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Medicare in New York

October 6, 2016

There may be several health insurance options available to persons in New York who are eligible for Medicare. Many Americans in this category enroll in Medicare to receive government-sponsored health coverage. In New York and across the United States, Medicare beneficiaries may have other Medicare plan options as well. Learning more about the A, B, Cs and D of Medicare can help you make informed decisions about how you receive your Medicare benefits.

Original Medicare for New York beneficiaries

Original Medicare consists of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). You are generally eligible for Medicare if:

  • You’re 65 or older, and
  • You’re a US citizen or a legal permanent resident of at least five continuous years, or
  • You receive disability benefits, have end-stage renal disease (ESRD), or have amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease). Disabled individuals can get Medicare regardless of age, if they’ve received disability benefits for 24 continuous months from the Social Security Administration (SSA) or the Railroad Retirement Board.

In New York as elsewhere, a Medicare eligible individual can sign up for Original Medicare during the seven-month Initial Enrollment Period, which begins three months before a person turns 65, includes the person’s birth month, and ends three months after the birth month. Individuals can also join Medicare during the General Enrollment Period, which takes place every year from January 1 to March 31. But be aware that if you miss your Initial Enrollment Period and sign up for Medicare at a later date, you will probably have to pay a late-enrollment penalty.

New York Medicare beneficiaries, like those in other states, receive premium-free Medicare Part A if they (or their spouses) have paid Medicare taxes for at least 10 years while working.

Medicare Part A health benefits include:

  • Hospital care
  • Skilled nursing facility care
  • Nursing home care (non-custodial)
  • Hospice care
  • Home health services

Medicare Part B provides medical insurance, but requires a monthly premium. The Part B premium may vary, depending upon when you enroll and your annual income. Medicare Part B health benefits include:

  • Physician services, including preventive care
  • Outpatient services
  • Radiology (x-ray) and laboratory services
  • Ambulance services
  • Durable medical equipment
  • Mental health (inpatient, outpatient, or partial hospitalization)

Medicare plan options in New York

In addition there are other Medicare plan options aside from Original Medicare. Medicare Advantage (Medicare Part C) offers an alternative way to get your Original Medicare benefits. Medicare Advantage plans are offered by private insurance companies contracted with Medicare.  A Medicare Advantage plan must offer at least the same benefits as Original Medicare, Part A and Part B (except for hospice care, which continues to be covered by Part A). Many Medicare Advantage plans offer extra coverage, such as routine vision, dental and hearing benefits. Furthermore, if you’re seeking health and prescription drug coverage through a single health plan, you may enroll in a Medicare Advantage Prescription Drug plan available in New York

To enroll in a Medicare Advantage plan you must select a plan that is available where you live in New York and you must have Medicare Part A and Part B .and continue paying the Medicare Part B premium to keep your health insurance coverage.

If you decide to stay with Original Medicare (Part A and Part B), another option you may have is to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Medicare Supplement plans are offered by private insurance companies. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles.

In New York, you can also sign up for separate prescription drug coverage through Medicare Part D, which is offered by private insurance companies approved by Medicare. Stand-alone Medicare Part D Prescription Drug Plans in New York have different costs, depending on the extent of the coverage you select, but most plans require payment of a monthly premium, annual deductible, and copayment or coinsurance.

As a New York resident, you can choose among various Medicare Advantage plans, depending on the county in which you live. If you live in Brooklyn in New York County, you may have different Medicare plan offerings than a resident of Syracuse in Onondaga County. Considering the many New York Medicare Advantage plans available, it’s important to customize your search for plans based on your own individual health and prescription needs as well as where you live.

For more information about Medicare insurance options for New York beneficiaries, please see:

New York resources for Medicare beneficiaries

There are a number of resources designed to help New York Medicare beneficiaries with Medicare-related issues and concerns. Here are some of the resources that may be helpful to you:

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