Medicare in New York

In this article...
  • Find out about Medicare coverage in New York. This guide includes information about all the various Medicare Parts and when you become eligible.

What New York Medicare Plans Are Available? 

If you are recently retired in New York, you may want to take full advantage of your retirement benefits, including signing up for Medicare. You are able to receive medical coverage through Medicare Part A and B, Medicare Advantage, Medicare Part D and private Medicare Supplement plans. Make sure that you understand what the plans you enroll in cover and what you will be responsible for financially so that you can plan ahead and not be caught off guard. The plans available in New York follow below.

  • Medicare Part A: You will hear this referred to commonly as traditional Medicare because it is part of the original Medicare law. Part A covers the cost of inpatient care, such as emergency room visits, nursing home care, home health care and hospice.  
  • Medicare Part B: This is the second part of traditional Medicare and covers all of your preventative care, such as doctor’s visits, physical examinations, blood work and diagnostic tests. It also covers your prescribed medical equipment, medical supplies and medical transportation. 
  • Medicare Advantage: These privately offered insurance plans cover everything you receive under traditional Medicare but are administered by private companies rather than the government. You may receive more freedom to choose your physicians and be able to add coverage for things such as dental and vision that are not provided under Medicare Parts A and B. 
  • Medicare Part D: This plan covers the cost of prescription medications, and you may enroll in Part D whether you’ve chosen a Medicare Advantage plan or not. Because Medicare Advantage plans vary, you may find that you still need prescription coverage not offered by your Advantage plan. If you enroll in Parts A and B instead, this plan will reduce the cost of your medications. 
  • Medicare Supplement Plans: Your medical coverage through Medicare will only cover about 80% of your medical bills. The rest is your responsibility and called a copayment. A Medicare Supplement plan is meant to cover a portion of your copayment, making it less of a burden for you to receive quality medical care. 

In 2020, About 2 million residents in New York enrolled in traditional Medicare compared with 1.5 million who elected to join an Advantage plan. There are benefits to each route, and your choice may depend on the type of care you desire, whether you want to see specific doctors and your medical conditions. Medicare Supplement plans are advised if you're worried about not being able to meet your copayment in the event of an unexpected diagnosis or trip to the hospital. 

Who Is Eligible for New York Medicare? 

Chances are that if you wish to be enrolled in traditional Medicare, you will be signed up automatically when you turn 65. If you wish to enroll in Medicare Advantage instead or have not met certain requirements for automatic enrollment, you will need to sign up on your own. For example, if you have not contributed enough to Social Security or have not been receiving your benefits for four months before enrollment, you might need to handle your own enrollment. 

Medicare Part A is part of your Social Security benefit and as long as you contributed for 10 years to Social Security, it is free. Medicare Part B might cost you $150 a month, and the rate could change in the future. The good news is that it is automatically taken from your benefit checks each month so that there is no hassle over paying a monthly bill.  

Medicare Advantage plans are like regular insurance policies, except that they are required to offer everything provided by Part A and B. You may be able to receive coverage for prescription medications, dental and vision with one of these plans, but keep in mind that with more coverage comes a higher premium. A portion of your premium will be provided by the government, however, so you will see significant savings. 

Medicare Part D has a tiered pricing system. Your premium will depend on what type of drug coverage you seek. It will be more expensive if you require certain medications that do not have generic equivalents. 

Your initial enrollment period begins 90 days before your 65th birthday, and you have until 90 days after your birthday to enroll without penalties. Failing to sign up during your initial enrollment period will mean that you are required to wait for the yearly general enrollment period, which begins on January 1 and ends on March 31 each year. The penalties for not enrolling during your initial enrollment period could impact your premiums for life. 

If you were on your work health care plan past the age of 65, served abroad or needed to care for someone with a disability, you can wait for a special enrollment period. These circumstances will qualify you to enroll without the penalties mentioned above. 

Medicare Supplement plans are offered by regular insurance companies, but you do have the right to sign up without any rate increases due to your age or health conditions as long as you do this within six months of your 65th birthday. You may not be denied coverage or be charged excessively if you enroll during this period, but these protections expire if you do not act quickly enough. 

How Do I Enroll in Medicare in New York? 

To sign up for a Medicare plan or to switch plans, adjust your coverage or opt-out, you can visit Medicare.gov. The website will provide you with many of the answers to your questions and let you complete your enrollment online. Medicare Supplement plans need to be purchased through private insurers, however. 

Contact Information for New York Medicare, Medicaid and Insurance Help 

If you have further questions or would like help finding an insurance plan or assistance program that meets your needs, you can refer to the following resources. 

Health Insurance Information, Counseling and Assistance (HIICAP) 

New York Medicaid Eligibility and Enrollment 

Medicare Savings Programs 

Elderly Pharmaceutical Insurance Coverage (EPIC) Program 

Aged, Disabled and Blind in New York City