The Ultimate Guide to Medicare Advantage on Long Island (2025 Edition)

The Ultimate Guide to Medicare Advantage on Long Island (2025 Edition)

Let’s talk about Medicare like we’re sitting down for a cup of coffee.

If you live on Long Island and you’re on Medicare — or about to be — you already know one thing: it’s confusing as heck. You’ve got commercials telling you everything is free, flyers in the mailbox promising the world, and online tools that show 30+ plans but give zero context.

Let’s break it all down. No gimmicks. Just real talk, real numbers, and some things your TV ad definitely didn’t mention.

What Is Medicare Advantage (Part C)?

Medicare Advantage (also called Part C) is a private insurance alternative to Original Medicare. These plans replace your Part A (hospital) and Part B (medical) coverage — and most include Part D drug coverage too. Plus, they often throw in extras like dental, vision, OTC cards, gym memberships, and transportation.

But here’s the kicker: when you join a Medicare Advantage plan, the insurance company — not Medicare — is now in charge of your care. That means rules, networks, authorizations, and sometimes…headaches.

Key Medicare Advantage Terms You Should Know in 2025

MOOP (Maximum Out-of-Pocket)

This is your annual safety net. After you hit your MOOP, the plan pays 100% for the rest of the year. On Long Island, MOOPs range from $3,400 to $9,350 in 2025.
    One of my clients had an unexpected surgery, multiple follow-ups, and some physical therapy. By July, she’d hit her MOOP. Everything else that year? Covered.

Part D Drug Deductible

Usually around $500–$590 in 2025. Some plans waive it for Tier 1 or Tier 2 generic drugs. Don’t confuse this with your medical deductible — they’re separate.

Copay vs. Coinsurance

  • Copay = flat fee (e.g., $20 to see your doctor)
  • Coinsurance = percentage (e.g., 20% of a hospital bill)

What Do Medicare Advantage Plans Cost on Long Island in 2025?

Here’s a breakdown of what’s available in two key counties:

Suffolk County (ZIP 11772)
  • 29 plans
  • $19 average monthly premium
  • $6,700 – $9,350 MOOP
  • 14 $0-premium options
  • Most popular: Aetna Medicare Elite PPO (4.5 stars)
Nassau County (ZIP 11550)
  • 28 plans
  • $16 average monthly premium
  • $3,400 – $9,350 MOOP
  • 18 $0-premium plans
  • Top options: Aetna Premier PPO, UHC Dual Complete PPO

* Remember: $0 premium doesn’t mean $0 costs. You’ll still have copays, coinsurance, and possibly a drug deductible.

Long Island Medicare Advantage Carriers (and the Plans They Don’t Advertise)

You’ll see these names across Suffolk and Nassau:
  • Aetna
  • UnitedHealthcare (UHC / AARP)
  • Humana (USAA Honor PPO – no drug coverage!)
  • WellCare
  • Cigna
  • Healthfirst
  • Fidelis Care
  • Empire BlueCross BlueShield
  • VNS Health

But Here’s the Spicy Truth:

Not all plans on Medicare.gov are actively promoted — and that’s a big red flag.
  • Cigna PPOs: Non-commissionable
  • UHC Regional PPOs: Non-commissionable
  • Healthfirst PPOs: Non-commissionable

If a plan isn’t paying brokers and doesn’t have in-house reps, it’s usually because the carrier doesn’t want too many enrollments — often due to high claims, network issues, or financial pressure.

We call these “ghost plans.” You can enroll in them, but when things go sideways… you’re often left with no support.

Why Popular Plans Can Lose Value Over Time

Just because everyone you know is on a certain plan doesn’t mean it’s still the best.

Plans like the Aetna Medicare Elite PPO may be great now, but when a plan gets too popular:
  • Networks shrink
  • Benefits drop
  • Formularies change
One top-rated plan in 2021 dropped half its providers by 2024.

How to Choose the Best Medicare Advantage Plan on Long Island

Here are 5 smart steps to follow:
  1. List your doctors and pharmacies
  2. Make a list of your current prescriptions
  3. Decide between PPO (freedom) or HMO (lower cost)
  4. Look beyond premiums — compare MOOP and copays
  5. Work with a local expert who knows the plans inside and out
Example: Snowbirds often choose PPOs for out-of-state coverage. But year-round Long Islanders may save more with an HMO.

Don’t Pick a Plan Just Because It Works for Someone Else

Every Medicare Advantage plan has its own formulary and own network. Just because your neighbor loves their plan doesn’t mean it will work for you.

Final Thoughts: Medicare Advantage Isn’t One-Size-Fits-All

  • PPOs = more freedom, possibly higher cost
  • HMOs = lower cost, tighter networks and referrals
I’ve helped thousands of Long Island seniors find the right plan — and I’m happy to help you too. No pressure. No hype. Just facts and friendly guidance.

Medicare Advantage FAQ for Long Island (2025)

Yes — both Suffolk and Nassau counties have multiple $0 premium options in 2025. But $0 premium doesn’t mean zero cost. You’ll still pay copays and possibly a drug deductible.
As of 2025, the Aetna Medicare Elite PPO is the most enrolled plan in the area. But popularity doesn’t always mean best fit — networks and benefits can change yearly.
MOOP (Maximum Out-of-Pocket) ranges from $3,400 to $9,350, depending on the plan. Lower MOOPs usually come with higher premiums or tighter networks.
It depends. PPOs give more flexibility, especially for snowbirds or out-of-network needs. HMOs are typically more affordable if you’re local and your doctors are in-network.
Yes — plans can and often do change yearly. That’s why it’s crucial to review your coverage every year, even if you’re happy with your current plan.
Want a personalized Medicare Advantage review for 2025?

Schedule a free consultation today: 631-358-5793 or www.paulbinsurance.com

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