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New York State Medicare Coverage Guide

Medicare is a federally funded and regulated program primarily for older and disabled adults to receive quality health care. Even though it is federally regulated, private insurance companies can offer different plans in every state, county, and zip code. That’s why the benefits and details may be different based on where you live. This guide can help you navigate the New York State Medicare market and select the best health care options for you and your individual needs.

A Guide to New York State Medicare Includes:

NY Medicare Eligibility

Medicare eligibility is based on both age and health status. As you may know, you will automatically qualify for Medicare when you turn 65. What a lot of people don’t realize is that there are actually two other ways to qualify for Medicare as well. You can qualify if you have a qualifying disease (ALS or ESRD), or if you receive Social Security Disability Insurance (SSDI). You will qualify for Medicare in your 25th month of receiving SSDI and will be automatically enrolled.

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What Does Medicare Cover in NY?

The Original Medicare that you’re probably thinking of consists of Part A and Part B. Part A covers hospital, nursing home, hospice, and home health services. Part B covers ambulance travel, durable medical equipment, mental health, partial hospitalization, and doctor services (including lab tests and x-rays).

You may have noticed that prescription drugs are not included in that list - but doesn’t Medicare cover prescriptions? Yes, it does! Your prescription coverage will come separately in a Part D plan. You can select a Part D plan from a private insurance company in your area, but be sure to pay attention to the plan’s formulary (list of covered drugs).

That’s everything that you can get with Original Medicare, but we’ll discuss two other options, Medicare Advantage and Medicare Supplements, a bit later.

What is the Cost of New York State Medicare?

Your New York State Medicare costs will depend on your employment history and your income. Keep in mind that what you pay may be different from what your spouse or your friends pay! The best example of this is Part A. If you worked for over 39 quarters, about ten years of your life (and paid your Medicare income taxes), you can get premium-free Part A. However, if you only worked between 30 and 39 quarters, you will have to pay a $240 monthly premium in 2019. If you worked even less than 30 quarters, your premium in 2019 will be $437 per month.

Whether you have a Part A premium or not, everyone will have a Part B premium. Most people will pay the standard of $135.50 per month in 2019. However, that number can increase or decrease based on your income.

Finally, as long as you enroll in a Part D plan, you’ll have to pay a separate premium for that plan. You can choose a plan with a premium as low as $20, or as high as $80! It all depends on the coverage that you want and the coverage that you can afford. It also depends on what plans are available in your area - not everyone will have access to those $20 premium plans!

*Keep in mind that Parts A, B, and D will also require co-payments/coinsurance for certain services. There is also a $185 deductible for Part B, and you may have a deductible for Part D.

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Medicare Advantage Plans NY (Part C)

If you want more coverage than what your Parts A, B, and D provide, consider Part C! Part C, more commonly called Medicare advantage, is an option that can combine your Parts A, B, and D with even more benefits. Additional benefits vary based on where you’re located and what kind of plan you select, but one of the most popular options is to enroll in an MAPD, or Medicare Advantage with Prescription Drug coverage plan. Medicare Advantage and MAPD plans usually come with other benefits which may include dental, vision, hearing, fitness, transportation, meal delivery, and more.

Some people may even be able to select a $0 premium Medicare Advantage plan and opt for a higher deductible and high copayments. That’s a great option for those who are superbly healthy and don’t plan on using their health plan often.

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Medicare Supplement Plans NY

If Medicare Advantage is not right for you and you want to stick to Parts A, B, and D, consider adding a Medicare Supplement plan (often called Medigap). Some Medicare Supplement plans do add additional benefits like fitness programs and additional prescription drug coverage, but for the most part, that’s not what Medigap plans are for. Instead, Medigap plans are designed to provide additional coverage that helps you afford to pay your Part A, B, and D premiums, deductibles, coinsurance, and co-payments.

Can I have Medicaid and Medicare in NY?

Yes! If you meet both the New York State Medicare and Medicaid requirements in New York State, you can benefit from both programs. Even better, there are Medicare Advantage plans that are specifically designed for those who qualify for both programs. These plans can help you ensure that you are getting the most out of your benefits. These are called “dual-eligible special needs plans.” When you are eligible for both New York State Medicare and Medicaid, you are eligible to enroll in or switch into a new Medicare Advantage plan during ANY time of the year - you do not have to wait for the Annual Enrollment Period.

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Other New York Senior Resources

Aside from the New York State Medicare help that we can provide, these are some other top resources that you may want to take advantage of as a New York State senior:

EISEP (Expanded In-Home Services for the Elderly) - If you do not qualify for Medicaid, you may be able to qualify for EISEP. EISEP can provide services like adult day care, companion services, housekeeping, meal preparation and meal delivery, medication reminders, PERS, respite care, transportation, and home modifications. You can apply through your local Area Agency on Aging.

Free Transportation through Project CART - Seniors age 60 and older in Manhattan can schedule rides Monday through Friday from 9 to 5 by calling 212-965-0855.

New York Foundation for Senior Citizens Home Attendant Services (NYFSCHAS) - Provides home health aides, personal care aides, housekeeping, and nursing supervision for New Yorkers with Medicaid, EISEP (Expanded In-home Services for the Elderly), or Medicare/Medicaid. To get home attendant services for you or a loved one, call 212-962-7559.

NYC Department for the Aging - Locate Senior Centers by borough and available services. Report elder abuse and crime.

How to Apply for New York State Medicare

Medicare Plan Finder

There are a couple ways to apply for Medicare in NY. You can walk into your local Social Security office and ask for help enrolling in person, you can visit the Social Security website, or you can call Social Security directly at 1-800-772-1213 (TTY 1-800-325-0778).

Since Medicare Parts A and B are the only parts that are hosted by the federal government, those are the parts that Social Security is going to be able to help you enroll in. If and when you decide you are ready to enroll in a Part D, Medicare Advantage, or Medicare Supplement plan, the best way to do that is to find an agent in your area. Most New York State Medicare Plan Finder agents are licensed to sell plans from every major carrier, which means they can lay out all of your options and help you pick the best one.

Meeting with an agent does not cost you anything extra, and there is never any obligation to buy. To schedule a meeting with a licensed agent in NY, click here or give us a call at 833-438-3676.

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