sign up for a new insurance plan to participate. If you think you meet the BMI and health criteria, schedule an appointment with your doctor. Your physician will need to write the prescription with specific instructions for the Bridge program, and they will submit the required medical paperwork directly to the program’s central processor (managed by Humana) to approve your $50 rate. You may want to provide your provider with a copy of the CMS Prescriber Guide and the CMS Pharmacy Operational Framework. for their review.

Click below and watch our June 9 “Ask the Experts” interview where Chris, Kate and I answer some questions about the GLP-1 Bridge Program:

An interesting article comparing several GLP-1 medications: https://www.health.com/glp-1s-weight-loss-8674445

Tags Albany NY, cdphp, drug formulary, GLP-1 Bridge Program, Medicare Part D, Medicare PDP, Prescription Drug Plan, Saratoga NY, Schenectady NY, Troy

Medicare A & B Part D Prescription Drug

Changes to the NY Medicare Savings Program in 2026

Post author By Dan
Post date March 2, 2026

If you are enrolled in Medicare Parts A and B and have limited income you may be able to get assistance with your Medicare health care costs through a Medicare Savings Program (MSP) administered through each state’s Medicaid office: https://www.health.ny.gov/health_care/medicaid/program/update/savingsprogram/

If eligible, you will receive help paying the Medicare Part B premium, (currently $202.90) and are automatically enrolled in Extra Help, the federal program that helps with Medicare prescription drug (Part D) costs such as monthly premium, drug deductible and prescription copays.

The Medicare Savings Program has two eligibility levels – with additional benefits available to those with the lower income. You do not choose which program to apply for – you will be enrolled in the level program that corresponds to your income.

**2026 New York Monthly Income Limits (*)**

Program	Individual	Couple
QI	Up to $2,494	Up to $3,375
QMB	Up to $1,856	Up to $2,509

(*) Eligibility is based on your income after subtracting for eligible health insurance premium deductions such as i) Medicare Supplement, ii) Part D drug plan, iii) dental, iv) vision, and iv) long term care premiums. The Part B premium ($202.90) or any IRMAA surcharges deducted from your Social Security award cannot be used to lower your income.

(QI) Once enrolled as a Qualified Individual with individual monthly income at or below $2,474 you will no longer have the Medicare Part B premium deducted from your Social Security check. And you may receive up to three months of retroactive reimbursement for Part B premiums paid before your MSP effective date and within the same year of the effective date.

(QMB) If your individual monthly income is at or below $1,856 you would be enrolled in the Qualified Medicare Beneficiary Program and, like QI, will no longer have the Medicare Part B premium deducted from your Social Security check.
- This program also pays for Medicare Parts A and B deductible and cost sharing however no retroactive Part B reimbursements are available to QMB enrollees.
FYI: If your individual monthly income is at or below $1,856 and your assets are below $33,308 you may apply separately for Full Medicaid you may enjoy the same benefits as QI and QMB plus some additional benefits such as:
- County based transportation to and from medical appointments.
- Dental and vision allowances approved by NY State Medicaid

Once approved at the QMB or Full Medicaid level, you may want to consider a Medicare Advantage DUAL (Medicare / Medicaid) plan. On top of the benefits described above, these plans include additional benefits like dental, vision, fitness membership and even an allowance for healthy food. Ask your local agent about the Medicare Advantage DUAL plans we offer for individuals enrolled in QMB or Full Medicaid.

Your local agent can help you with the request. Start by downloading the form below. Then, along with a copy of your Medicare ID card, we’ll need documents to confirm your date of birth, residency and income. If you are paying another health insurance premium, such as i) Medicare Supplement, ii) Part D drug plan, iii) dental, iv) vision, and iv) long term care premiums, you will need to provide some proof of that expense. Your local agent will work with you in getting this to your county’s Department of Social Services and follow up with you during the approval process which can takes up to 45 days.

>> To download application form: click here

Include the following verification documents with your Medicare Savings Program application:

A photocopy of the front and back of your Medicare card(s) (red, white and blue card).
Proof of Date of Birth, such as State Driver’s license, U.S. Birth Certificate, U.S. passport, Permanent Resident Card (“Green Card”), or NYS Benefit Identification Card.
Proof of Residence, such as lease/ letter/ rent receipt with your home address from landlord, utility bill (gas, electric, phone, cable, fuel or water), property tax records or mortgage statement. These documents must be dated within 6 months of when you signed the application.
Proof of income, such as paycheck stubs (4 weeks), a letter from employer, pension information indicating amount and frequency of payment, income tax return, award letter for any unearned income benefit such as Social Security, unemployment, or veteran’s benefit, or letter from renter, boarder or tenant.
Proof of any other health insurance premium that you pay other than Medicare, such as Medicare Supplement, Medicare Advantage, Part D prescription drug, dental, vision or long term care policy.
If you are not a U. S. citizen, you must provide documents indicating your current immigration status such as I-551 Permanent Resident Card (“Green Card”), I-766 Employment Authorization Card.

Check with New York State Department of Health for an online listing of each county’s Local Department of Social Services: https://www.health.ny.gov/health_care/medicaid/ldss.htm

Tags Albany NY, Medicaid spend down, Medicare Part B, Medicare Part D, Medicare Savings Program, NY Medicaid, Saratoga NY, Schenectady NY, Social Security Extra Help, Social Security LIS

Part D Prescription Drug

Part D Sticker Shock

Post author By Dan
Post date January 15, 2026

I heard from a client who had just returned from picking up and paying for a tier 4 medication at her pharmacy and was shocked at the co-payment of $837.73. She knew her Part D drug plan has a deductible on higher tier medications, meaning she pays the full amount of the drug cost up to the deductible amount, and that higher tier medications have higher cost sharing. Still, she asked “I was able to pay this but how are other people supposed to come up with $800 on the spot?”

Medicare Prescription Payment Plan (PPP)

Click image for page 83 “Medicare and You 2026”

I mentioned that the PPP allows individuals to spread that high cost of their Medicare Part D prescription drugs over the rest of the year; as monthly payments instead of all at once. A few points on this:

This payment plan applies only to covered Part D drugs – not Part B medications administered in a doctor’s office.
The M3P is voluntary and so enrollment is not automatic. If you want to spread those higher costs out in installment payments, you must opt-in by contacting your plan’s customer service number provided on your 2026 plan ID card.
Beginning January 1, your pharmacist is supposed to provide information on this. However if they cannot assist with the actual opt-in, call your plan’s customer service number.
If you expect high out of pocket costs soon, you can opt-in now – call your Part D plan’s customer service number. Of course, you can opt-in at any time later in 2026, too.
Under certain urgent circumstances, you may opt-in to the payment plan retroactive IF:
- A delay in filling the medication while waiting for the PPP processing would have jeopardized your health, and
- You contact your Part D plan to opt-in within 72 hours of having picked up and paid for the medication. Be sure to keep the receipt showing the medication, date and payment amount.
This may not be the best choice for you if you already receive help paying for drugs through NY EPIC, Extra Help or Medicare Savings Program.
You’ll find more information at https://www.medicare.gov/prescription-payment-plan/will-this-help-me

OUT-OF-POCKET LIMIT ON DRUG COSTS

As a reminder, once your Part D drug costs (deductible, co-payments and other credits combined) reach $2,100, your cost for covered Part D medications will be reduced to $0 through December 31, 2026.

Tags Albany NY, Buffalo NY, Deductible, drug formulary, Medicare Part D, Medicare Savings Program, MPPP, MSP, Part D, Prescription Payment Plan, Saratoga NY, Schenectady NY, Syracuse NY

Medicare Part C Medicare Advantage Part D Prescription Drug

What If I Missed the Medicare AEP Deadline?

Post author By Dan
Post date December 8, 2025

This year’s Medicare Annual Enrollment Period (October 15 through December 7) was a busy time and we are grateful for the hundreds of individuals and couples who permitted our team of agent advisors to help with their 2026 Part C Medicare Advantage plan selection. (The December 7 deadline does not apply to a Medicare Supplement plan selection.)

Q: But I missed that deadline. Is there another option for me to choose a new plan for 2026?
A: Possibly. Some Medicare participants are eligible for what is called a Special Enrollment Period during which you can make a change to your Medicare Advantage Plan.

Q: Am I eligible for a Special Enrollment Period?
A: Let’s look at some special situations that may apply to you. If one does, you can make changes to your Medicare Advantage plan coverage outside of the normal Annual Enrollment Period:

Has your 2025 Medicare Advantage Plan been discontinued? If so, you have some additional time to enroll in new coverage for January 1. One of our agents can assist you with finding a plan that matches your providers, medications and budget.
Do you belong to New York State EPIC? If so, you have one Special Enrollment Period per calendar year to enroll in a new Medicare Advantage or Part D prescription drug plan. [Download the EPIC application here.]
Are you a veteran? Many veterans may not be aware of a valid Special Election Period available by having their prescriptions filled through the Veterans Administration (VA.) Veterans can use that Special Enrollment Period to enroll in a “MA only” plan – a Medicare Advantage plan with no drug benefits. Click here for more information on MA Only plans.
You may be eligible for Social Security Extra Help – Eligibility for this program is based on your income and assets. Extra Help subsidizes part or all of your plan’s premium, drug deductible and reduce prescription co-payment. With Extra Help, you may be able to make changes to your coverage one time during each of these periods:
- January – March
- April – June
- July – September

Q: Do any of these Special Circumstances apply to Medicare Supplement plans?
A: No. However three states, including New York and Massachusetts, do require Medicare Supplement plan insurers to offer policies to Medicare beneficiaries age 65 and older through continuous open enrollment, with guaranteed issue rights throughout the year.

That means if you want to drop a Medicare Advantage plan (which includes prescription drug coverage) and return to Original Medicare with a Medicare Supplement plan; you need a Special Enrollment Period to add the third piece, your Part D prescription drug coverage.

Q: I’m not sure of my eligibility status, can you help me with my questions?
A: Yes. Simply use the form below and send a note to an agent advisor or call (518) 346-2115. We’ll discuss your options by telephone or Zoom web conference. And, during your Special Enrollment Period, we may be able to identify a Medicare Advantage, Medigap or Prescription Drug Plan more suited to your needs – even though the December 7 deadline has passed.

Medicare supplement

Why Choose a High Deductible Medicare Supplement Plan?

Post author By Dan
Post date November 17, 2025

“Ask the Experts TV” asked about the Medicare Supplement High Deductible Plan G. Click and watch the video from the February 17 livestream interview here:

reason 1: Lower your MAXIMUM annual out-of-pocket

The annual maximum out-of-pocket is the amount you could potentially pay in medical co-pays after which your plan covers 100%.

Most Medicare Advantage plans include an annual maximum out-of-pocket amount for medical co-pays, ranging from $6,000 to $9,250. With a Medicare Supplement High Deductible plan, your maximum out-of-pocket is $2,950.

So, you would be lowering the amount you would pay before your plan covers 100% – reducing your potential exposure by thousands of dollars.

reason 2: Lower YOUR COMBINED annual premium and deductible costs

Let’s do some math:

Traditional Plan G:
$4800 annual premium (avg. $400/month) check your county
+ $283 Part B deductible
$5083

High Deductible G
$900 annual premium (avg $75/month) check your county
+$2950 maximum (Parts A and B deductible and 20% cost share)
$3850

Smart Tip: Set aside $250 saved in monthly premium payment for the $2950 to cover the Parts A and B deductible and 20% share. Depending on your medical claims you should have money left over on December 31.

NY STATE RATES

APPLICATION

IS this Like with other deductibles and I pay the first $2,950 in medical bills?

No. After you pay the Parts A and B deductibles, Medicare pays its share of claims (usually 80%) and you pay the 20%. Once your deductible and 20% share reaches $2,950, then your supplement plan pays 100% for the rest of the year. Think of it as a $2,950 cap on your out of pocket costs.

	2026
Part A deductible per period	$1,736
+ Part B deductible	$283
+ Part B co-share	20%
= Maximum Out of Pocket	$2,950

Will hospitals and doctors will accept my High Deductible plan?

Yes, if your provider participates in Original Medicare for your primary coverage, they will accept your Medigap supplemental coverage; including plans with deductibles like Plans G, N and High Deductible. This way you have access to the nationwide network of doctors and hospitals participating in Original Medicare.

How does a High Deductible compare to Medicare Advantage plan?

- - Medicare Advantage plans include a limit on out-of-pocket costs; ranging from $6,000 to $9,250 per year for in-network medical services. (Up to $13,900 for in and out of network) Compare to a Medicare Supplement High Deductible plan with the annual maximum out-of-pocket cost capped at $2,950

- - Medicare Advantage plans manage your Medicare benefits through contracts with in-network providers and hospitals. As mentioned above, any provider accepting Original Medicare for your primary coverage will accept your supplement coverage – eliminating the “is my doctor in-network with my plan” questions.
  - Most Medicare Advantage plans, including those with a low monthly premium, include Part D prescription drug coverage. With Medicare Supplement, you will need to obtain separate creditable Part D drug coverage. during an Annual Enrollment, Open Enrollment or Special Enrollment Period. VA drug benefits are considered creditable coverage.
  - Many Medicare Advantage plans include features like dental allowance, fitness membership, eyewear and hearing aid benefits not available with Original Medicare.

Download 3 separate documents↓↓↓

Globe Life application Form 1 sign page 3 (and 5 for EFT)

Globe Life application Form 2 sign page 1

Globe Life application Form 3 sign page 1

About Globe Life Insurance of NY

Our agents are authorized to represent the Globe Life Insurance Company and Humana Medicare Supplement High Deductible Plans. Please call us at (518) 346-2115 or send any agent a quick note with your questions:

Tags Albany NY, Buffalo NY, Globe Life, High Deductible, High Deductible F Plan, Humana Medicare, Medicare, Medicare Part A, Medicare Part B, Medicare supplement, Medigap, MedSupp, New York, Rochester NY, Schenectady NY, Syracuse NY

Medicare Part D Prescription Drug

The New Law and Medicare Part D

Post author By Dan
Post date August 15, 2022

The US House and Senate has passed a bill (H.R. 5376 titled Inflation Reduction Act of 2022) which includes some important changes to the Medicare Part D prescription drug coverage.

Some of these changes take effect next year and others over the next several years. I have looked over the text, studied several analysis and have summarized below the 4 changes most likely to Medicare beneficiaries:

Insulin – Effective 2023
Adult Vaccines – Effective 2023
Cap on Out of Pocket Drug Costs – Effective in 2024 and 2025
Medicare to Negotiate Part D and Part B Drug Prices – Effective 2026

Please note: If you are receiving Part D financial assistance through state Medicaid or the Social Security Extra Help program, your benefits may already exceed what is becoming effective in this new bill. Also, if your medications are covered through your VA benefits, you may want to compare these new benefits to what VA covers and compare your options in the years ahead.

1. Insulin – Effective 2023 Beginning in 2023, for Medicare Part D beneficiaries who need insulin, monthly out-of-pocket costs will be capped at $35, and starting in 2026, the cap would be $35 or 25% of the negotiated price if that is lower. And insulin products will no longer subject to a Part D deductible.

2. Adult Vaccines – Effective 2023
Beginning in 2023, Medicare Part D cost-sharing will be eliminated for adult vaccines that are recommended by the Advisory Committee on Immunization Practices. For most clients, the most significant change will be the new $0 Part D copay for the two shot Shingles vaccine, previously covered through Part D however frequently subject to a deductible and higher Tier copay.

3. Cap on Out of Pocket Drug Costs – Effective in 2024 and 2025
For clients with drug costs placing them in the “Coverage Gap” (aka Donut Hole) and Catastrophic Coverage Phase, this change will be very welcomed although phased in over time.

In 2024, that 5% coinsurance payment that now kicks in after someone reaches the catastrophic drug spending level in Medicare will end. As you may imagine, 5% on some of those expensive drugs that cost thousands monthly can be a lot of money. That ends in 2024.

And in 2025 your Medicare Part D out-of-pocket spending will be capped at $2,000 a year, increased to $2,100 in 2026.

4. Medicare to Negotiate Part D and Part B Drug Prices
CMS (Centers for Medicare & Medicaid Services) will be authorized and required to negotiate maximum prices for brand-name drugs that do not have other generic equivalents and that account for the greatest Medicare spending.

There is not yet an official, publicly available list of drugs that Medicare plans to target for negotiations. However Kaiser Family Foundation reports how just a handful of drugs represent the lion’s share of Medicare drug costs. Some likely candidates, based on how much Medicare spent on them in 2020: Eliquis, Xarelto and Januvia.

Today, those brand name drugs that do not have generic equivalents and represent the greatest cost are typically listed as Tier 4 or Tier 5 specialty medications under Medicare Part D coverage.

CMS will begin by negotiating the prices of 10 drugs in 2026, 15 drugs in 2027 and 2028, and 20 drugs in 2029 and each year thereafter. The negotiations would apply first to drugs people get at the pharmacy (Part D), but in the later two years, drugs administered in doctors’ offices (Part B) could also be covered.

If you have any questions or would like for me to review with you your plan benefits please schedule a telephone or Zoom conference convenient for you and direct to my calendar, call us at (518) 346-2115 or send a note to one of our licensed and carrier certified agents closest to you:

Medicare

Get Questions Answered at “Medicare 101” Webinar

Post author By GoatCloud Admin
Post date September 14, 2020

Are you going to be eligible for Medicare in the near future? Have you been enrolled in Medicare for awhile and want to better understand what it offers? Do you have a family member you help with Medicare issues?

If you answered yes, then “Medicare 101” is for you. This no sales-pitch educational webinar, led by multi-state licensed and Medicare Plan Specialist Dan Alcorn:

We’ll explore Medicare Parts A, B, C and D, the difference between a Medicare Supplement and Medicare Advantage plan, and more. After registration, you will receive the login instructions by e-mail.

Tags Albany NY, Annual Enrollment Period, Buffalo NY, Medicare, Medicare Advantage, Medicare Part A, Medicare Part B, Medicare Part D, Medicare PDP, Medicare supplement, New York State, Saratoga NY, Schenectady NY

Medicare supplement

What is a Medicare Supplement Plan G?

Post author By GoatCloud Admin
Post date April 29, 2020

Medicare Supplement Plan G, also called Medigap, coverage is very similar to Plan F. It offers great value for beneficiaries who are willing to pay a small annual deductible. After that, Plan G provides full coverage for all of the gaps in Medicare. It pays for your hospital deductible, copays and coinsurance. It also covers the 20% that Part B doesn’t cover.

Plan G is an increasingly popular supplement for several reasons.

First, it has great coverage. For Medicare Part A in-patient hospital stays, it covers all of your expenses. That includes the Part A hospital deductible, which is $1,556 in 2022.

Second, Plan G covers each of the gaps in Medicare except for the $233 annual Part B deductible. We can often find a supplement Plan G that saves quite a bit in annual premiums over Plan F, substantially more than the $198 annual deductible.

Compare for Yourself! New York State Department of Financial Services publishes the Medicare Supplement monthly premiums by county. Yes, it is as simple as that. I represent several of the insurance companies listed here and can assist you with the application process, please call (518) 346-2115 or book a telephone or video appointment directly to my calendar.

Attn: New York Residents. Did You Know?

Enrollment Calendar: New York State residents enrolled in Medicare can choose or change to a Medicare Supplement / Medigap Plan at any time. That’s because New York is a “guaranteed issue” state.
Health Underwriting? New York State residents enrolling in a Medicare Supplement / Medigap Plan are not subject to health underwriting.
Pre-Existing Conditions? The six month pre-existing condition claims exclusion can be eliminated for New York State residents changing to a Medigap plan from other creditable coverage.

Tags AARP, Albany, Albany NY, Buffalo NY, Medicare Part A, Medicare Part B, Medicare supplement, Medigap, MedSupp, New York, Saratoga NY, Schenectady NY

Medicare A & B

Switching Medicare Supplement (Medigap) policies

Post author By Dan
Post date March 28, 2017
1 Comment on Switching Medicare Supplement (Medigap) policies

Reasons Why New Yorkers Switch Their Medicare Supplement (Medigap) Policies:

You’re paying for benefits you don’t need.
You need more benefits than you needed before.
Your current Medigap policy has the right benefits, but you want to change your insurance company.
Your current Medigap policy has the right benefits, but you want to find a policy that’s less expensive.
NY State online tool: Simply Enter Your 5-Digit New York Zip Code to Compare MediGap Policies in Your Area

As a reminder, Medicare Supplement, also known as Medigap, are policies designed primarily to supplement (or fill the gap) Medicare benefits. You simply present your red, white and blue Medicare card to the provider or facility along with the Supplement / Medigap card to help with out-of-pocket costs; such as deductible and co-insurance amounts with Original Medicare Part A and Part B.

Currently, there are 10 standardized Medigap plans, each represented by a letter (A, B, C, D, F, G, K, L, M, N; both Plans F and G offer a high-deductible version). These plans are available in most states. While premiums will vary from state to state the standardized benefits of each lettered plan remain the same despite the insurance company or location. For example, Plan F benefits are the same in Florida as they are in New York.

Q: Is there an Annual / Open Enrollment Period?

Most people buy their Medicare Supplement / Medigap policy during the six month period after they first enroll in Medicare. After that, in many states, Medigap insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the Medigap policy.

Q: So How Do New York State Residents Have More Protection?

New York State laws and regulations continue this open enrollment period. A person enrolled in Medicare Parts A and B may purchase a Medigap policy at any time. Insurers may not consider an applicant’s health status, claims experience, or age. Laws in New York also prohibit insurers from basing Medigap premiums on age and charging a higher premium as they grow older. Also,

Q: But What About Pre-Existing Conditions; Are They Covered?

Medigap insurers may impose up to a six-month waiting period to be covered for any preexisting conditions a person may have. Federal law and New York State regulation define a preexisting condition as any condition for which medical advice was given or treatment was recommended by or received from a physician within six months before the effective date of coverage.
Under New York State regulation, the waiting period may be either reduced or waived entirely, depending upon whether an individual has had previous health insurance coverage. Medigap insurers are required to reduce the preexisting condition waiting period by the number of days an individual was covered under some form of “creditable” coverage so long as there were no breaks in coverage of more than 63 calendar days. Translation: If you are switching from a “creditable” plan that you have held consecutively for six months, New York regulation requires the new Medicare Supplement / Medigap plan to reduce or waive the six month pre-existing condition waiting period.

Tags Albany NY, Buffalo NY, Colorado, Florida, Medicare, Medicare Part A, Medicare Part B, Medicare supplement, Medigap, MedSupp, New York, Retirement Plan, Rochester NY, Schenectady NY, Syracuse NY, Virginia