***If you already have Medicaid and want to learn more about the CDPAP program click here.
For individuals in low-income situations, Medicaid is an essential part of being able to obtain adequate healthcare. Medicaid is a federally and state funded insurance program that provides coverage for medical treatment costs. The Medicaid insurance program in New York offers coverage for adults, pregnant women, children, the disabled, and the elderly, and other qualifying individuals.
If you qualify and apply for Medicaid you will be able to receive cost coverage for doctor’s visits, nursing care, ambulance rides and trips to the ER, home health care, CDPAP, and more.
Medicaid is provided at the state level and every state has slightly different rules and regulations for who can apply and what medical costs are covered under the program. In New York State, individuals under age 21, pregnant women, and patients in long-term care receive free Medicaid coverage.
Other applicants may be required to pay a small copay to maintain coverage. This article will focus on the regulations specific to New York State and some of the the best health insurance companies offering Medicaid in this state.
Who Qualifies for Medicaid in New York
To be able to get Medicaid in New York State, you have to meet certain requirements. The government only provides healthcare support to individuals in qualifying situations, so it’s important to analyze your situation first before attempting to apply. Medicaid healthcare is only offered to people who aren’t able to pay their medical bills. Individuals who meet this criteria may be on Supplemental Security Income (SSI) or be facing other circumstances that make it difficult to pay for adequate healthcare.
Medicaid is available to both children and adults, though different provider plans must be chosen based off of age group and personal healthcare requirements. Older individuals may need to choose a Managed Long-Term Care Medicaid plan, while children need a plan that specializes in covering children’s healthcare costs. People with mental or physical disabilities must also choose a plan specific to them to ensure the best possible coverage and care.
For average individuals between the ages of 19 and 65+, these are the requirements that you must meet to qualify for Medicaid in New York:
● Proof of United States citizenship – Medicaid in New York is currently only offered to United States citizens. To prove your citizenship you can provide one of the following documents: a valid American passport, a birth certificate, certificate of citizenship, or a naturalization certificate.
● Proof of New York residency – To qualify for Medicaid coverage in New York State, you must be able to prove your state residency status. Examples of proof of residency include a dated utility bill, a valid New York driver’s license, valid New York voter’s registration card, or other similar documents that demonstrates New York residence.
● Documentation of current housing/living situation – This can be a rental agreement in your name or some other similar form of proof of your living situation. People with more difficult or unusual living situations (due to low income or a health condition) are more likely to qualify for Medicaid coverage so proof of domicile can be shown in a number of different ways.
● Marriage license (if you are married)
● Social security number
● Documented proof of monthly income – Medicaid is only available for individuals who make 138% or less of the Federal Poverty Level (FPL). For pregnant women or infants, their income must not be greater than 218% of the FPL. Please note that the income requirements are different for people who are over the age of 65, blind, or who have a disability. The requirements also vary according to whether or not the applicant is single or married, and whether they have or do not have children.
Keep in mind that the monthly income requirements for Medicaid coverage change greatly depending on your personal situation. An excellent example is that children, pregnant women, disabled or blind people, and individuals over the age of 65 may be able to qualify for Medicaid even if their income exceeds the base requirements. Beyond income, your assets will also be examined when you submit your application for Medicaid.
● Proof of other insurance – If you currently have other types of insurance, you will be required to submit proof of and information about these other insurance plans with your Medicaid application.
Be aware that you will not be required to cancel other health insurance plans that you may have at the time that you apply for Medicaid. Having other health insurance plans does not disqualify you to receive Medicaid. In fact, while not extremely common, there are even certain situations in which Medicaid may cover the premiums for other health insurance plans that you currently have. Investigate and inquire about these rules when you’re looking for the best Medicaid provider for you.
How to Apply for Medicaid in New York
In the state of New York, Medicaid applicants are separated into 2 different groups: MAGI (Modified Adjusted Gross Income) and non-MAGI applicants. The Medicaid application process is different depending on which group you fall into.
MAGI applicants include:
● Pregnant women,
● Foster children,
● Children under the age of 19,
● Relatives of parents or caregivers
● Childless adults between the ages of 19 and 64 who are not pregnant and who do not have and do not qualify for Medicare, but who have a certifiable disability,
● Women who are receiving fertility treatments,
● FPBP (Family Planning Benefit Program) beneficiaries.
Medicaid applicants who fall under the MAGI applicant category must apply through the New York State Department of Health Marketplace.
Non-MAGI applicants include people in the following groups:
● Medicaid Cancer Treatment Program
● AIDS Health Insurance Program (AHIP)
● Medicaid Savings Program (MSP)
● Social Security Income (SSI) recipients
● ADC-related medical needy individuals
● COBRA
● People age 65+ who are not relatives of parents or caregivers
● People who are blind or disabled, but who do not fall into any of the MAGI applicant categories
● Medicaid Buy-In for People with Disabilities
● Residents of Adult Home by LDSS, OMH Residential Care Centers/Community Residences
For non-MAGI applicants, it’s necessary to apply through your local Department of Social Services.
For both MAGI and non-MAGI applicants, the final Medicaid application can be submitted in the following ways:
● Apply by phone – Call the New York State Department of Health to obtain the correct phone number for your area. Then call and follow the instructions to apply.
● Apply online – Visit the New York State Department of Health Marketplace website to access the online Medicaid application.
● Apply through mail – Download the appropriate Medicaid application form from the Health Marketplace website and then send it to your local District Service Office.
● Apply in-person – Visit your local District Service Office and follow their instructions to apply for Medicaid.
● Apply through a Facilitated Enroller (FE) – If you want or need assistance with gathering the appropriate documentation required for your Medicaid application, or if you would like the input of a professional who can help you get the best Medicaid coverage possible, it may be the right choice to apply for Medicaid with the help of a Facilitated Enroller (FE).
If you are located in New York City, you can easily obtain Medicaid application forms at the Human Resources Administration and can finish the application process from there.
Before applying for Medicaid, make sure that you have access to all the required documents listed above in the previous section so that you can prove your eligibility. Having all your documents in order before applying greatly increases your chances of being able to receive Medicaid coverage.
Which health insurance company is the best for Medicaid recipients in New York?
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There are a number of health insurance providers in New York State that offer Medicaid coverage plans to Medicaid recipients. It can be difficult to know which plan is the best for you or for your family, but a little bit of research and inquiry will help you identify which provider will suit your needs the best.
As you research, keep in mind that you may only be accepted by one or two of the insurance companies that you apply to for coverage. Out of all the New York health insurance providers, these are the best for Medicaid recipients:
● Fidelis Care –
Fidelis Care offers a Medicaid Managed Care plan for Medicaid recipients. The plan is available to anyone who qualifies for Medicaid based off of age, disability, income, or resource requirements. This plan covers preventative care visits, dental care, vision care, emergency room and ambulance services, hospital and outpatient care, behavioral health services, and prescription and non-prescription medicines. Medicaid recipients can enroll in this plan year-round, a benefit not offered by all Medicaid care providers.
Fidelis had high rankings in almost all health sectors and rating categories. Fidelis Care has better coverage of medications and ranked especially high in the illness care sector.
● Affinity Health Plan –
Affinity offers both a Medicaid Managed Care plan as well as an Enriched Health plan for Medicaid-eligible individuals. The Medicaid Managed Care plan is a standard plan with a long list of covered services, including maternity services, ER visits, family planning services, preventative care, and dental and vision care (among other services).
The Enriched Health plan is designed specifically for people with complex mental health needs. This plan includes coverage for substance abuse disorder services, group and individual counseling, and more. The Enriched Health Plan that Affinity offers makes it stand apart from the rest. For individuals who struggle with mental health issues, this Medicaid health plan ranks high because it specifically caters to individuals in this group.
The Affinity Medicaid healthcare plan provides excellent coverage of maternity care and family planning services. Children’s care was also ranked highly with this plan. Because of its high rankings for mothers and children, this plan would be more highly recommended for families.
● UnitedHealthcare –
UnitedHealthcare provides three different Medicaid healthcare plans, all with slight differences that cater to specific eligible groups. The Essential Plan is for American citizens with low income who qualify for Medicaid.
This plan has a number of sub-plans to choose from based on your individual situation. The Wellness4Me healthcare plan is designed to accommodate people with a history of substance abuse and for individuals with serious mental or behavioral disorders. This plan requires that applicants are age 21+ and that they meet the New York State eligibility requirements. The Community Plan offers the New York State Medicaid Managed Care plan.
UnitedHealthcare has higher rankings for its coverage in regard to illnesses such as cardiovascular disease, mental illness, diabetes, and respiratory afflictions. This plan has especially high rankings for care, prevention, and patient follow-through in the mental health department. Postpartum care for new mothers also ranked high
● Healthfirst –
Healthfirst provides the New York State Medicaid Managed Care plan to Medicaid eligible individuals. This plan covers a long list of health-related expenses at a $0 monthly plan premium and little to no copay cost.
The Healthfirst Medicaid Managed Care plan is available for low-income families and individuals under the age of 65 and covers doctor’s visits, emergency care, maternal care, health and wellness programs, hearing, vision, and dental care, prescription drugs, lab tests, and more.
Healthfirst was one of the highest ranked Medicaid providers in New York State according to the NCQA Health Insurance Ratings in the years 2017-2018. This provider had exceptional scores in mental and behavioral health, child and adolescent care, eye care, and diabetic care, among other categories.
● Medicaid NY Aetna –
Aetna Medicaid provides Medicaid Managed Care in New York under the title Aetna Better Health of New York. Their healthcare plan covers a wide range of situations including everything from preventative care visits to care for the blind, disabled, or elderly.
The plan also covers adults and children with special needs, children in foster care, and people who require support with managing a substance abuse problem. The Aetna Medicaid healthcare plan is tailored to suit the individual needs of each applicant, which is a unique feature that makes it stand out from the rest.
Medicaid NY Aetna is one of the top-rated Medicaid providers in the state with a 4.5 out of 5 overall rating according to NCQA. The Aetna Medicaid plan offers not only regular healthcare coverage, but also has the option for managed long-term care under Medicaid coverage. For elderly individuals who expect that long-term care may be required in the future, the Aetna Medicaid plan has coverage just for you.
Choosing the Best Medicaid Plan
When choosing a Medicaid provider, it’s important to analyze your options carefully to ensure that you’re getting the best coverage for your individual situation. Depending on your age, medical situation, income bracket, and more, one provider may suit your needs better than another. Here are some things to consider when choosing the best Medicaid plan for you:
Are your medications covered?
If you’re currently taking medications, it’s important to consider whether or not a particular Medicaid plan will cover the expense for those particular medications. Most New York Medicaid health plans will cover certain medications, but it’s still necessary to check in and see if your specific medications are covered. If you’re in doubt about the coverage of the medications you’re taking under a specific plan, contact the Medicaid plan provider directly.
Is your doctor “in-network”?
Medicaid plan providers utilize a “network” of doctors, hospitals, and medical care providers, and checking to see if your doctor or care provider is within the Medicaid network is important before making your final decision on a plan. Most Medicaid plans cover the cost of routine check-ups, doctor’s visits, emergency room costs, and other related expenses as long as the healthcare providers are within the Medicaid network.
Do you have a health condition that must be covered?
Different Medicaid plans cover different health conditions, and while most New York Medicaid providers offer standard care for most common ailments, if you have a specific condition that needs to be addressed it’s worth investigating to see if your desired provider covers that condition.
For example, if you’re pregnant (or planning to become pregnant), have a mental disability, or face behavioral issues, it’s important to check and make sure that your plan covers the specific expenses related to these situations. Some Medicaid providers offer specialized Medicaid plans for different situations like these, so be aware.
Are you looking for coverage for yourself or your whole family?
If you’re looking for Medicaid for your whole family, it’s important to choose a plan provider that will cover all the possible situations your family might face. That means you’ll need to choose a plan that will take care of children’s expenses as well as adult’s expenses.
If you or a family member has a disability or medical condition, it’s necessary to take this into account as well when choosing the best Medicaid provider for your family.
If you’re choosing Medicaid for only yourself, it’s still crucial to choose a plan that will cover as many healthcare-related situations as possible! Consider the current moment as well as the future. For instance, older people will want to make sure that their coverage can handle health issues that may arise in old age, while young women may want to choose a plan with excellent coverage for family planning and maternity care.
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