Medicare Health Insurance in New Windsor, New York

New Windsor, New York, is a beautiful town in the Hudson Valley. It’s home to many retirees, and Medicare is a big part of the human healthcare landscape here. If you’re new to Medicare or just looking for some information on it, this blog is for you.

We’ll discuss all things Medicare, from enrolling to choosing a plan to using your benefits.

What is Medicare?

Most people think of Medicare as health insurance for seniors. And it is. But Medicare is also the federal health insurance program for people with specific disabilities. The program helps cover health care costs, but you should 

In general, to be eligible for Medicare, you must be:

– 65 years old or older, OR

– Under 65 and have a disability, OR

– Any age and have End-Stage Renal Disease (ESRD) or Lou Gehrig’s Disease (ALS).

Once you’re eligible for Medicare, your coverage plays a vital role in your medical expenses. Still, it doesn’t cover 100% of your bills, and you can decide how to fill those insurance gaps. 

The Four Parts of Medicare

Original Medicare:

• Part A: It covers medical services, such as inpatient hospitalizations, skilled Nursing facility (SNF), blood, home health care, and Hospice care. 

• Part B: Part B covers doctor and other medical provider expenses like doctor’s services, preventive services, outpatient hospital care setting, and ambulance services, among other medical services such as Durable Medical Equipment, laboratory services, chemotherapy, radiation Therapy, part-time or intermittent home health, and also rehabilitative services (e.g., physical and occupational therapy). It may even include extensive dialysis care for people with kidney failure. Think of Part B about services related to people and Part A about a building where you live. 

Medicare beneficiaries pay a monthly premium. The monthly premium of Part B for 2023 will be $164.90 for most people.

Options Beyond Original Medicare:

• Part C: Part C is also called Medicare Advantage. Private insurance companies contracted by Medicare offer it. They are an alternative option to Original Medicare.

• Part D: Part D covers prescription drugs.

Every Part D plan includes a list of covered drugs called a drug formulary. The formulary indicates what tier your medication is on. The higher the tier level, the higher your costs tend to be. In addition to Medicare, you pay a monthly premium for the drug plan. Part D is an optional plan. No one is required to enroll. However, suppose you qualify and delay your registration. In that case, you risk paying the penalty in the form of increased insurance premiums for life if you register later. 

What are the different types of Medicare plans available?

Four Medicare plans are available in New York: Original Medicare, Medicare Advantage, Medicaid, and long-term care insurance.

• Original Medicare: 

The traditional fee-for-service plan covers hospitalizations, doctor visits, and preventive care. It is managed by the federal government and is available to all eligible New Yorkers.

• Medicare Advantage: 

It is a managed care plan that covers all of the benefits of Original Medicare, plus additional benefits such as prescription drug coverage and routine vision and dental care. Private insurance companies offer these plans. They are available to New Yorkers enrolled in Medicare Parts A and B. 

If you choose Part C or Medicare Advantage, you won’t use the original Medicare while participating in the Medicare Advantage program. While on the plan, you are subject to the rules of private insurance companies. At the same time, you limit your maximum out-of-pocket expenses. You may receive extra benefits that Original Medicare doesn’t provide. 

Medicare Advantage plan costs vary. A variety of factors could include the insurance company, the plan chosen, and your location or where you live. 

Several different Medicare Advantage plans are available in New Windsor, New York. Each program has benefits and coverage levels, so comparing the plans is essential before choosing one.

Each Medicare Advantage plan uses a network of providers in a geographic area. To sign up for the program, you must live within the plan’s location. Then, you’ll need to find providers that join your plan’s network to make your coverage work. There are several types of networks available. The most common are:

1. Health Maintenance Organizations (HMOs): HMOs are popular because of their low premiums, sometimes as low as $0 per month. (This doesn’t make them “free,” as there will be costs in addition to the premium!) The downside of HMO plans is that their networks are usually very tight and do not offer participants a wide range of providers. 
2. Preferred Provider Organizations (PPOs): PPO networks are usually larger than HMO networks, giving members more freedom when choosing providers. There’s also insurance coverage if you’re being served outside the network, but you’ll pay more out of pocket. 
3. HMO-POS (Point of Service) plan: These plans are part of an HMO network but offer some out-of-network benefits, with a Primary Care referral. However, as with PPO plans, members’ out-of-pocket expenses will be higher than if they had stayed within the network. 

Other Medicare Advantage plans include Private Fee-for-Service (PFFS) and Special Needs Plans (SNPs). PFFS plans allow providers to choose whether or not to accept contractually agreed amounts for services. Special needs plans are only offered to people who meet specific criteria. For example, you must have a particular chronic condition or live in a nursing home to qualify for an SNP plan. 

Now that you know the different Medicare plans, it’s time to learn the step-by-step guide to choosing the right health plan for your health needs. 

• The best drug coverage: If you choose Original Medicare, you can enroll in a Part D prescription drug plan. It would be helpful to compare the rates available in your area regarding coverage and costs. You would also have to pay an additional premium for the plan. The Medicare Advantage plan will most likely include prescription drug coverage in Part D. You can purchase it separately if the program is not part of it. 
• Compare the original Medicare Advantage, and Medicare Advantage plans: By comparing the coverage and price of Medicare Advantage plans with those of Original Medicare, you can decide which one is best for you. 
• Calculate the cost: Your costs are different if you choose a Medicare Advantage plan instead of a traditional Medicare.

Can you change insurance agency or insurance agent after you enroll in Medicare? 

If you’re enrolled in Medicare Advantage, you can change your plans in two enrollment periods. These are the Annual open enrollment (October 15 to December 7) and the Medicare Advantage Open Enrollment period (January 1 to March 31). 

However, once your broker enrolls you in a plan, you usually can’t switch brokers to that plan. You’ll usually have to change your insurance plan if you want another broker. 

How do I enroll in Medicare in New Windsor, New York?

When you reach 65 years or older and are a legal resident of the United States are eligible for Medicare. You can enroll in Medicare three months before your 65th birthday, during your birthday month, or up to three months after your 65th birthday.

There are two ways to enroll in Medicare in New Windsor, New York: online or by mail.

If you enroll online, you must create an account with the Social Security Administration. Once you have created an account, you can log in and complete your application for Medicare.

If you enroll by mail, you must complete a paper application and mail it to the Social Security Administration.

How can you find an Agent or Broker Near You?

Do you live in New Windsor, New York, and need help finding the best licensed Medicare agent so you can get all the information about Medicare? 

Two types of agents:

• Independent Agent: They represent different insurance companies, so they are more qualified to find the plan that fits your needs. 
• Captive Agent: These agents only work with a single or one insurance company. The insurance company usually provides training, opportunities, and support. The broker only needs to talk to prospective clients (potential customers), explain the insurance company’s programs, and sell them. A captive agent owned by the company cannot offer rates from other providers. 

Things to consider when choosing a broker

• Experience: Choose a broker with extensive experience selling Medicare plans in your state. 
• License: Check with your state insurance department for license status to ensure that you are working with a licensed broker. The license card must also include your license number.
• Customer Service: Choose a broker with excellent customer service. For recommendations, you may ask your family and friends. When you interview a representative or broker, ask them about the plans they manage and the type of customer they usually hire. You can also check their online reviews.

Health insurance brokerage advantage

• Advice: It is the responsibility of a licensed professional insurance broker to advise you to ensure that you choose the best deal for your unique needs. A Medicare agent can educate you on all your Medicare choices. They can help you understand the differences between types of plans.
• Time savings: Brokers help make sure that you save time. 
• Comparison of Policies: The broker’s job is to save you time comparing plans and making a recommendation. 
• Range of options: Brokers usually know the options and can help you resolve them faster than you can.
• You can keep in touch with your agent by phone or email or even stop by their office if they have one. Your representative will likely contact you occasionally to provide you with news or updates. 

How are independent Medicare agents paid?

Agents who sell you a Medicare supplement plan generally earn recurring fees as long as you are their customer. Let’s say you give up your policy and move to another agency. They will no longer receive a commission on your policy unless they help you with the new policy. 

The Certified Medicare Agent Directory will help you get the following:

• Consumer Tips – Stay informed for the latest Medicare news and advice 
• Find Professionals – Find your local expert and compare.

If you live in New Windsor, New York, and are looking for an independent Medicare agent to help you with your Medicare plan inquiry, visit the Medicare Certified Agent Directory. 

Originally Published on https://www.certifiedmedicareagents.com/blog/

Katherine Kline Podcaster, Blogger

I host the Rock Your Retirement Show, which is about Lifestyle, not money or insurance! I started the show in 2016 before anyone knew what a podcast was, and now it's had over one million downloads. At this point, there is a lot of information in our back catalog and we try to release an episode every month.

I'm a retired Financial Advisor (after 25 years) and now I try to have fun with my husband, my dog, and my friends.

I'm also the founder of CertifiedMedicareAgents.com, a site that brings insurance agents together with people who are looking for help with Medicare.