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Cost for Medicare in New York – Eligibility and Enrollment

Who qualifies for Medicare in New York?

Any individual who is 65 or older, has End-Stage Renal Disease or is a young person with a disability will qualify for Medicare in New York. Qualifying for Medicare Part A and Part B is not instant though. To determine if you are eligible for Medicare coverage in New York, see below.

65 and older:

– Are a U.S. citizen
– Receiving or are old enough to have eligibility for Social Security or Railroad Retirement benefits
– You or your spouse is an employee or retiree of the government and has paid Medicare taxes.
– End-Stage Renal Disease, permanent kidney failure requiring routine dialysis or a transplant for a kidney.

65 or younger:

– You have been eligible for SSDI for 2 years (do not have to be consecutive)
– Receiving disability pension from the Railroad and meet certain conditions
– Have Lou Gehrig’s Disease

Note: If you are younger than 65 and have End-Stage Renal Disease, permanent kidney failure that requires routine dialysis, or are in need of a transplant for a kidney, then you have eligibility for Medicare enrollment.

Is Medicare in New York free?

Although individuals may have earned their Medicare benefits in New York, not all of the Federal Government program is free. There are different parts, plans, and coverage options to Medicare, and there will be out of pocket costs depending on the one you choose. The four main parts of Medicare are:

Hospital Insurance: Medicare Part A

Medical Insurance: Medicare Part B

Medicare Advantage: Medicare Part C

Medicare Prescription: Medicare Part D

For the below services, Medicare Advantage Plans must cover them for both Medicare Part A (hospital insurance) and Part B (medical insurance). Costs will differ per plan and could be higher/lower than Original Medicare.

How Much does Medicare Part A Cost Per Month?

Part A is referred to as “premium-free” because most individuals do not pay for this part of Medicare. If it should have to be purchased in 2021, it will cost $471 monthly if you paid taxes for 30 quarters or less. If you paid taxes for 30 to 39 quarters, then the premium will be $259 monthly.

Note: If you do not purchase Part A when you are first eligible for Medicare benefits, there will be a late enrollment period penalty, and your premium could go up by 10%.

Part A with Original Medicare has the following copays, coinsurance, and deductibles.

Home Health Care services $0 (20% of Medicare approved cost for durable medical equipment (DME)

Hospital Care is $0 pay with no more than $5 for each prescription drug or product for pain or symptom control while in hospice. If the provider should not cover a certain drug for wellness, check with your Part D Medicare drug plan. There may also be a 5% pay of Medicare approved amount for respite care.

Note: Medicare will not pay for rooms and board if you live in the facility where you are receiving care.

– Hospital Inpatient stays will cost $1484 deductible to be paid for each benefit period. For hospital stay length coinsurance costs, see below.

Up to 2 months: $0

2 to 3 months: $371 per day

3 months or more: $742 per each lifetime reserve day (up to 60 days over the course of your life). Beyond lifetime reserve days, it requires all costs.

If you choose a private room or nurse or ask for a television or phone in your room, these will be out of pocket expenses for you.

Inpatient Mental Health stays also have a $1484 deductible. Cost per days are the same as hospital inpatient stays but with the addition of 20% of the Medicare approved amount for services related to mental health.

Note: With mental health, there is no limit to the number of benefit periods. In a psychiatric hospital, there’s a lifetime limit of 190 days.

Skilled Nursing facilities costs $0 for the first 20 days. For 21 to 100 days, it will cost $185. Beyond 101 days, all costs are required.

How Much is Medicare Part B?

The below is based on the income and filed tax returns for Individual, Joint, and Married and Separate based on 2019.

$148.50: $88,000 or less/$176,000 or less/$88,000 or less

$207.90: $88,000-$111,000/$176,000-$222,000/Not Applicable

$297.00: $111,000-$138,000/$222,000-$376,000/Not Applicable

$386.10: $138,000-$165,000/$330,000-$750,000/Not Applicable

$475.20: $165,000-$500,000/$330,000-$750,000/$88,000-$412,000

$504.90: Above $500,000/Above $750,000/Above $412,000

If you enroll late, your premium could go up 10%; the penalty could last as long as you have Part B. Also, you may have to wait until the General Enrollment period (1/1 – 3/31). Coverage starts 7/1 upon enrollment.

The annual deductible for 2021 is $203. Once the deductible is met, then you will typically pay 20% of the following Medicare approved amounts:

Most all services from doctors (including inpatient)

Doctor or other provider visits for the diagnosis of a condition

Durable medical equipment

Therapy (Outpatient)

There is $0 cost for clinical lab services, home health services, and the yearly screening for depression (if provider accepts assignment).

Note: Treatment at an outpatient clinic could cost an additional copayment or coinsurance to that facility.

How Much Does Medicare Part D Prescription Drug Plan Cost in New York?

For Individual, Joint, or Married and Separated, see income specifics below. For those with higher income could pay more.

Your plan premium: $88,000 or less/$176,000 or less/$88,000 or less

$12.30 + premium: $88,000-$111,000/$176,000-$222,000/Not Applicable

$31.80 + premium: $111,000-$138,000/$222,000-$376,000/Not Applicable

$51.20 + premium: $138,000-$165,000/$330,000-$750,000/Not Applicable

$70.70 + premium: $165,000-$500,000/$330,000-$750,000/$88,000-$412,000

$77.10 + premium Above $500,000/Above $750,000/Above $412,000

For deductibles, copayments, and coinsurance, that will vary by plan.

What if I Choose a “Free” $0 Premium Medicare Advantage Plan?

You are still required to pay your Medicare Part B premium for a Medicare Advantage plan. These plans will often include a Part D prescription drug plan as well as bonus coverage for the following:

  • Dental
  • Vision
  • Silver Sneakers/Fitness
  • Hearing

How Much is a Medicare Supplement Plan in New York?

All Medigap plans will vary based on age, gender, service area, and the plan selected. No matter the choice of the 10 standardized plans available, your premium will be in addition to the Part B premium.

Note: These plans do not include a prescription drug Part D plan. The advantage to a Medigap insurance plan is the freedom of no network, predictable monthly premium costs, and comprehensive health plan coverage.

What Medicare plans are available in New York?

Best for Network Freedom: Medicare Supplement

With Medigap policies, the monthly cost is higher, and premiums can change, but the health coverage is nationwide. For those that travel or may get care at a specialty center in another state, this plan is the best Medicare health coverage. Also, coverage options include no annual changes to the plan or referrals required for Medicare beneficiaries.

Best for Lowest Premiums: Medicare Advantage

PPO (larger network/no referrals): premiums for PPO range from $0 to $100 per month.

HMO (smaller network/requires referrals): premiums for HMO are generally $0 per month.

Best for Low-Income or Health Conditions: Medicare Advantage D-SNIP

This is the best plan for individuals with a low-income or for those that have chronic health conditions.

Note: You can have Medicare AND Medicaid in your service area to help lower the costs of copays, prescription drug coverage, premiums, coinsurance, etc.

New York Medicare FAQs:

What is the income limit for Medicare in New York?

There is no income limit for Medicare in New York. For individuals ($500k)/joint ($750k)/married and separate ($412k), the Part B monthly premium is $504.90.

How do I apply for Medicare in New York?

There are three ways you can apply to the Medicare program in New York: online, phone, and in person.

Online: Social Security Administration website

Phone: 1-800-772-1213 Monday through Friday 7 am to 7 pm. For the hearing impaired, 1-800-325-0778.

In person: Your local SSA office

Note: Medicare beneficiaries can also visit insurance companies to shop for Medicare health care plans.

When can I apply for Medicare in New York?

Your age and wellness will determine when you can apply for Medicare Part A and Part B. Centers for Medicare & Medicaid Services will not generally notify you as to when you can apply. Most will sign up for the Medicare program within the first three months prior to turning 65.

Where do I Apply for Medicare?

You can apply online with the SSA, by phone, or in person at your local SSA office in New York. You can also visit insurance companies and speak with an insurance agent. At Policyguide, we can go through all the Medicare program parts and health insurance plans and help you choose the best coverage options for you.

What should I bring when applying for Medicare?

When you are ready to apply for Medicare, there are a few documents you will need. See below.

Birth Certificate/Social Security Card/Proof of Citizenship
Health Insurance
Tax documents
Military papers (DD214, etc.)
Part B application

Is enrollment in Medicare mandatory at age 65?

Upon enrollment into Medicare Part A or Social Security, the enrollment in one triggers the other. You can’t have one without the other because they are linked. Medicare Parts B, C, and D (prescription drug) are optional, and enrollment can be delayed if you so choose for these coverage options.

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Key Take Aways
  • In New York, Medicare Advantage & Medicare Supplement plans are the most popular choices
  • Your initial Medicare enrollment period begins three months before your 65th birthday and includes the entire month
  • Apply for Medicare online, by phone or at a Social Security office in your service area.
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