Free Medicare Guidance for New Yorkers
What Is Medicare?
A Complete Guide for 2026
Medicare is the federal health insurance program for Americans 65 and older. This guide explains every part of the program, what it covers, what it doesn’t, and how to choose the right plan for your situation.
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What Is Medicare?
Medicare is the federal health insurance program administered by the Centers for Medicare & Medicaid Services (CMS). Established in 1965, it today covers more than 65 million Americans and serves as the primary source of health coverage for most people once they reach retirement age.
In general, you are eligible for the program if you meet one of the following criteria:
| Who Qualifies | Requirement |
|---|---|
| Age-based eligibility | Age 65 or older and a U.S. citizen or legal permanent resident (5+ years) |
| Disability | Under 65 and receiving Social Security Disability Insurance (SSDI) for 24+ months |
| End-Stage Renal Disease (ESRD) | Permanent kidney failure requiring dialysis or a transplant, at any age |
| ALS (Lou Gehrig’s Disease) | Automatically enrolled upon receiving Social Security disability benefits |
The Four Parts Explained
The program is divided into four parts: A, B, C, and D, and each one covers a different category of healthcare services. Understanding how they work together is essential before you choose a plan.
Part A — Hospital Insurance
Part A covers inpatient care in hospitals, skilled nursing facilities, hospice care, and some home health care. In most cases, people receive Part A at no premium cost if they or their spouse paid payroll taxes for at least 10 years (40 quarters).
2026 deductible: $1,736 per benefit period | Skilled nursing coinsurance (days 21–100): $217.00/day
Part B — Medical Insurance
Part B covers outpatient care, including doctor visits, preventive screenings, lab work, durable medical equipment, mental health services, and certain medications administered in a clinical setting. Unlike Part A, Part B always requires a monthly premium.
2026 premium: $202.90/month (standard) | 2026 deductible: $283/year | Coinsurance: 20% after deductible
Part C — Medicare Advantage
Part C, also known as Medicare Advantage, is an alternative to Original Medicare offered through private insurance companies approved by the federal government. These plans bundle Part A and Part B benefits and usually Part D drug coverage into one policy. They often include extra benefits like dental, vision, hearing, and fitness memberships that Original Medicare doesn’t provide.
Premium: Often $0/month (plus Part B) | Networks: HMO or PPO | Out-of-pocket max: $9,350 (2026)
Part D — Prescription Drug Coverage
Part D covers prescription medications through private plans approved by the federal government. If you choose Original Medicare with a Medigap plan, you’ll need a standalone Part D policy. However, most Medicare Advantage plans include drug coverage automatically, so no separate plan is needed.
2026 max deductible: $615 | 2026 out-of-pocket cap: $2,100 | See our Part D Costs guide for full details.
Coverage at a Glance
Original Medicare (Parts A and B) covers a wide range of medically necessary services. However, there are notable gaps, particularly around dental, vision, and long-term care. Here’s a quick reference for the most commonly asked coverage questions:
| Service | Covered? | Notes |
|---|---|---|
| Hospital stays | ✅ Part A | Inpatient care after the Part A deductible |
| Doctor visits | ✅ Part B | 20% coinsurance after Part B deductible |
| Preventive care | ✅ Part B | Welcome to the Medicare visit, annual wellness, and screenings |
| Prescription drugs | ✅ Part D | Requires a separate Part D or a Medicare Advantage plan |
| Mental health | ✅ Part B | Outpatient therapy, counseling, and psychiatric services |
| Home health care | ✅ Part A/B | Skilled nursing or therapy if homebound and medically necessary |
| Hospice care | ✅ Part A | For terminal illness with a life expectancy of 6 months or less |
| Skilled nursing facility | ✅ Part A | After a qualifying 3-day hospital stay, limited to 100 days |
| Durable medical equipment | ✅ Part B | Wheelchairs, walkers, oxygen equipment, CPAP machines |
| Dental care | ❌ Not covered | Routine dental is not included; however, some Advantage plans do cover it |
| Vision/eye exams | ⚠️ Limited | Cataract surgery is covered; routine eye exams and glasses are not |
| Hearing aids | ❌ Not covered | Not included in Original Medicare; however, many Advantage plans do cover them |
| Long-term care/nursing home | ❌ Not covered | Custodial care (help with daily activities) is not a covered benefit |
| Care outside the U.S. | ❌ Generally not | Limited exceptions for border emergencies; some Medigap plans cover foreign travel emergencies |
For a complete breakdown of what the program covers for dental, vision, and hearing, and how to fill those gaps, see our Does Medicare Cover Hearing Aids, Vision, and Dental? guide.
How It Differs From Medicaid
One of the most common points of confusion is the difference between these two programs. Although the names sound similar, they serve very different populations and work in distinct ways.
| Medicare | Medicaid | |
|---|---|---|
| Who it’s for | Adults 65+ and certain disabled individuals | Low-income individuals and families of any age |
| Administered by | Federal government (CMS) | Federal and state governments jointly |
| Eligibility basis | Age or disability | Income and assets |
| Cost to enrollee | Premiums, deductibles, copays | Little to no cost for enrollees |
| Can you have both? | Yes — people with both are called “dual eligible.” In that case, Medicaid often helps pay premiums and cost-sharing. | |
Choosing the Right Path
Once you have Original Medicare (Parts A and B), you face the most important coverage decision of your retirement: which supplemental path to take. Essentially, there are two options, and they work very differently.
Path 1
Medicare Advantage (Part C)
Replaces Original Medicare. Offered through private insurers. Often $0 premium. Usually includes drug coverage and extra benefits like dental, vision, and hearing. However, it requires using a provider network.
Path 2
Medicare Supplement (Medigap) + Part D
Works alongside Original Medicare to cover out-of-pocket costs. Higher monthly premium, but minimal surprise bills. You can see any doctor who accepts the program — no networks, no referrals. A separate Part D drug plan is required.
For a detailed side-by-side comparison, see our Medicare Advantage vs. Medicare Supplement guide.
2026 Costs and Premiums
| Coverage | Monthly Premium | Key Cost |
|---|---|---|
| Part A | $0 for most people | $1,736 deductible per benefit period |
| Part B | $202.90.00/month (standard) | $283 deductible, then 20% coinsurance |
| Medicare Advantage (Part C) | Often $0 (plus Part B) | Copays per service; $9,350 out-of-pocket max |
| Medicare Supplement (Medigap) | $100–$300+ (varies by plan) | Plan G: only $283 Part B deductible out of pocket |
| Part D | Varies by plan | Max deductible $615; out-of-pocket cap $2,100 |
📌 Higher-income note: If your income exceeds certain thresholds, you may pay a higher Part B or Part D premium due to the IRMAA surcharge. Use our IRMAA Calculator to check. For a complete breakdown of all 2026 costs, see our Medicare Costs 2026 guide.
How to Enroll
Most people first become eligible at 65. Specifically, your Initial Enrollment Period (IEP) is a 7-month window centered on your 65th birthday month. Enrolling during the first three months of that window gives you the earliest possible coverage start date.
There are three ways to sign up:
- Online: Visit ssa.gov — the process typically takes about 10 minutes
- By phone: Call Social Security at 1-800-772-1213
- In person: Visit your local Social Security Administration office
It’s important to act on time — missing your enrollment window without a qualifying exception can result in permanent late enrollment penalties on your Part B and Part D premiums. For further guidance, see our step-by-step enrollment guide and our Medicare Enrollment Periods guide.
Frequently Asked Questions
Is Medicare free?
Most people receive Part A at no premium cost. Part B, on the other hand, requires a monthly premium of $202.90 in 2026 for most enrollees. Whether the program feels “free” overall depends on which supplemental coverage you add. Advantage plans often have $0 premiums, while Medigap plans charge $100–$417 or more per month in exchange for lower costs at the point of care.
What is the difference between Medicare and Medicaid?
Medicare is a federal program for people 65 and older (and certain disabled individuals), regardless of income. Medicaid, by contrast, is a joint federal-state program for low-income individuals and families of any age. Importantly, you can qualify for and receive both at the same time, which is known as being “dual eligible.”
Does the program cover dental, vision, and hearing?
Original Medicare does not cover routine dental care, routine eye exams, or hearing aids. Cataract surgery, however, is covered under Part B. As a result, many people choose Medicare Advantage specifically because those plans frequently bundle dental, vision, and hearing benefits at no extra cost.
Does the program cover home health care?
Yes — skilled home health care is covered when you are homebound, and the care is medically necessary and ordered by a doctor. This includes skilled nursing visits, physical therapy, occupational therapy, and speech-language pathology. However, custodial home care, such as help with bathing, dressing, and daily activities that don’t require medical training, is not a covered benefit.
Does Medicare cover long-term care or nursing home stays?
The program covers short-term skilled nursing facility care (up to 100 days) following a qualifying 3-day hospital stay. However, it does not cover long-term custodial nursing home care — the ongoing assistance that most people picture when they think of a nursing home. In that case, coverage typically requires Medicaid (after spending down assets), long-term care insurance, or private pay.
Can I have Medicare and employer insurance at the same time?
Yes, but which insurance pays first depends on the size of your employer. If your employer has 20 or more employees, your employer plan is primary, and the federal program is secondary. On the other hand, if your employer has fewer than 20 employees, the federal program becomes primary even while you’re still working. For a full breakdown, see our Turning 65 in New York guide.
What changed for 2026?
Several changes took effect this year. First, the Part B premium increased to $202.90/month. In addition, the Part D out-of-pocket cap increased to $2,100 (up from $2,000 in 2025), while the Part D deductible rose to $615. Furthermore, starting July 1, 2026, coverage expanded to include GLP-1 weight loss medications like Wegovy for eligible beneficiaries. See our Medicare Costs 2026 guide for the full update.
Which plan is best for me?
There is no single “best” plan — the right choice depends entirely on your health needs, preferred doctors, budget, medications, and travel habits. As an independent broker, I compare every plan available in your ZIP code across all major carriers at no cost to you. Call or text 917-740-1895 or schedule a free consultation to get a recommendation built around your specific situation.
Ready to Explore Your Options?
Craig Smith is an independent broker serving New York, New Jersey, and nationwide. Consultations are 100% free — I’m paid by the carriers, never by you.
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Or call: 917-740-1895 | craigsmith@csmedicare.net
Craig Smith Insurance Group | Independent Medicare Broker | Licensed in New York, New Jersey, and 14 additional states
We are not connected with or endorsed by the United States Government or the federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
