Blog / General Medicare
📋 General Medicare
By Mike Miligi | Michael M Insurance Services
Walk through the reasons Babylon residents pick Medicare Supplement coverage and one thing stands out immediately: New York simply plays by different rules than most of the country. Between the state’s uniquely strong consumer protections and the reality of navigating two competing hospital systems on the South Shore, Medigap solves problems for Babylon-area Medicare beneficiaries that other states’ residents don’t even think about. Here’s the full picture — the real advantages, the genuine trade-offs, what the most popular plans actually cost, and the Medicare Advantage alternative for anyone who’d rather skip the premium entirely.
Before getting into plan comparisons, it’s worth understanding why Medigap works differently here than it does almost anywhere else in the country. In most states, you get exactly one guaranteed window to buy a Medicare Supplement plan without medical underwriting — the six months starting when you turn 65 and enroll in Part B. Miss it, and insurers can review your health history, charge you more, or turn you down outright. New York doesn’t work that way. The state requires year-round guaranteed issue and community rating for every Medigap plan sold here:
Guaranteed issue, every day of the year. Every carrier must accept every applicant, regardless of health history, at any time — not just during a single enrollment window. Community rating. Your premium is based on the plan and your location, not your age or health. A 78-yearold with diabetes pays the same community-rated premium as a healthy 65-year-old buying the identical plan. Freedom to switch. You’re not locked into your first choice. You can start with a lower-cost plan and move up later, or switch carriers entirely, without a health screening standing in the way. The trade-off is that New York’s Medigap premiums run higher than in most other states, precisely because insurers can’t use underwriting to manage risk. But for Babylon residents, particularly anyone managing an ongoing health condition, this flexibility is a real, tangible protection that most of the country simply doesn’t have.
Babylon residents have excellent hospital options close to home — but they don’t all belong to the same network. Good Samaritan Hospital Medical Center in West Islip is part of Catholic Health, while South Shore University Hospital in Bay Shore is part of Northwell Health, New York’s largest health system. Beyond these two local anchors, both networks extend much further: Catholic Health also operates Mercy Medical Center and St. Francis Hospital, while Northwell includes North Shore University Hospital, Long Island Jewish Medical Center, and dozens of other facilities across Long Island and the city. And when Babylon residents need specialized care that means heading into Manhattan, that list expands again — NewYork-Presbyterian, NYU Langone, Mount Sinai, and Memorial Sloan Kettering are all common destinations for cardiac care, cancer treatment, and other specialty services that a South Shore hospital may refer out to. That’s a lot of ground to cover, and a Medicare Advantage plan’s network doesn’t automatically follow you across all of it. If you needed a specialist at one system and a hospital stay at another — say, a Catholic Health primary doctor in Babylon but a Northwell specialist in Bay Shore, or a follow-up procedure at a major Manhattan hospital — an Advantage plan’s network could leave you choosing between the two, or paying more to go outside it. A Medicare Supplement plan sidesteps that question entirely. Since Medigap pairs with Original Medicare rather than a private network, it covers any doctor or hospital nationwide that accepts Medicare — Good Samaritan, South Shore University, any other Catholic Health or Northwell facility, any of the major New York City hospitals, or anywhere else in the country, all with the same coverage and no referrals required.
No network to navigate. See any Medicare-accepting provider — right here in Babylon, anywhere in the Catholic Health or Northwell systems, at a major New York City hospital, or anywhere in the country — no referrals, no prior authorizations, no network directory to check first. Predictable costs. With Plan G or Plan N, once your Part B deductible is met, the vast majority of your Part A and Part B cost-sharing is covered. No surprise bills after a hospital stay. Community-rated pricing. Your premium doesn’t climb just because you had a bad health year. Everyone in the same plan pays the same rate. Freedom to change your mind. Thanks to New York’s year-round guaranteed issue rules, you’re never stuck. You can adjust your coverage down the road without a health screening working against you. Ideal for snowbirds and frequent travelers. Since coverage isn’t tied to a network, spending part of the year outside New York doesn’t complicate your coverage the way a Medicare Advantage network might.
Higher monthly premium. Medigap plans cost more per month than most Medicare Advantage plans, and in New York specifically, community rating tends to push that premium higher than in other states. Prescription drugs aren’t included. Medigap plans don’t cover Part D drugs. You’ll need to purchase a standalone Part D plan separately, which adds another monthly premium on top of your Medigap premium. No bundled extras. Unlike many Medicare Advantage plans, Medigap doesn’t include dental, vision, hearing, or over-the-counter allowances. Anything beyond what Original Medicare covers needs to be purchased on its own. Three premiums to track instead of one. Your total monthly cost is your Medigap premium, plus your Part D premium, plus your Part B premium ($202.90/month for most beneficiaries in 2026) — that adds up compared to a single Medicare Advantage premium, which is often $0.
This is the piece people most often leave out when comparing costs on paper. The national average Part D premium for 2026 runs around $34.50 a month, though the actual cost depends entirely on the specific plan and formulary you choose. Add that to whatever Medigap plan you select, and the true monthly cost of the Medigap path is meaningfully higher than the Medigap premium alone. It’s a fair trade for many people given the flexibility and predictability Medigap provides — but it should be part of the real math, not an afterthought.
Plan G, Plan N, and High Deductible Plan G are the three plans most Babylon-area clients ask about. All three are federally standardized, meaning the benefits are identical no matter which carrier you choose — only the premium and customer service differ by company.
| Benefit | Standard Plan G | Standard Plan N | High Deductible Plan G |
|---|---|---|---|
| Monthly Premium | $372.00/month | $299.00/month | $91.00/month |
| Plan Deductible | Part B deductible only — $283/year (2026) | Part B deductible only — $283/year (2026) | $2,950 total annual deductible (2026) |
| Annual Max Out-of-Pocket | Not applicable — pays your share in full after Part B deductible | Not applicable — pays your share after Part B deductible, subject to copays | Not applicable — pays your share in full once the $2,950 deductible is met |
| Primary Care Visit | $0 copay* | Up to $20 copay per visit | $0 copay after deductible* |
| Specialist Visit | $0 copay* | Up to $20 copay per visit | $0 copay after deductible* |
| Inpatient Hospital Stay | $0 copay* (unlimited covered days) | $0 copay* (unlimited covered days) | $0 copay after deductible* |
| Outpatient / Ambulatory Surgery | $0 copay* | $0 copay* | $0 copay after deductible* |
| Skilled Nursing Facility | $0 copay* (up to Medicare’s 100-day benefit) | $0 copay* (up to Medicare’s 100-day benefit) | $0 copay after deductible* |
| Part B Excess Charges | Covered in full | NOT covered — up to 15% above Medicare-approved amount if provider doesn’t accept assignment | Covered in full after deductible |
| Emergency Room | $0 copay* | Up to $50 copay (waived if admitted) | $0 copay after deductible* |
| Urgent Care | $0 copay* | Up to $20 copay per visit | $0 copay after deductible* |
| Ambulance | $0 copay* | $0 copay* | $0 copay after deductible* |
| Foreign Travel Emergency | 80% of billed charges after $250 deductible, up to plan lifetime max | 80% of billed charges after $250 deductible, up to plan lifetime max | 80% of billed charges after $250 deductible, up to plan lifetime max |
| Labs, X-rays, Diagnostic Tests, MRI/CT, DME | $0 copay* | $0 copay* | $0 copay after deductible* |
| Prescription Drugs (Part D) | Not included — purchase separately | Not included — purchase separately | Not included — purchase separately |
| Dental / Vision / Hearing | Not included | Not included | Not included |
| Referral Needed for Specialist | No | No | No |
*Plan G and Plan N pay your Medicare Part A and Part B coinsurance and copayments (subject to the copays noted for Plan N) once the annual Part B deductible ($283 in 2026) is met. High Deductible Plan G pays in full once its $2,950 total deductible (2026) is met. This is a simplified summary for discussion purposes; refer to the applicable Medigap Outline of Coverage for full plan details before enrolling.
Plan G offers the most complete, worry-free coverage of the three — the only thing you pay out of pocket for covered services is the annual $283 Part B deductible. Plan N trades small, predictable copays ($20 for office visits, up to $50 for an ER visit that doesn’t result in admission) for a lower monthly premium — a real savings for people who don’t visit the doctor constantly. The one thing to watch for with Plan N is Part B excess charges: if your provider doesn’t accept Medicare assignment, you could owe up to 15% above the Medicare-approved amount, something Plan G fully protects against. High Deductible Plan G is the budget-conscious option. At $91/month versus $372/month for standard Plan G, that’s a savings of $3,372 a year — more than enough to cover the $2,950 deductible in a bad year, with money left over. In a light year, you simply keep the savings.
Not everyone wants — or can comfortably afford — three separate monthly premiums. For Babylon residents who’d rather have one bundled plan, often with a $0 premium, Medicare Advantage is worth a real look. Medicare Advantage plans are offered by private insurers and, by law, must cover everything Original Medicare covers. Most go further, often including Part D drug coverage, dental, vision, hearing, and other extras built into a single plan — frequently for no additional monthly cost beyond the Part B premium. The trade-off is the network. Since Good Samaritan Hospital Medical Center (Catholic Health) and South Shore University Hospital (Northwell) belong to two different systems — each with their own broader network of affiliated hospitals across Long Island and into New York City — it matters a great deal which network a given Medicare Advantage plan uses. Some plans include both systems and reach into the city; others are far more limited. This has to be confirmed for your specific Babylon address and specific doctors before enrolling — it isn’t something to assume from a brochure. The other trade-off is exposure. Medicare Advantage plans come with an annual Maximum Out-of-Pocket limit (federally capped at $9,250 in-network for 2026), which is a real protection, but it means your total costs in a high-need year could run into the thousands before that cap kicks in — a very different risk profile than Medigap’s near-total cost predictability.
How much do you value network freedom? If you want the ability to see any doctor or use any hospital — including both Good Samaritan and the Northwell facilities — without worrying about which plan covers which system, Medigap is built for exactly that. How much predictability do you need? If a stable, mostly-fixed monthly cost matters more to you than a lower starting premium, Medigap’s structure fits better. What’s your monthly budget? If a $0 or low premium matters most and you’re comfortable with a network and an annual out-of-pocket cap, Medicare Advantage is worth serious consideration. Do you travel often or split time outside New York? Medigap’s nationwide coverage tends to serve frequent travelers and snowbirds better than a network-based plan. Which Medigap plan fits your habits? Frequent doctor visits favor Plan G’s zero-copay simplicity. Infrequent visits and comfort with modest copays favor Plan N’s lower premium. Comfort with some financial risk in exchange for a much lower premium favors High Deductible Plan G.
New York’s year-round guaranteed issue and community rating rules make Medigap far more flexible here than in most states, and Babylon’s position between two hospital systems — Catholic Health’s Good Samaritan Hospital Medical Center and Northwell’s South Shore University Hospital, each with their own wider network stretching into New York City — makes network-free coverage especially appealing
No. New York requires year-round guaranteed issue for Medigap, meaning insurers must accept your application at any time, regardless of your health history, and cannot charge you more because of it.
Plan G covers your Part A and Part B coinsurance and copayments in full after the annual Part B deductible. Plan N covers the same core benefits but adds small copays for office visits (up to $20) and ER visits that don’t result in admission (up to $50), in exchange for a lower monthly premium. Plan N also doesn’t cover Part B excess charges, while Plan G does.
For many people, yes. The premium savings between High Deductible Plan G and standard Plan G can exceed the plan’s own annual deductible, meaning even in a high-cost year you often come out ahead — and in a light year, the savings are pure upside.
No. Medigap plans don’t include Part D coverage. You’ll need to enroll in a separate standalone Part D plan, which adds its own monthly premium — averaging around $34.50/month nationally for 2026, though this varies by plan.
Yes. Since Medigap pairs with Original Medicare rather than a private network, it covers any provider nationwide that accepts Medicare — including Good Samaritan Hospital Medical Center, South Shore University Hospital, any other Catholic Health or Northwell facility, major New York City hospitals like NewYorkPresbyterian, NYU Langone, Mount Sinai, or Memorial Sloan Kettering, or any other Medicare-accepting facility, with no network restrictions.
It depends entirely on the specific plan. Some Medicare Advantage plans include both Catholic Health and Northwell facilities; others don’t. This needs to be confirmed directly for your address and providers before enrolling — it isn’t safe to assume based on marketing materials alone.
In most states, switching later could trigger medical underwriting. In New York, thanks to year-round guaranteed issue, Babylon residents can move to Medigap at community-rated prices regardless of their health history at the time they switch — a real safety net if a Medicare Advantage plan’s network or costs stop working for you down the road.
Not the way there is for Medicare Advantage. Medicare Advantage enrollment is largely restricted to the Annual Enrollment Period each fall, but because New York guarantees year-round issue for Medigap, Babylon residents can apply for or switch a Medicare Supplement plan any month of the year. The one thing to time carefully is your Initial Enrollment Period when you first become eligible for Medicare — enrolling in Part B and a Medigap plan promptly avoids any gap in coverage, even though New York’s rules give you more room than most states if you need to revisit your decision later
Because Plan G, Plan N, and every other Medigap plan letter are federally standardized, the coverage itself doesn’t vary by company — only the premium, rate-increase history, financial strength, and customer service do. For Babylon residents, this usually comes down to comparing current premiums across carriers licensed in New York and considering each company’s track record for rate stability over time, since your community-rated premium is set by carrier, not by your personal health.
Plan F closed to new Medicare enrollees back in 2020, but if you already have it, you can keep it. Whether switching to Plan G makes sense depends on the premium difference between what you’re currently paying for Plan F and what Plan G would cost — since Plan G’s only real gap versus Plan F is the annual $283 Part B deductible, it’s often a straightforward math comparison. Thanks to New York’s guaranteed issue rules, you could make that switch without a medical underwriting review standing in the way
Using the current numbers: the standard Part B premium is $202.90/month for most beneficiaries in 2026, Plan G runs $372.00/month, and a Part D plan averages around $34.50/month nationally (though your actual drug plan cost depends on the specific plan and formulary). Added together, that’s roughly $609/month in combined premiums for a Babylon resident on Original Medicare, Plan G, and a standalone Part D plan — before any covered care is even used. It’s a real monthly number worth comparing directly against Medicare Advantage’s typically lower or $0 premium, alongside the network and cost-predictability trade-offs covered above.
If anything, it strengthens the case for Medigap. Since Medicare Supplement coverage isn’t tied to a network, Babylon residents who spend part of the year elsewhere — Florida snowbirds are the most common example — get the exact same coverage wherever they are, with no need to find in-network providers in a second state. A Medicare Advantage plan’s network is generally local to where you enrolled, which can complicate care during extended time away
These are separate, income-based programs that primarily help with Part B premiums and Part D drug costs rather than Medigap premiums directly. If you think you might qualify based on income, it’s worth checking eligibility before finalizing your plan choice, since it can meaningfully change the total monthly cost math laid out above for a Babylon resident on a fixed income.
Choosing between Medicare Supplement and Medicare Advantage — and picking the right Medigap plan if you go that route — comes down to your health needs, your budget, and how much you value flexibility over a lower monthly premium. I’ve spent over 10 years helping individuals work through exactly this decision, and I’m a Medicare beneficiary myself, so I understand these choices firsthand. If you’d like help comparing your specific options in Babylon, give me a call. That conversation is always free.
