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Medicare in New York

New Yorkers aging into Medicare can save on quality healthcare

Reviewed by: Stephanie Demus, Licensed Insurance Agent. Written by: Bryan Strickland.

Key Takeaways

  • All New Yorkers age 65 and older who are U.S. citizens qualify for Medicare in New York.

  • Medicare isn’t free; most parts of Medicare have a monthly premium. There are programs available to help lower some or all costs for those who qualify.

  • Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). in New York is an alternative to Original MedicareOriginal Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). that can offer savings regardless of financial need.

 

The state of New York is the proud home of the city that never sleeps.

GoHealth won’t sleep until New Yorkers understand their options when it comes to Medicare. If you want to be a part of it, keep reading to learn everything you need to know about Medicare in New York.

Who is Eligible for Medicare in New York?

The federal government created Medicare in 1965 to benefit U.S. citizens ages 65 and older. You are eligible for Medicare in NY regardless of your age if:

  • You have received 24 monthly payments of Social Security Disability Insurance or Railroad Benefits.
  • You have End Stage Renal Disease or Lou Gehrig’s disease (also known as Amyotrophic Lateral Sclerosis or ALS).

Those who are eligible can select Part A (also known as “hospital insurance”) and Part B (“medical insurance”). Once enrolled in Part A and B, Medicare beneficiaries have the option of switching to Medicare Advantage in New York (also known as Part C) for Parts A and B from a private insurance company that includes other benefits like dental and vision coverage.

What is the Income Limit for Medicare in NY?

Medicare is offered to qualified New Yorkers regardless of their income, though it is possible that your annual income could mean you pay less than the standard costs associated with Medicare. And, though rare, it is possible you could pay more than the standard because of your income level.

  • If you’re a Medicare beneficiary facing financial hardships but you make too much money to qualify for Medicaid — a federal health insurance program for those in need regardless of age — you still may qualify for a Medicare Savings Program to help ends meet.
  • On the other end of the spectrum, less than 5 percent of people utilizing Original Medicare in New York have to pay more than the standard monthly Part B premium of $148.50 for 2021. Higher rates come into play for individuals with a modified adjusted gross income above $88,000 (or married couples above $176.000). [1]

How Much Does Medicare Cost in New York?

The cost of Medicare in New York varies by plan, but some part of Medicare may have a standard monthly premium. Still, if you or your spouse have contributed to Medicare and Social Security taxes for at least 10 years, your Part A plan will not have a monthly premium. Part B and Part D (an optional addition) will always have a monthly premium with Original Medicare. Medicare Advantage is a private insurance alternative to Part A and Part B, and costs can vary by plan and carriers.

Does New York have Free Healthcare?

If you’re looking for affordable healthcare insurance, Part A provides hospital coverage without a monthly premium, though because of the plan’s deductibles, copays and coinsurance, it can’t be called “free.”

If you’re in need of free or low-cost health insurance because of your financial situation, some people on Medicare in New York can save through a Medicare Savings Program, while some facing more needs may qualify for Medicaid in New York.

Income limits for Medicaid eligibility change annually. The New York State Department of Health periodically updates income limits on its Medicaid web page under “General Medicaid FAQs.” [2]

How Does Medicare Work in NY?

Knowing whether you are eligible to enroll in Medicare in NY and whether you qualify for financial assistance is one thing; knowing what you’re actually enrolling in is another thing.

Parts A and B are known as “Original Medicare,” and enrolling in Original Medicare in New York triggers the option to add Part D and Medigap. Medicare Advantage in New York (Medicare Part C) bundles coverage offered by Parts A, B,  and usually Part D.

Original Medicare

While Part A is “hospital insurance” and Part B is “medical insurance” offered by the federal government, Part D is drug coverage administered by private insurance companies under federal guidance. Medigap is Medicare supplemental insurance, also administered by private insurance companies, that helps control out-of-pocket costs for people with Parts A and B.

Medicare Advantage

Medicare Advantage is private insurance approved by Medicare to meet all of the needs mentioned above while also offering things like dental and vision and hearing coverage.

Apply for Medicare in New York

You can apply for Medicare in NY online with the Social Security Administration [3] , by visiting a Social Security office in New York [4] or by calling 1-800-772-1213 (TTY: 1-800-325-0778).

What are 4 Types of Medicare Advantage Plans?

Enrolling in both Parts A and B of Original Medicare opens the door for you to replace it with Medicare Advantage in New York. While Original Medicare can be used at any provider nationwide that accepts Medicare, Medicare Advantage plans feature a regional network of providers. One of these four types of Medicare Advantage networks may be the right fit for your specific situation:

  • Health Maintenance Organization (HMO)
  • Preferred Provider Organization (PPO)
  • Fee for Service (FFS)
  • Point of Service (POS)

What is the Best Medicare Advantage Plan in New York?

The advantage of Medicare Advantage plans is that they offer some coverage that Original Medicare doesn’t (like dental and vision and hearing coverage) while also matching the coverages offered by Original Medicare at a savings.

While there’s only one Original Medicare plan, there are countless Medicare Advantage plans. A GoHealth licensed insurance agent can help you navigate Medicare Advantage in New York so you can make an educated decision.

Medicare in New York by the Numbers

Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 3,275,794 people are enrolled in Medicare in New York. The total number of beneficiaries enrolled in Medicare Advantage in New York is 1,520,159. The previous year, 1,432,482 enrolled in Medicare Advantage. Medicare Advantage participation in New York went from 44.65% to 46.61% year over year. If you’d like to dive deeper into how Medicare in New York breaks down across the state, we provide a glance at who is using Medicare, and how.

Outline of New York
3,275,794
Beneficiaries with Part A & Part B
1,520,159
Medicare Advantage Beneficiaries
46.41%
Medicare Advantage Participation Rate
55.68%
% Female
44.32%
% Male
1.07
Average HCC Score
$12,580.74
Actual Per Capita Costs
25.49%
% Eligible for Medicaid
29.79%
% of Beneficiaries with an Emergency Department Visit
19.28%
Hospital Readmission Rate
75.88%
% Non-Hispanic White
9.81%
% African American
6.81%
% Hispanic
7.50%
% Other/Unknown

Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)

Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.

NY Medicare Resources & Contacts

Beneficiaries spend an average of $12,607 each year on Medicare in New York. To be certain you are not leaving anything on the table, let us help. A GoHealth licensed insurance agent can assess your coverage or explain which New York-based resources, like these, may be able to help:

New York State Department of Financial Services (DFS)

1-800-342-3736
Phone lines open M-F, 8:30 a.m. to 4:30 p.m.

https://www.dfs.ny.gov/contact_us/main

What should I know about the New York Department of Financial Services?
State-run department within DFS is a resource for consumers seeking insurance information.

Health Insurance Information, Counseling, and Assistance Programs (HIICAP)

1-800-701-0501

https://aging.ny.gov/health-insurance-information-counseling-and-assistance

What should I know about HIICAP?
New Yorkers utilizing Medicare or considering it can call to be connected with a local New York State Office for Aging for confidential, free assistance.

Department of Health (Medicaid)

1-800-541-2831
Phone lines open M-F, 8 a.m. to 8 p.m.; Saturday 9 a.m. to 1 p.m.

https://www.health.ny.gov/health_care/medicaid/

What should I know about the Department of Health?
Call to see if you qualify or for helping applying for Medicaid or Medicare Savings Programs.

New York State of Health

1-855-355-5777
Phone lines open M-F, 8 a.m. to 8 p.m.; Saturday 9 a.m. to 1 p.m.

https://nystateofhealth.ny.gov/ 

What should I know about New York State of Health?
Acts as the official Healthcare Marketplace for New York residents.

New York State Division of Veterans’ Services

1-888-838-7697

https://veterans.ny.gov/

What should I know about the New York State Division of Veterans’ Services?
Toll-free phone number helps veterans access free assistance with their military benefits.

Nationwide Resources

Speak with an insurance agent that is licensed in New York about your Medicare questions.

1-855-792-0088 TTY: 711

Monday - Friday, 8 AM - 9 PM CT

Medicare & Medicaid

If you have general questions about Medicare in NY, or need help with current Medicare benefits.

1-800-MEDICARE (1-800-633-4227)

Social Security Administration

You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.

Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online

Speak to SSA Representative, Monday - Friday, 8 AM - 7 PM ET

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