New York Medicare Guide

Get personalized Medicare advice from a licensed New York Medicare Advisor! Schedule a free consultation or give us a call at (888) 604-0055 to get started.

This guide is intended to help you understand the basics of Medicare in New York so that you can make informed decisions and get the best value from Medicare.

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A Snapshot of Medicare in New York

There are 1.7 million New York Medicare beneficiaries, making up 19% of the state’s population. Most people are on Medicare due to age, but about 13% of New York residents are on Medicare because they have a disability. 26% of all New York Medicare recipients also receive Medicaid benefits. When it comes to Original Medicare vs. Medicare Advantage, 54% of beneficiaries stay on Original Medicare and 46% choose to move to a Medicare Advantage plan.

New York Medicare Eligibility and Enrollment Steps

All US citizens who meet one of the following requirements are eligible for Medicare:

You’re 65 or older
You have certain disabilities like ALS and End-Stage Kidney Disease

Medicare Enrollment Steps

1. Enroll in Original Medicare (Part A & Part B)

Most people age into Medicare and can enroll as soon as their Initial Enrollment Period (IEP) starts. Your IEP lasts for seven months, starting three months before the month you turn 65 and ending three months after. Some people choose to enroll in Part B later because they are still working and receiving employer coverage. If you do this, just be sure you’ll qualify for a Special Enrollment Period, or you may have to pay a Part B late enrollment fee.

2. Compare additional coverage options

Medicare beneficiaries have options. The first choice you’ll have to make is between staying on Original Medicare or enrolling in a Medicare Advantage plan. If you stay on Original Medicare, you may also choose to add a Medicare Supplement (also called Medigap) plan and/or a Part D (prescription drug) plan. If you choose to enroll in a Medicare Advantage plan, you’ll choose from the different plans available to you. Which path you should take depends on your unique health and financial needs. We’ll explain more about the different options below, but you can also reach out to us any time for personal advice. Just give us a call at (888) 604-0055 or schedule a free consultation with one of our licensed New York Medicare Advisors.

3. Get the best value from Medicare

To get the best value from Medicare, you should do two things. First, use it! Even if you don’t have any immediate health needs, you can schedule your preventive appointments (like your annual wellness visit) and share your new insurance information with your preferred pharmacy.

Every year, we also recommend that you use the Medicare Open Enrollment Period between October 15 and December 7 to compare other plan options. Medicare Advantage and Part D plans change every year, and your healthcare needs may change too! During this time, you can switch Medicare plans without consequence, and some people are able to save thousands!

New York Medicare Advantage Plans

There are 195 Medicare Advantage plans in New York, but exact plan pricing and availability varies by county. For example, Kings County, NY has 49 Medicare Advantage plans with premiums ranging from $0 to $254 each month. Albany County has 59 plans with premiums from $0 to $199. To hear about specific plans available to you, give us a call at (888) 604-0055 or schedule a free consultation with a licensed New York state Medicare Advisor.

Medicare Advantage plans replace Original Medicare and must provide at least the same level of coverage. Most of them also provide Part D coverage, and 70% of Medicare Advantage enrollees are on plans with Part D benefits. To attract customers, these plans advertise additional benefits, which may include:

Meals
Transportation
Telehealth
Fitness perks
Dental
Vision
Hearing

Many Medicare beneficiaries choose Medicare Advantage plans because they can get extra coverage and benefits, often for no, or a low, additional premium. Note: Medicare Advantage enrollees do still need to pay their Part B premiums, so these plans aren’t “free.”

While they aren’t free, more coverage for no (or a low) additional cost sounds great, so what’s the catch? There are a few:

Network limitations
Frequent preauthorization requirements
Higher out-of-pocket costs (compared Original Medicare + Medigap)

New York Medicare Supplement Plans

While Medicare Advantage plans replace Original Medicare, Medicare Supplement plans stack on top of Original Medicare. Medicare Supplement (also known as Medigap) plans exist to fill the gaps in coverage left by Original Medicare. They help beneficiaries cover the 20% of costs not covered, and significantly reduce out-of-pocket costs.

There are ten types of Medigap plans available in New York, labeled by letters A-N. Each plan of the same letter is identical in coverage, but pricing may vary from one insurance company to another. Plan G is generally considered the most comprehensive because once you’ve met your Part B deductible ($226 in 2023), you owe nothing else for Medicare-covered services for the year!

Compared to Medicare Advantage, Medigap plans have some key benefits:

You can see any doctor that accepts Medicare (about 90% of doctors nationwide)
You don’t need prior authorization for covered services
Your out-of-pocket costs are significantly reduced (sometimes almost eliminated)

Unlike other states, New York has an incredibly flexible Medigap enrollment policy. New York residents are guaranteed acceptance into any Medigap plan and will never need to answer questions about their health history. Furthermore, insurance companies cannot charge you more based on your health status.

New York Part D Plans

Part D provides Medicare beneficiaries with prescription drug coverage. You can get Part D coverage either by enrolling in a Medicare Advantage plan that includes it or through a stand-alone Part D plan. There are 19 stand-alone Part D plans available in New York, with an average monthly premium of $48.02 (the highest average in the country).

Even if you don’t need prescription coverage when you first enroll in Medicare, we recommend getting Part D coverage to ensure you don’t have to pay a late enrollment penalty later on!

If you have questions about your Medicare options or want to compare plan benefits and pricing, schedule a free consultation with one of our licensed New York Medicare Advisors or give us a call at (888) 604-0055.

Get help paying for Medicare in New York

The government has three programs that can help low-income individuals with healthcare-related expenses.

New York Medicaid

Medicaid is a joint federal and state program that’s operated by each state. The New York State Medicaid program is run by the Department of Health and assists over 7.3 million residents.

New York has four programs to help low-income individuals with their Medicare costs:

Full Medicaid for Dual Eligibles

If you are eligible for both Medicaid and Medicare and meet the income and resource requirements, this program will pay for a wide range of medical services and supplies. You’ll also receive support for Medicare premiums, coinsurance, and deductibles.

Qualified Medicare Beneficiary Program (QMB)

Eligible individuals receive support for Medicare Part A and Part B premiums, coinsurance, and deductibles. It’s possible to be eligible for the QMB program and Medicaid at the same time.

Qualifying Individuals (QI)

Eligible individuals receive support for Part B premiums. Someone cannot be eligible for both the QI Medicare Savings Program and Medicaid at the same time.

Qualified Disabled and Working Individual (QDWI)

If you’re disabled, under 65, and working and lost your Part A benefits because you returned to work, this program will help with your Part A premium.

Learn more about Medicaid services for older adults here and Medicare Savings Programs here.

Medicare Extra Help

Extra Help is a federal program that helps pay for costs associated with prescription drug coverage. Extra Help is also sometimes called the Part D Low Income Subsidy (or LIS).

You automatically qualify for Extra Help if you:

Receive full Medicaid coverage from New York
New York pays your Part B premium
Are eligible for Supplemental Security Income (SSI)

If you don’t automatically qualify for Extra Help, you can learn more about the program here or talk to one of our licensed New York Medicare Advisors to get free support with your application.

Supplemental Security Income (SSI) Benefits

Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:

You are 65 and older, blind, or have a disability
You have limited income and limited resources

You can apply for SSI Benefits online or by calling 1-800-772-1213 / TTY 1-800-325-0778.

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