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Requirements for Medicare in New York

Medicare is a comprehensive health insurance plan for the elderly and disabled. It is federally administered and available nationwide. Medicare is available either through private plans, known as Medicare Advantage plans, or as traditional Medicare. New York state offers each of these options. The eligibility requirements are the same throughout the nation; however, there is some specific information for New York residents that is helpful to know when one is new to Medicare.

  1. Age Requirements

    • Most Medicare enrollees are eligible because of age. The age requirement is 65 years or older.

    Disability Requirements

    • Age is not the only way to qualify for Medicare, however. Those who receive Social Security Disability Insurance (SSDI) for a condition also qualify for Medicare. They must have been receiving SSDI for at least 24 months, unless they are diagnosed with Lou Gehrig's Disease (ALS), in which case they are qualified for Medicare during their first month of receiving SSDI benefits.

    End Stage Renal Disease Requirements

    • Some individuals qualify for Medicare if they have been diagnosed with End Stage Renal Disease (ESRD). Those with ESRD are eligible to receive their Medicare benefits either three months after they begin dialysis treatment or once they are hospitalized for a kidney transplant.

    Work and Residency Requirements

    • In order to qualify for premium-free Part A (hospital benefits) coverage, enrollees must have worked in the United States for at least 10 years (40 working quarters) for an employer that paid into the Medicare system. Those who have not worked the full 10 years have two options: They can qualify through their spouses' work years if they have the full 10 years, or they can enroll in Part A and pay a Part A premium. All Medicare recipients must be legal, documented citizens.

    Low-income Program Requirements

    • New York state has several programs for low-income Medicare enrollees. Medicare savings programs are available for those who fall under 135 percent of the federal poverty level. In 2010, an individual would need to have an income under $1,219 to qualify while a married couple would need an income under $1,640. Medicare savings programs offer varying coverage of Medicare co-payments, co-insurances, deductibles, premiums and other costs. New York also offers Elderly Pharmaceutical Insurance Coverage (EPIC), which assists with the Part D drug costs and works for many as a low-cost Part D insurance. Individuals with incomes under $30,000 and married couples with a combined income under $50,000 are eligible for this program.

    Enrollment Requirements

    • There are only selected points, during the year, when a beneficiary can enroll in Medicare. First, they can enroll when they originally become eligible during the initial enrollment period. This is three months prior to, the month of and the three months following the enrollee's 65th birthday. They can also enroll during the open enrollment period which lasts from January 1 through March 31. They may not make changes to their Part D drug coverage during this time. The final enrollment period is the annual coordinated election period which lasts from November 15 through December 31 each year. Beneficiaries can make any changes they want during this period, effective January 1 of the following year. Finally, there are several ways to qualify for a special enrollment period. Those enrolled in EPIC or a Medicare savings program qualify for one special enrollment period a month.

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