How Does Medicare Work In New York | Empire Blue
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What is Medicare?

A retiring couple researching and getting answers to what is Medicare

When exploring Medicare for the first time it's normal to have a lot of questions. That's why we've organized all the Medicare information you need to navigate the process more easily.

How does Medicare work?

Medicare is a federal health insurance program that provides benefits to those older than 65 and to some younger individuals with disabilities. If you want to understand how Medicare works you can learn more about the different parts of Medicare – that begins with a better understanding of Original Medicare.

What is Original Medicare?

Medicare is made up of two main parts: Part A and Part B. Part A covers hospital expenses. Any inpatient care falls under Medicare Part A coverage.  That includes:

  • Hospital stays (semi-private rooms) up to 60 days
  • Hospital meals
  • Nursing services
  • Intensive care services
  • Drugs, medical supplies and equipment used on the premises
  • Lab tests and X-rays taken while hospitalized
  • Surgery and recovery costs
  • Rehabilitation and therapy services
  • Part-time home nursing care

Medicare Part B is your general medical insurance for outpatient medical needs, including:

  • Doctor visits
  • Tests, screenings and X-rays
  • Flu shots and other vaccinations
  • Necessary medical supplies
  • Outpatient mental health care
  • Medically necessary preventive care

What is Medicare Part C?

More Medicare coverage  means more peace of mind. That's why many people choose Part C, called a Medicare Advantage plan, which you can get from private insurers like Empire. Medicare Part C plans cover Part A and Part B (Original Medicare).

Many plans include prescription drug coverage as well as other benefits Original Medicare does not cover.

Medicare Advantage plans  may include:

  • Routine dental care including cleanings, X-rays and dentures
  • Routine vision care including contacts and glasses
  • Routine hearing care including hearing aids
  • Fitness benefits including exercise classes

What is Medicare Part D?

Original Medicare doesn't cover prescription medications. For that, you can either get a Medicare Advantage plan that includes prescription drug coverage, or a standalone Part D plan, which solely covers prescription drugs.

When are you eligible for Medicare?

You have a seven-month window to apply for Medicare:

  • Three months before you turn 65
  • The month you turn 65
  • Three months after you turn 65

It's good to know your Medicare enrollment dates. These are times when you can add, switch or drop coverage so you have a plan that fits your needs.

Apply for the first time: Medicare Initial Enrollment Period

Medicare Enrollment – that seven-month window we just mentioned – is your first chance to apply for Original Medicare. Try to sign up during this time to avoid penalties and delayed coverage.

Make changes to coverage: Medicare Annual Enrollment Period

If you already applied for Original Medicare but find you need to make changes, you can do that during the Annual Enrollment Period.

Also known as the Annual Election Period, from October 15 to December 7 each year, the Annual Enrollment Period is your opportunity to add, drop or change your benefits.

Annual Enrollment is also a good time to sign up for a Medicare Advantage plan if you need more coverage. Or if you have one already, you can use this to make changes to a Medicare Advantage plan or Part D plan. You also have a chance to change your Medicare Advantage plan from January 1 to March 31 during the Medicare Advantage Open Enrollment Period.

How to Apply for Medicare

Visit your local Social Security office to sign up for Medicare, or sign up with Social Security online in about 10 minutes. You may need the following documents:

  • Your Social Security card
  • Your original birth certificate
  • Proof of U.S. citizenship or legal citizenship status documentation if you were not born in the U.S.
  • A copy of your W-2 form

Find a Medicare plan that fits your needs. Explore your plan options.

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