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Medicare in New York: How to Apply, Who is Eligible and More

February 7, 2022

Medicare in New York: How to Apply, Who is Eligible and More

Whether you live in New York City or New York State, it’s important to understand how Medicare works. When you get to know the various parts of Medicare, you can make a better decision about what coverage you need.

Medicare is designed to provide health insurance coverage for Americans 65 and older, as well as younger individuals with disabilities or end-stage renal disease.

This article will help you understand who is eligible for Medicare in New York as well as how to apply for Medicare in NY.

Medicare in New York City

When it comes to Medicare, New York City operates the same way the rest of the state does, and the rest of the country; there are no different eligibility rules for Medicare in New York City or the rest of the state.

If you have Medicare Part C, known as Medicare Advantage, you’ll have a medical network based on your local area. That means your New York City coverage for Part C will be different than Part C coverage in other areas of the state.

Medicare in New York State

Medicare in New York State is the same Medicare coverage in other areas of the country. There are several parts to Medicare, and each one has its own purpose.

The parts of Medicare are:

  • [Medicare Part A] hospital insurance
  • Medicare Part B: medical insurance
  • Medicare Part C: a replacement for A & B known as Medicare Advantage
  • Medicare Part D: drug coverage for Original Medicare

No matter where you live, these coverages work the same way for you.

How to Apply for Medicare in New York

If you live in New York or NYC, you might wonder how to apply for Medicare coverage. Fortunately, the process is simple.

Many New Yorkers will receive Medicare Parts A and B automatically when they are eligible. This might be around your 65th birthday, or it might involve having a qualifying medical condition.

If you don’t receive Part A and Part B automatically, you’ll have to enroll. The steps for enrollment are in the following section.

How Do I Apply for Medicare in New York State?

The process to apply for Medicare in New York State is the same as NYC and the rest of the country. If you aren’t automatically enrolled, you can apply by taking one of the following steps:

  • Contact your local Social Security office
  • Calling 1-800-772-1213 to enroll over the phone
  • If you retired from a railroad, call the Railroad Retirement Board at 1-877-772-5772
  • Sign up for Part A online at and Part B using Form CMS-40B

Of course, your local Social Security office will depend on where you live. If you aren’t sure, you can go to the field office locator at

New York Medicare Eligibility

How do you become eligible for Medicare? The program is designed for older Americans and those with specific health conditions. Generally, these groups are not in the workforce and don’t have access to work-provided health insurance.

To be eligible for Medicare in New York, you need to be a citizen of the U.S. or a permanent resident and have been living here for at least five years. Also, one of the following must apply:

  • Age 65 or older
  • Under 65 but disabled and receiving disability benefits from Social Security or the Railroad Retirement Board
  • Having end-stage renal disease (ESRD)
  • Having Amyotrophic Lateral Sclerosis (ALS), better known as Lou Gehrig’s disease

What is the Income Limit for Medicare in New York?

There is no upper-income limit that disqualifies you from receiving Medicare benefits in New York. However, if you have income over $88,000 a year for an individual or $176,000 for a couple, you may pay a higher premium for Medicare Part B and pay higher copayments for medication under Medicare Part D.

If you have a lower income, you may qualify for extra assistance with your monthly Medicare premium and out-of-pocket costs. There are several Medicare Savings Programs available, and each one has a different income and asset limit to qualify. If you make more than these limits, you won’t be able to use the program to assist you with Medicare costs.

What Does Medicare Cover in New York?

Different parts of Medicare cover different medical services that you may need. Understanding what each Medicare Part covers is essential to making the best use of your benefits.

Medicare Part A focuses on inpatient hospital stays. Medicare Part B helps pay for outpatient visits, doctor’s appointments, preventive care, and certain medical supplies and equipment. Medicare Part D can be added to A and B if you need prescription drug coverage.

Medicare Part C, or Medicare Advantage, is a replacement for Parts A, B, and D. It offers at least as much coverage as Original Medicare, but you may also get additional benefits. However, Part C plans are limited to a specific medical network, so be sure your providers are included before you decide to go this route.

It’s important to keep in mind that Medicare does not cover 100% of your medical costs. You’ll pay a deductible first, and then you’ll have a copayment or coinsurance amount to cover. For example, with Medicare Part B you pay 20% of the cost after you have paid your deductible.

What is the Best Medicare Advantage Plan in New York?

Medicare Advantage can be an attractive option to many New Yorkers. The best Advantage plan is one that meets your medical needs and includes all of your preferred providers at a cost you can afford.

Some Medicare Advantage plans won’t charge you a monthly premium beyond what you already pay for Part B. Others will have an additional cost. You also need to consider what deductible, copayments, and coinsurance are involved.

Finally, ensure that the medical network meets your needs. You don’t want to sign up for Medicare Advantage and discover that your primary doctor isn’t available within the network!

What is the Look Back Period for Medicare in New York?

A look back period is the amount of time your income is reviewed to see if you are eligible for specific assistance. There is no look-back period for Medicare in New York.

However, Medicaid — which is a medical coverage program for lower-income New Yorkers — does have a look-back period to determine eligibility for specific types of long-term care. This timeframe ranges between 2.5 and 5 years.

Learn More About Medicare in New York

Ensuring that you have the right Medicare plan for your needs can be challenging, but working with a licensed insurance agent can help. If you have more questions or would like to compare Medicare plans, contact us today!

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