Medicare plays a key role in providing health and financial security to beneficiaries residing in New York. With more than 3.6 million New York beneficiaries enrolled in Medicare, we’ll cover some very important information below about Medicare in New York. We want to help you better understand your options and make the decision-process as seamless as possible once you’re ready to enroll in Medicare or discover different coverage options.

Who Qualifies for Medicare in New York?

Medicare covers most New York residents who are 65 or older, and it also covers disabled New York residents. In general, Medicare enrollment in New York works the same way as it does in the rest of the country. If you qualify for Original Medicare, also known as Part A and Part B, it will help cover 80% of your health care costs.

When you’re first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B. If you’re eligible for Medicare when you turn 65, you can sign up during the 7-month period that:

  • Begins 3 months before the month you turn 65
  • Includes the month you turn 65
  • Ends 3 months after the month you turn 65

In most cases, if you don’t sign up for Part B when you’re first eligible, you’ll have to pay a late enrollment penalty. You’ll be responsible for paying this penalty for as long as you have Part B, and you could have a gap in your health coverage.

Once you reach Medicare eligibility, you can begin choosing additional coverage options to help pay for the remaining 20% of your medical expenses through Medicare Advantage (Part C), Medigap, and/or a Medicare Prescription Drug (Part D) plan.

Who Qualifies for Medicare

New York Medicare Enrollments

2,062,225

Original Medicare Plans
(Part A and B)

1,595,200

Medicare Advantage & Other Health Plans

1,437,619

Stand-alone Medicare
Part D (Drug plans)

3,657,425

Total Medicare Beneficiaries
in New York

New York Medicare Advantage Plans (Part C)

More than 42% of New York Medicare beneficiaries select Medicare Advantage plans.

Medicare Advantage plans are private, Medicare-approved insurance companies. They provide all of your Original Medicare benefits and often include extra benefits such as drug, dental, and vision coverage.

The Medicare Advantage Open Enrollment Period runs from January 1 to March 31. During this period, Medicare beneficiaries in New York who already enrolled in a Medicare Advantage plan can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare.

As of 2020, 261 Medicare Advantage plans are available in New York. The average monthly Medicare Advantage premium changed from $35.84 in 2019 to $33.50 in 2020. $0 is the lowest monthly premium for a Medicare Advantage plan in New York.

According to the Centers for Medicare and Medicaid Services (CMS), as of May 2020, there are 1,595,200 beneficiaries enrolled in Medicare Advantage and other plans in New York. More than 42% of New York Medicare beneficiaries were enrolled in a private Medicare Advantage plan in 2019. 100% of people with Medicare have access to a Medicare Advantage plan.

New York has a very robust Medicare Advantage market. In fact, depending on your county, New York Medicare beneficiaries can select from between 18 and 92 Medicare Advantage plans.

New York Medicare Supplement (Medigap) Insurance Plans

New York has some of the strongest Medigap consumer protections in the nation.

Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that beneficiaries would otherwise incur if they only had Original Medicare on its own. Typically, Medigap plans are popular for those who want little to no copay when they access healthcare services.

Compared to other states, New York has some of the strongest Medigap consumer protections in the nation. As long as New York Medicare beneficiaries are enrolled in Medicare Part A and Part B, they are able to enroll in a Medigap plan at any time, year-round. Moreover, premiums don’t vary based on the beneficiary’s age or health status. This also applies to individuals who are under 65 and eligible for Medicare due to a disability.

Since New York has year-round availability, community rating, and lack of medical underwriting, the premiums for Medigap enrollees tend to be generally higher than they are in other states when enrollees are 65 years old.

New York Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t cover outpatient prescription drugs. However, Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D plan. Medigap plans don’t cover prescription drugs unless they’re covered under Part B.

As of May 2020, There are 1,437,619 Medicare beneficiaries in New York enrolled in stand-alone Part D prescription drug plans and 1,465,205 enrolled in Medicare Advantage Prescription Drug plans. For 2020 coverage, there are 27 stand-alone Part D plans available in New York, with premiums ranging from about $16 to $93 per month. About 36% of people with a stand-alone Medicare prescription drug plan get Extra Help (also called the low-income subsidy, or LIS). When deciding on a Part D plan, it’s important to evaluate several factors such as each plan’s premium, formulary, and copays since every plan is different. Learn how you can save money on your out-of-pocket costs with a Medicare Advantage, Part D, or Medigap plan, fill out this form or give us a call.

Local Medicare Health Plan Resources in New York

  • Health Insurance Information Counseling and Assistance Program (HIICAP): Approximately 500 trained HIICAP counselors located in local offices for the aging across the state are available to answer New Yorkers’ questions about Medicare, Medicare Advantage programs (managed care), Medicare prescription drug coverage, Medigap, and other health and long term care insurance.
    Contact: Call 1-800-701-0501

  • Community Health Advocates (CHA): CHA, a program of the Community Service Society, provides free and confidential individual counseling and educational community presentations to individuals, families, advocates, and providers about health insurance in New York State. Their network of community-based organizations and small business serving groups help New Yorkers access the health care they need, understand their health insurance options, and how the health care system works.CHA helps all New Yorkers: the privately insured, publicly insured, and uninsured.
    Contact: Call 1-888-614-5400. A list of CHA affiliated organizations with staff who are qualified to assist consumers with health insurance questions and enrollment issues can be found online at CHA’s website.

  • New York State Attorney General’s Health Care Bureau safeguards the rights of health care consumers statewide through investigation of and enforcement actions against insurers, providers, drug companies, and other individuals and entities that engage in fraudulent, misleading, deceptive, or illegal practices in the health care market.
    Contact: Call 1-800-428-9071

  • NYC Health: You can get free, in-person help signing up for low- or no-cost health insurance through the NY State of Health Marketplace by visiting an NYC Department of Health Certified Application Counselor. Their counselors will: explain your health insurance and care options, regardless of your immigration status; help you and your family enroll in or renew health insurance; and find out if you qualify for financial help to pay for a low-cost private health insurance plan.
    Contact: Find a counselor in your borough of residence by searching the NYC Health Map. You can also set up an in-person or telephone appointment by calling 311 or texting “CoveredNYC” to 877-877. A list of locations broken down by borough is also available by visiting NYC Health’s website.

  • New York StateWide Senior Action Council is a group that provides health care advocacy and support to New York elders. The organization runs a confidential health and prescription medication coverage helpline, where certified counselors provide information on Medicare Advantage benefits and prescription drug coverage, answer consumer questions, and assist with plan enrollment free of charge.
    Contact: Call 1-800-333-4374 or email [email protected].

  • The Jewish Association Serving the Aging (JASA) is a nonprofit organization that provides a multitude of no-cost services for seniors of all races and religions residing in Long Island and New York City’s five boroughs. JASA is one of New York’s largest and most trusted agencies serving older adults in the Bronx, Brooklyn, Manhattan, and Queens, and they provide life-sustaining programs for seniors and peace of mind for their families and friends.
    Contact: Call 212-273-5272 or fill out a brief online form.

The licensed agents that are partnered with Timefor65 can help you compare the availability, benefits, and costs of Medicare plans in your specific region of New York. Our process makes it easier for you to access your Medicare eligibility in New York so that you receive personalized, affordable, and easy-to-use coverage options and solutions. Fill out the form or give us a call at (866) 327‑0148 anytime to get a free quote or to ask any questions.

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