Medicare is a health insurance program offered by the United States government. New Yorkers are generally eligible for Medicare when they turn 65, but you may be eligible at a younger age if you have certain disabilities or medical conditions.
Read on to learn more about Medicare New York, including who’s eligible, how to enroll, and tips for shopping for Medicare Advantage plans in 2020.
If you’re eligible for Medicare, there are two ways you can get coverage. One is original Medicare, the traditional program run by the government. The other is Medicare Advantage plans, which are offered by insurance companies as an alternative to original Medicare.
Original Medicare has two parts:
- Part A (hospital insurance). Part A helps you pay for inpatient hospital stays, hospice care, and home health care. In certain circumstances, it may cover short-term skilled nursing care.
- Part B (medical insurance). Part B covers a long list of medically necessary services. These include doctors’ services, outpatient care, health screenings, preventative services, and durable medical equipment.
Original Medicare doesn’t cover 100 percent of your healthcare costs. For more coverage, you may opt to sign up for one of these supplemental insurance policies:
- Medigap. These policies help fill the gaps in original Medicare. Medigap policies may cover coinsurance, copayments, and deductibles, as well as extra benefits such as foreign travel emergency coverage.
- Part D (drug coverage). Medicare drug plans help you pay for prescription medications.
Medicare Advantage plans are your other option. These bundled plans must cover everything in original Medicare, and they often include prescription drug coverage, too. Depending on the plan, you could also get other types of coverage, such as dental care, vision care, or even gym memberships.
When you start shopping for Medicare plans in New York, you’ll notice there are plenty of options. In 2020, the following insurance companies sell Medicare Advantage plans in New York:
- Healthfirst Health Plan, Inc.
- Excellus Health Plan, Inc.
- Aetna Life Insurance Company
- UnitedHealthcare of New York, Inc.
- Health Insurance Plan of Greater New York
- Empire HealthChoice HMO, Inc.
- Independent Health Association, Inc.
- MVP Health Plan, Inc.
- Oxford Health Plans (NY), Inc.
- HealthNow New York, Inc.
- Sierra Health and Life Insurance Company, Inc.
- The New York State Catholic Health Plan, Inc.
- Capital District Physicians’ Health Plan, Inc.
- American Progressive Life & Health Insurance Company of New York
- WellCare of New York, Inc.
- Humana Insurance Company of New York
- Elderplan, Inc.
Availability varies by county. Before choosing a plan, call the provider and confirm that they cover your area.
In New York State, you’re eligible for Medicare if you fall into one of the program’s eligibility groups:
- You’re over 65. New York residents are generally eligible for Medicare when they turn 65.
- You have a disability. If you’re under 65, you may be eligible if you receive Social Security Disability Insurance (SSDI). Generally, you’re eligible after receiving SSDI checks for 24 months, but this waiting period is waived if you have Lou Gehrig’s disease.
- You have end stage renal disease. You’re eligible for Medicare if you’ve been diagnosed with this condition, which is also called end stage kidney disease.
In addition, Medicare Advantage plans have eligibility rules. You can join one of these plans if you live in the plan’s service area and have already signed up for Medicare parts A and B.
If you qualify for Medicare based on your age, your first chance to apply is during your Initial Enrollment Period. This period starts three months before the month you turn 65 and ends three months after your birthday month. You can sign up for Medicare at any time during this seven-month period.
If you miss your Initial Enrollment Period, you can sign up for Medicare during the General Enrollment Period. This runs from Jan. 1 through March 31 every year. Note that if you sign up late, you may need to pay higher monthly premiums for your coverage.
You may qualify for a special enrollment period that lets you sign up for Medicare at any time without paying a penalty. If you have job-based coverage, you can sign up at any time. You can also qualify for a special enrollment period if you lose your job-based coverage.
Original Medicare is the default for new enrollees, but it’s easy to sign up for a Medicare Advantage plan if that’s what you prefer. You can sign up for one of these Medicare plans during your Initial Enrollment Period. You can also sign up during Medicare’s fall open enrollment, which runs from Oct. 15 to Dec. 7.
When deciding which type of plan works best for you, consider the following:
- Out-of-pocket costs. Monthly plan premiums aren’t the only cost to consider as you compare plans. You’ll also pay coinsurance, copayments, and deductibles until you meet your plan’s annual out-of-pocket limit.
- Services covered. All Medicare Advantage plans cover Medicare parts A and B services, but other covered services may vary. Make a list of services you’d like your plan to cover, and keep your wish list in mind as you shop around.
- Doctor choice. Medicare plans generally have a network of doctors and other healthcare providers. Before you choose a plan, make sure your current doctors are in the network.
- Star ratings. The Centers for Medicare & Medicaid Services (CMS) Five-Star Rating System can help you find high-quality plans. CMS ratings are based on customer service, care coordination, healthcare quality and other factors that affect you.
- Healthcare needs. If you have a chronic health condition, such as diabetes or HIV, you may want to look for a special needs plan. These plans offer tailored coverage for people with specific health conditions.
To learn more about Medicare and Medicare Advantage plans, you can contact:
- The New York State Health Insurance Information, Counseling, and Assistance Program (800) 701-0501
- The Social Security Administration (800) 772-1213
When you’re ready to get Medicare or learn more about your plan options, here’s what you can do:
- To get Medicare parts A and B, fill out the Social Security Administration’s online application. If you prefer, you can also apply in person or by phone.
- If you want to sign up for a Medicare Advantage plan, you can shop for plans at Medicare.gov. After you choose a plan, you can enroll online.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.