New York State Medicare Coverage and Agent Finder
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
- What Does Medicare Cover in NY?
- What is the Cost of New York State Medicare?
- Medicare Advantage Plans NY (Part C)
- Medicare Supplement Plans NY
- Can I Have Medicaid and Medicare in NY?
- Other New York Senior Resources
- How to Apply for New York State Medicare
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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Why Work With a Local Medicare Insurance Agent in New York?
If you live in New York, choosing Medicare coverage can feel like a lot to sort through. The coverage options available to you can vary depending on where you live, and the Medicare Advantage plans, provider networks, prescription drug coverage, and insurance companies available in one New York county may not be available in another.
That is where working with a local Medicare insurance agent can really help.
Our job as Medicare insurance agents is not to tell you which plan is best for everyone in New York. It is to help you understand your Medicare insurance options and find coverage that makes sense for you. That might mean staying with Original Medicare and adding a Medicare Supplement and Medicare Part D plan, or comparing Medicare Advantage plans available in your county.
A licensed Medicare agent in New York can help you:
- Compare plans and coverage options from multiple insurance companies serving your area
- Review provider networks to see if your doctors, specialists, and preferred hospitals participate
- Compare prescription drug plans and formularies based on the medications you actually take
- Understand your monthly premium, deductibles, copays, and out-of-pocket costs
- Explain how Part A, Part B, Part C, and Part D work together
- Compare Medigap plans and Medicare Supplement insurance plans
- Review important enrollment deadlines, including Medicare Open Enrollment and special enrollment periods
- Determine whether New York programs such as EPIC or a Medicare Savings Program may be worth exploring
- Review your Medicare coverage each year as your health needs, prescriptions, and available plans change
New York also has programs that Medicare beneficiaries should know about. The state’s EPIC program can help eligible New Yorkers age 65 and older with Medicare Part D prescription drug costs. New York’s Medicare Savings Programs may also help eligible residents pay Medicare premiums and, depending on eligibility, certain other Medicare costs.
You can also receive free Medicare counseling through New York’s Health Insurance Information, Counseling and Assistance Program (HIICAP), which is New York’s State Health Insurance Assistance Program, or SHIP.
One of the biggest advantages of working with independent Medicare insurance agents or a Medicare broker is having someone you can actually call when you have a question. Plans can change from year to year. Provider networks can change. Prescription drug coverage can change. And your own healthcare needs can change too.
Having a local Medicare insurance agent who understands the New York Medicare market gives you someone who can help you compare your options and make a more informed decision about your coverage.
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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New York Medicare Advantage Plans (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.
In important reminder that these plans are county specific, so certain plans may not be available depending where you live in New York. For example, Medicare Advantage Plans in New York city will be different than plans downstate.
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Medicare Supplement Plans New York
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 New York?
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
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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) 567-3163.
If you are moving out of the state of New York to another state, you can use our national directory to find a local health insurance agent near you to help with your Medicare options.
