Resources for New York beneficiaries
State Health Insurance Assistance Programs (SHIPs) provide free, in-depth, one-on-one insurance counseling and assistance to Medicare beneficiaries, their families, friends, and caregivers. SHIPs operate in all 50 states.
In New York you can reach SHIP at 1-800-342-9871 or online here.
Snapshot of Medicare in New York
Total Medicare enrollment in New York
In 2009 there were 309,3591 Medicare beneficiaries in New York, which is 15.9 percent of its total population. That compares with 16 percent of the United States population enrolled in Medicare.
The states with the highest percentage of beneficiaries are West Virginia and Maine with about 21 percent each. Those with the lowest percentage are Alaska (9.5 percent) and Utah (10 percent). In raw numbers, Alaska has the least recipients at 69,301 and California (which has about an eighth of the country’s population within its borders) has the most at a little over 5 million (13 percent of its population).
Breakdown of the aged vs. disabled
Individuals who qualify by virtue of their age alone make up 82 percent of New York Medicare recipients. The balance — 18 percent — are on Medicare as the result of a disability. Kentucky has the highest percent of Medicare recipients listed as disabled (28 percent), followed by Alabama, Mississippi, West Virginia and Arkansas. Hawaii has the smallest percentage at 12 percent, followed by North and South Dakota at 14 percent each.
Medicare spending per recipient
Medicare pays about $11,603 annually per enrollee in New York. Growth in per-enrollee spending in New York from 1991 to 2009 has been about 6.4 percent.
In terms of spending per recipient, about 20 states spend $10,000 or more per recipient. (Medicare spends the most per beneficiary — $11,903 — in New Jersey and the least per enrollee — $9,576 — in Montana. South Carolina and Nebraska lead in per-enrollee spending growth at 7.4 percent, and Pennsylvania‘s growth per enrollee has been the least at just over 5 percent.
Medicare spending overall
In total spending on Medicare, New York ranks #3 with $34.1 billion per year. With the largest and smallest numbers of recipients, itʼs no surprise that California accounts for $50.6 billion of overall Medicare spending while Alaska spends only $553 million. Total Medicare spending for all states and the District of Columbia was $471 billion in 2009 (latest available data).
Medigap in New York
Medigap is the only form of private coverage for Medicare beneficiaries that does not have any federally-mandated annual open enrollment period. Medigap coverage is only guaranteed issue during a six month window when you turn 65 and enroll in Original Medicare. During that time, enrollees can select any Medigap plan available in their area, with no medical underwriting.
But once that six month window is over, enrollees often find themselves locked into the plan they initially selected – regardless of how the premium changes – because in most states, switching to another plan can be impossible or prohibitively expensive due to medical underwriting (federal guidelines allow for guaranteed issue plan changes triggered by seven limited circumstances, but there is no general annual open enrollment window for Medigap the way there is for Medicare Advantage and Medicare Part D).
In response to the lack of a nationwide annual open enrollment period for Medigap, some states have implemented legislation that makes it easier for seniors to switch from one Medigap plan to another. New York is one of them, with among the strongest consumer protections in the nation. Medigap coverage is guaranteed issue year-round in New York, for both seniors and younger Medicare beneficiaries who are disabled. Medigap carriers can impost a six month pre-existing condition waiting period for enrollees who were not previously insured, but coverage is guaranteed issue and community rated, which means all current enrollees pay the same premium, regardless of age.
Medicare Advantage in New York
Medicare Advantage offers Americans health benefits through private plans instead of through Original — or traditional — Medicare (the federal government’s fee-for-service program). These plans are one option for consumers who desire additional benefits beyond what Original Medicare offers, but are not considered a wise option by some consumers who are concerned that government spends more per enrollee on the private plans than it does on its own program.
In 2014 in New York, 35 percent of all Medicare recipients chose a Medicare Advantage plan. New York is in a two-way tie with Wisconsin for #11 among all states for insureds choosing an Advantage plan. Nationwide, 30 percent of Medicare beneficiaries enrolled in a Medicare Advantage program. A full 32 percent of urban dwellers choose them, compared to only 20 percent of rural dwellers, likely due to less access to plans.
Minnesota is the only state where more than half (51 percent) of Medicare eligibles enrolled in a Medicare Advantage plan. Alaska, with only 22 Advantage enrollees, is the only state to have zero percent enrolled in Medicare Advantage. Five more states have Medicare Advantage enrollment (by percentage of the state’s Medicare enrollees) in the single digits: Wyoming with 3 percent, New Hampshire with 6 percent, Vermont and Delaware (both with 7 percent) and Maryland squeaking in with 9 percent.
Stand-alone Medicare Prescription Drug plans
New York has 1,357,662 in stand-alone prescription drug plans. The state has 29 plans with premiums ranging from $13 to $144 per month. That amounts to 45 percent of all enrollees in New York having a stand-alone Rx plan compared to an average of 47 percent nationally. (Florida is highest with 52 percent.)
Medicare prescription drug coverage — called Medicare Part D — was the result of legislation passed in 2003 and signed into law by President George W. Bush in 2006. It is a bit of a controversial program because it was an unfunded liability — meaning that the vast majority of costs fell on taxpayers — and the law also barred Medicare from negotiating lower drug prices with drug makers.
For those under 65 in New York