Medicare in New York

Medicare is a federal health care program for citizens aged 65+ and younger people with qualifying disabilities. As of 2022, 65 million Americans are enrolled, with seniors accounting for 57.3 million. As of 2023, around 3.8 million of those enrolled live in New York. Medicare Advantage is steadily becoming more popular in the state, with 50% of seniors adopting a plan — a 2.20% rise from 2022. Consequently, 2023 is the first year New York’s Medicare Advantage beneficiaries have exceeded the national average of 48%. The latest cost figures are for 2021, revealing New York’s Medicare burden to be almost $26.3 billion.

Original Medicare is the foundation program, comprising two parts: A and B. Part A provides essential coverage, such as nursing home care, hospital stays, hospice care and some home health care services. For most people, there is no premium for Part A. However, 2023’s premium for Part B is $164.90. Part B provides coverage for outpatient care, such as diagnostic testing, medical supplies and transportation. Medicare Part D exclusively covers prescription drugs. Premiums vary because several factors determine costs, such as an enrollee’s prescriptions and the tiers the drugs are assigned to. 

Medicare Advantage, known as Part C, combines the coverage of Parts A and B, minus hospice care, into one plan. As of 2023, New Yorkers have a choice of 288 plans, eight more than in 2022. They’re administered by private insurance companies approved by the Centers for Medicare and Medicaid Services (CMS). The starting premium for all Part C plans is 0%, but this increases when beneficiaries include extra coverage, such as prescription drugs, vision and dental care. Consequently, the median monthly premium for New York is $26.02 — a savings of $4.02 on 2022’s average. Seniors concerned about expenses not covered by Medicare, such as deductibles and coinsurance, can sign up for Medicare Supplement Insurance, better known as Medigap.

This guide covers Medicare in more detail, including how to customize Medicare plans. It also catalogs some nonprofit organizations dedicated to helping New Yorkers get the most from Medicare.

Options for Medicare Coverage in New York

Each person has their own health care needs, so despite offering extensive coverage, Original Medicare is unlikely to satisfy everyone. Happily, private insurance companies provide New Yorkers with other options that enable them to build Medicare plans that cover the costs they anticipate and add to their peace of mind. 

Original Medicare (Parts A & B)

Original Medicare provides consistent coverage throughout the country, ensuring seniors can access the same care whether they’re at home, on vacation or moving to another state. However, in almost all cases, Medicare won’t cover health care costs incurred outside the United States. Consequently, the U.S. Department of State strongly recommends that citizens traveling abroad get appropriate health insurance before they leave. 

Original Medicare beneficiaries pay their care expenses at the time of receipt. The insurance program covers 80% of costs, with the beneficiary covering the remainder. Part A’s deductible for 2023 is $1,600, while Part B’s is $226.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

While Original Medicare offers a uniform, if rigid, level of coverage, Medicare Advantage offers flexibility. There are five types of Medicare Advantage Plans, all of which must conform to the rules and regulations imposed by the CMS.

Approved private insurance companies can tailor these plan types to provide personalized coverage for seniors with varying needs. For example, a PFFS plan provides beneficiaries with a wide network of providers, allowing them more say over who delivers their care. On the other hand, seniors with HMO plans have a limited network at their disposal, but they often enjoy lower premiums.

Who Should Consider Medicare Advantage

Medicare Advantage may satisfy the needs of those who:

• Are generally healthy, so may benefit from lower premiums
• Are comfortable with the provider choosing their health care professionals
• Want more coverage, such as dental care and prescription drugs
• Are looking to control their out-of-pocket expenses

The Top 10 Medicare Advantage Plans

With so many Medicare Advantage plans to choose from, New Yorkers may struggle to identify the ones most suited to their needs. Using enrollee figures as the benchmark, the following list comprises the state’s top 10 plans as of August 2023. It also lists the types of care plans and their costs. An additional resource for Medicare Part C plans can be found on the Medicare Advantage Plans in New York page.

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2023 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in New York

Some New York residents may find it difficult to steer their way through the wealth of information about the different Medicare plans. It can be challenging to find the right plan, but fortunately, many organizations can help residents compare plans and find the one that suits their needs and budgets. The following resources can help potential enrollees understand the advantages, disadvantages and costs of various plans and how to apply. Some can also provide legal assistance if Medicare denies their claim.