There’s some confusion surrounding Medicaid plans in New York. Many people think that everyone who qualifies receives the same plan. In reality, there are various options out there, and choosing the right one is critical.
First, you need to know if you qualify for Medicaid. If you do, there are some questions to ask yourself before finding a plan. Then, you’ll be ready to look over the best Medicaid providers in New York so you can choose the best plan for you.
Let’s get started by seeing if you qualify. Remember if you qualify for Medicaid you can apply for CDPAP.
Who Qualifies for Medicaid in NY?
You need to meet specific requirements to qualify for Medicaid in NY. You must:
· Reside in New York
· Be a United States national, citizen, legal alien, or permanent resident
· Have low or very low income
The income requirement is based on your household size. As of 2021, you qualify if you:
· Are a single-person household and earn $17,131 or less
· Live in a two-person household with an income of $23,169 or less
The income requirement increases based on the number of people who live in your home. You can find the income limits for your household size on New York State’s website.
Along with those requirements, you may also qualify if you are:
· Pregnant
· Caring for a child who is 18 or under
· Blind or disabled
· Caring for a disabled family member in the household
· 65 years of age or older
If you meet the eligibility requirements, you can apply for a plan today. However, what happens if your circumstances change and you stop meeting the retirements after you get your plan? Let’s take a look.
What Happens If You No Longer Meet the Eligibility Requirements?
Your income might increase, or your circumstances could change after getting a Medicaid plan. For example, you might have your baby, so you are no longer pregnant, or a disabled family member could leave your household.
Most Medicaid plans in New York offer guaranteed eligibility. Once you get a plan, you can continue to use the benefits for six months after approval, even if your circumstances change. Then, at the end of six months, you won’t be on Medicaid any longer. This allows people to use Medicaid as a short-term solution when needed.
Whether you need a plan for the short term or the rest of your life, you want to make sure you choose the right one. There are some questions you should ask before you get a plan. The answers to these questions will help you choose the right NY Medicaid plan.
Questions to Ask Before Choosing a Medicaid Plan
Asking questions allows you to analyze plans to see if they meet your requirements for health care. If a plan doesn’t meet your needs, you can move on to the next one. There are numerous Medicaid options for New York residents, so you can find one that’s ideal for your health needs and lifestyle.
Are Your Medications Covered?
Prescriptions are expensive without insurance coverage. Before choosing a Medicaid plan in New York, make sure that all of your medications are covered.
The New York State Department of Health has a Medicaid drug lookup page on its website. Just type the name of the drug, choose the plan, and see if it’s covered.
If some or all of your medications aren’t covered, you should move on to another plan. Otherwise, you will either have to pay out of pocket or ask your physician to change to a covered medication.
Is Your Doctor “In-network”?
You likely already have a health care provider that you’d like to continue to see after getting Medicaid. There could be a problem, though.
Your doctor might not be in-network for you the plan you intend to get.
You can use the NYS Provider and Health Plan Look-Up Tool on the Department of Health’s website before choosing a plan. Find out if your doctor is in-network before choosing a plan. Then, you can have a seamless transition when you start using your new Medicaid plan.
Do the Providers Work With Your Hospital of Choice?
After you find out that your doctors are covered, take it a step further to ensure that the providers are working with your preferred hospitals. If they don’t, you will need to decide if you want to change providers or hospitals.
If you decide to keep the same provider and hospital, you can be charged out-of-network fees. Many people don’t realize this until it’s too late, so it’s a good idea to be proactive. This can save you thousands of dollars if you need a medical procedure in a hospital. It will also give you peace of mind since you will know that you are covered.
Do You Have a Health Condition That Must Be Covered?
You need a Medicaid plan that will reduce or eliminate your out-of-pocket costs when receiving health care. While all plans cover basic services, others provide outstanding coverage for health conditions.
Make a list of all of your health conditions before you choose Medicaid coverage in New York. Then, you can find a plan that will cover your specific needs. This can save you a lot of money while also ensuring you get the care you need.
Go beyond medical conditions, like cardiovascular disease and diabetes, to consider your other needs. For instance, do you have mental health or substance abuse needs? You can find a plan that offers coverage for that and more.
Does the Plan Cover Dental and Vision?
If you get a plan covering dental and vision care, you won’t have to purchase separate policies. Before you commit to a plan, see if it covers these services. If it doesn’t, you might want to choose another plan that does.
Choosing a plan that covers dental and vision care can save you hundreds of dollars a year, if not more. It will also make it easier for you to maintain your oral and eye health.
Do You Need A Referral to See a Specialist?
Some Medicaid plans allow self-referrals for some services but require referrals for others. It’s a good idea to see what specialists you can go to without a referral. If you tend to use lots of specialists, self-referral options will help you get care faster.
This doesn’t mean you won’t still discuss your needs with your primary care physician. However, you can choose your specialist and make an appointment without your primary care physician making a formal referral.
Is Transportation Provided?
If you require transportation to your medical appointments, make sure the plan covers it. Some include transportation, even for non-emergency appointments. Others require that you handle your transportation yourself.
If you find a plan that offers transportation, review the details. Make sure the plan will meet your specific transportation needs.
Are You Looking for Coverage for Yourself or Your Whole Family?
You also need to consider the type of coverage you need. Some providers excel with individual plans, while others offer extras for families. Some plans also provide extra coverage for kids. Consider your situation you can find a plan that addresses your family’s unique needs.
The Best Medicaid Health Insurance Companies in NY
There isn’t a single best Medicaid health insurance company in NY. Instead, several companies share that title, and you’ll need to pick one based on your specific needs. Let’s take a look at the top choices, starting with Fidelis Care.
Fidelis
Fidelis Care’s Medicaid Managed Care policy is one of the top in the industry. The program is open to children and adults who meet Medicaid’s age, resources, income, and/or disability requirements.
This plan covers the basics, including:
· Preventive care
· Dental and vision
· Prescription and non-prescription drugs
· Behavioral health services
· Hospital care
· Ambulance services
· Emergency room visits
This plan scores the highest marks when it comes to medication coverage. You should still check the database to ensure your medications are covered, but there’s a very good chance that they are.
While it’s known for its medication coverage, this plan is also a good choice for preventive care. Also, you will have access to high-quality providers when you choose Fidelis.
Are you in the market for a low-cost or free plan that covers families? If you meet the requirements, Healthfirst is a good option.
Healthfirst
With a $0 premium plus the chance for no copays, Healthfirst is popular with New Yorkers. The plan is available to low-income families and individuals under 65 years old.
Healthfirst’s plan covers:
· Doctor visits
· Lab tests
· Prescription drugs
· Hospitalization
· Urgent care
· Maternity care
· Dental care
· Vision care
· Hearing care
· Wellness
· Mental and behavioral health
Healthfirst excels when it comes to child and adolescent care and vision care. It also scores high marks for:
· Diabetic care
· Mental health care
· Behavioral health care
If you are suffering from diabetes, have mental health issues, or are raising children, this is a good plan to consider. You will get the care you need without spending your hard-earned money.
Do you want a policy that will cover your kids, but you aren’t sold on Healthfirst? Affinity might be the right plan for you.
Affinity
Affinity’s Medicaid program is open to individuals who qualify for Medicaid through SSI or Traditional Medical Assistance programs. This program is not open to people who are:
· On Medicare
· Live in a facility
· Are in hospice
· Are enrolled in a long-term home health program
Affinity has two programs available. You can get the Medicaid Managed Care plan to cover your basic medical needs. This includes:
· Preventative care
· Dental and vision care
· Maternity services
· ER visits
If you have mental health needs, you can upgrade to the Enriched Health plan. You can use it for counseling, substance abuse services, and more.
Affinity is an excellent choice if you have a family. The family planning and maternity care coverage stands out. It also does a great job of providing for children.
Are you searching for a customized option? UnitedHealthcare Medicaid NY could be a good fit for your health care needs.
UnitedHealthcare Medicaid NY
UnitedHealthcare takes a different approach to Medicaid in New York. If you are a low-income individual or family, you can get the Essential Plan. Then, you can tailor the plan to meet your specific needs.
For example, if you have substance abuse issues, you can get the Wellness4Me plan. It offers the services you need to get and stay clean.
You also have the option to go with the standard Community Plan. This is part of the New York State Managed Care plan and covers a wealth of medical-related services.
Regardless of the plan you choose, you can expect excellent coverage for a variety of illnesses and issues, including:
· Cardiovascular disease
· Diabetes
· Mental illness
· Respiratory problems
While UnitedHealthcare is an excellent plan for many people, you might need one for a special circumstance. For example, if you need coverage for kids with special needs or long-term care, Aetna can help.
Aetna
Like UnitedHealthcare, the Aetna Better Health of New York plan also covers a wide range of services, and you can customize it to your needs. The covered services range from preventive care for long-term health.
This plan stands out for the coverage options. You can use it to cover:
· Children in foster care
· Kids with special needs
· Care for blind and disabled individuals
It also excels when it comes to providing substance abuse help
Many people choose this coverage as part of their long-term planning. They get it today to use the standard medical services and then transition to long-term care.
Choosing a Plan
As you look through the plans, go down the list of questions. The answers to your questions will tell you if a plan is right for you. Once you find the right plan, you can fill out the application to begin the process of getting Medicaid.
It won’t be long before your Medicaid plan is active. Then, you can begin receiving low-cost or free medical care in New York. From preventive health to other needs, your plan will provide various coverage options, so you can maintain your health.