Finding the Best Medicaid Plans in New York

How Medicaid Works in New York

New York's Medicaid program is one of the most robust in the country. It provides free or low-cost public health insurance to qualifying low-income adults, children, pregnant women, elderly adults and people with disabilities in the state.

To qualify for Medicaid in New York, your income must fall below a certain level. The income limits vary based on your household size and other criteria. Some people qualify for Medicaid automatically when they enroll in other programs, like Supplemental Security Income (SSI).

New York expanded its Medicaid program under the Affordable Care Act to cover more low-income adults. And in 2023, it expanded eligibility even further through two pathways:

• The Essential Plan - Covers residents with incomes slightly above Medicaid levels
• State Options for Expanding Coverage - Raises the income limit for certain adults to 138% of the federal poverty level

This wider safety net helps make health insurance accessible to more New Yorkers. Those who qualify have access to comprehensive medical benefits through Medicaid with little to no out-of-pocket costs.

Types of Medicaid Plans in New York

New York's Medicaid program contracts with various health insurance providers across the state to offer coverage. The major types of Medicaid plans you’ll see include:

Managed Care Plans

Most Medicaid recipients in New York enroll in some type of managed care plan. These plans establish a network of doctors, hospitals and other providers that members can access. Most managed care plans fall into one of two main categories:

Managed Long Term Care Plans (MLTCs) – Provide long-term services and supports to people who need ongoing medical care. Some examples are home health aides, medical equipment and adult day care.

Mainstream Managed Care Plans – Offer comprehensive health benefits to the majority of Medicaid members who don't require long-term support services.

Within the mainstream plans, you have a choice of different plan types and provider networks:

• Health and Recovery Plans (HARPs) – Serve members with significant behavioral health needs.
• HIV Special Needs Plans (HIV SNPs) – Tailored for people living with HIV/AIDS.
• Managed Care Organizations (MCOs) – General networks for regular Medicaid benefits.

Fee-for-Service Medicaid

Some Medicaid recipients in New York remain in the original fee-for-service program. Under this model, you can see any doctor or hospital enrolled in NY Medicaid and get reimbursed for covered services. This offers more flexibility but no coordinated care.

When weighing Medicaid plans in New York, you mainly choose between joining a managed care network or opting to keep fee-for-service coverage.

Top-Rated Medicaid Plans in New York

New York’s Medicaid program contracts with dozens of health plans across the state. To help narrow it down, here is an overview of some of the top-rated Medicaid plans in New York based on quality ratings and member satisfaction.

Fidelis Care New York

Fidelis Care is one of the largest Medicaid providers in New York, with over 1.7 million members statewide. It has achieved 4 out of 5 stars for member satisfaction based on state quality reports.

Pros

• High marks for member satisfaction and care access
• Choice of plan types, from HARPs to HIV SNPs
• Large provider network across NY includes major medical centers

Cons

• Primarily serves downstate NY rather than statewide
• Site navigation and benefit information could be easier to use

UnitedHealthcare Community Plan

UnitedHealthcare Community Plan earned 4 out of 5 stars from New York’s Medicaid program. It operates plans in over 30 counties.

Pros

• High ratings for quality of care and call center performance
• National insurer with expansive coverage and resources
• Array of supplemental benefits and wellness incentives

Cons

• More limited provider network compared to some plans
• Mixed reviews on choice of specialists

Affinity Essential Plan

Offered by Affinity Health Plan, this Medicaid managed care plan focuses on serving low-income New Yorkers. It earned 4 out of 5 stars from the state Medicaid program.

Pros

• Top marks for well-child and women’s health services
• Good choice for affordable essential plan coverage
• Strong network includes major NYC health systems

Cons

• Mostly concentrated in NYC area
• Smaller plan so provides fewer overall providers

CDPHP Universal Benefits, Inc.

The Universal Benefits Plan from CDPHP Medicaid has achieved 4 out of 5 stars for quality. CDPHP offers Medicaid plans across 20 counties.

Pros

• High ratings for preventive care and chronic condition treatment
• Offers both Medicaid Managed Care and Child Health Plus plans
• Network based around the Capital Region and Hudson Valley

Cons

• Limited coverage beyond Eastern/Southeastern NY
• Mixed reviews on choice of specialists

This is just a sample of some of New York’s top Medicaid options out of two dozen or more available plans. Be sure to explore all the plans offered in your county when making a decision.

Factors to Consider When Choosing a Medicaid Plan

With so many plan choices, narrowing it down can be tough. Focus on these key factors when picking the right Medicaid plan for your needs:

Coverage Area

The first thing to look at is where each plan operates. Medicaid programs are regional, so the plans will differ county to county across New York. Make sure to examine the plans available in your location before further comparison.

Most mainstream Medicaid managed care plans in New York have coverage maps on their websites showing the exact counties they serve. If you move to another county, you may need to switch to a new plan offered there.

Network of Providers

An essential factor is whether your doctors and preferred hospitals are in the plan’s provider network. Check that your existing healthcare providers have contracted partnerships with any plan you are considering.

Look beyond just general networks too. If you have special medical needs, see if the plan offers adequate specialists, health centers or extended care facilities to match those needs. Those with chronic conditions or disabilities often depend the most on access to service providers.

Quality Ratings

Once you’ve narrowed potential plans based on location and provider networks, take a closer look at service quality. The New York State Department of Health grades plans on measures like preventive health, chronic disease management and member satisfaction. The ratings can give insight into the overall performance and value each plan provides.

Covered Benefits

While all New York Medicaid plans must offer essential health benefits, there can still be some differences in details like:

• Prescription drug coverage
• Rehabilitative services
• Vision and dental benefits
• Non-medical benefits like over-the-counter (OTC) allowances and rewards programs

Factor in any specific care or medications you need, especially expensive specialty drugs. Check if a plan’s formulary includes your prescriptions before enrolling. Those with disabilities should confirm details on supplies coverage and waiver programs too.

Cost Sharing Requirements

The great thing about Medicaid is costs are limited based on your income. But some plans do have minor out-of-pocket costs like:

• Small monthly premiums
• Copays for prescriptions or special services

The expenses are meant to be affordable based on your means. But it’s still helpful to understand the cost structure before signing up for a given plan. Those on very limited incomes should aim for plans with lower to no member costs.

By weighing all these aspects, you can zero in on New York Medicaid plans that truly fit your healthcare situation.

How to Enroll in Medicaid Plans in New York

If you are eligible for Medicaid coverage, you can enroll by submitting an application online, by phone or in person.

Here are some tips for smooth Medicaid enrollment in New York:

• Apply through the NY State of Health marketplace – This is the main portal for all health coverage in NY, including Medicaid. Visit nystateofhealth.ny.gov or call 1-855-355-5777 for assistance.
• Work with an enrollment helper – Community health navigators across the state provide free help with understanding requirements, choosing a plan and applying for Medicaid benefits.
• Keep records handy – Having identity documents, pay stubs, disability or immigration records on hand speeds verification. Know the most recent tax returns as well.
• Choose a primary care provider – Some plans ask which main doctor’s office you use to link your care through enrollment. Select a PCP in the plan's network you want to coordinate with.
• Follow up on status – Processing times for Medicaid in NY varies. Check back if you haven’t received eligibility determination within 45 days and provide any additional verification needed.

Once approved, your managed care plan will issue ID membership cards. You may still keep separate cards for pharmacy or dental benefits. Carry your insurance cards to access benefits through your chosen Medicaid health plan and providers.

Switching Medicaid Coverage in New York

In some cases, you may choose to change your New York Medicaid plan after initially enrolling. Members can switch health plans:

• During open enrollment each fall
• At any time for “good cause” reasons

Examples of “good cause” reasons to change plans include:

• You move to a new county where your current plan doesn’t operate
• The plan ends contracts with your primary doctors
• You need greater access to specialists, hospitals or clinics

Various consumer protections also allow members to appeal decisions or file grievances related to their benefits, providers or coverage. If issues cannot get resolved, switching plans may provide the access you require.

To request to change plans as a current Medicaid member:

1. Review available options in your region that can meet your needs better
2. Call your county Department of Social Services or the NY Medicaid Helpline
3. Explain why you want to switch plans
4. File forms to transfer coverage

The new insurance typically takes effect on the first of the following month after switching. Coordinate care gaps when transitioning between different Medicaid plans.

Maintaining Coverage Through Renewal

To stay enrolled in New York’s Medicaid program, members need to renew eligibility periodically. Requirements include:

• Confirm income – For most members, NY Medicaid reviews whether your household income remains within qualifying limits once per year. Report any pay changes when they happen.
• Check other status – Besides income, factors like disability, pregnancy, children in the home also help determine if you still qualify for Medicaid. Update any relevant life changes.
• Complete renewal packet – About 45 days before Medicaid expires; members get a renewal form in the mail to verify eligibility factors. Return required documentation by the deadline. Otherwise coverage may lapse.
• Switch to other coverage – If income rises above Medicaid levels at renewal, members move to affordable marketplace insurance plans, keeping care continuity.

Keeping current on eligibility rules and responding promptly to renewal notices ensures low-income New Yorkers maintain health benefits through Medicaid year after year.

FAQs

Does New York have Medicaid managed care?

Yes, the majority of New York’s Medicaid program operates under managed care models. Members enroll in set networks through health insurance providers contracted by the state Medicaid agency. These networks coordinate members' care and try to improve health access. Only about 15% of NY Medicaid recipients remain in original fee-for-service Medicaid.

How long does it take to get approved for Medicaid in NY?

Processing times varies, but New York aims to determine Medicaid eligibility within 45 days. Those in urgent medical need may receive temporary coverage sooner. Response times depend on how quickly one submits all documentation needed to verify eligibility factors. Applying at the NY State of Health marketplace can expedite processing.

Can I have Medicaid and Medicare in New York?

Yes, some New Yorkers qualify for and enroll in both Medicaid and Medicare programs. Dually eligible individuals include low-income seniors and younger adults with certain disabilities. The joint coverage helps pay for medical costs Medicare does not fully cover on its own. Managed care plans tailored for dual recipients coordinate the benefits.

CONCLUSION

Picking the right Medicaid plan ensures you have access to affordable, high-quality care. New York's program offers low-cost public health coverage with a variety of plan options extended across the state.

Consider coverage regions, doctor choices, benefits details and ratings when selecting the insurance that suits your situation.Knowing how to apply, renew and switch plans also empowers enrollees to make the most of Medicaid benefits.

Reach out to the many available resources for application assistance and help choosing between the variety of New York Medicaid insurers.

SOURCES

1.https://www.googleadservices.com

2.https://freedomcare.com/best-medicaid-plans-ny

3.https://www.nymedicaidchoice.com/comparing-plans

4.https://www.nyc.gov/medicaid-managed-care-plan