If you live in Rochester and have Medicare, now is the time to look at your coverage, because annual enrollment ends December 7. From October 15 to December 7 you can join, switch, or drop a Medicare Advantage or drug plan, with changes starting January 1.
This article is educational. Instant Health Help is a licensed health insurance agency, and our agent, Lobsang Rivas, is licensed in New York and certified as a broker with NY State of Health. We are not Medicare, CMS, NY State of Health, or an insurance company, and we do not quote prices or name plans here. Check official dates on Medicare.gov.
The short answer
- Medicare. Medicare.gov Plan Finder or 1-800-MEDICARE (1-800-633-4227) lists the plans sold in your ZIP code.
- HIICAP, New York’s Medicare counseling program. Call the statewide line at 1-800-701-0501, say your county, and you will be routed to local counselors. Learn more on the New York State Office for the Aging HIICAP page.
- A licensed agent. An agent can compare options with you and help you enroll. Medicare.gov suggests checking the rules agents must follow.
Key Medicare dates
- Annual enrollment: October 15 to December 7. The plan must get your request by December 7.
- Medicare Advantage open enrollment: January 1 to March 31, only if you already have a Medicare Advantage plan.
- Turning 65: a seven month initial enrollment period that starts three months before the month you turn 65.
Work and Medicare in Greater Rochester
Bureau of Labor Statistics data put education and health services among the largest groups in Rochester area employment, with trade and transportation, government, and manufacturing also large. The region’s optics, imaging, and photonics cluster still supports many local manufacturing and research jobs. That mix shows up in Medicare decisions:
Still working past 65 at a campus, clinic, or plant. If you have coverage through your current job or your spouse’s current job, Medicare.gov describes a Special Enrollment Period that lets you sign up for Part B later without a late enrollment penalty. Talk with your benefits office and Social Security about timing.
Retiring from an employer or union plan. Ask your benefits administrator before you join a Medicare Advantage plan. Medicare.gov warns that joining Advantage coverage can sometimes cost you retiree coverage for you and your family, and you may not get it back.
Winters somewhere warmer? If you live in another state for part of the year, Medicare.gov suggests checking whether the plan will cover you there.
Three New York rules and programs worth knowing
Medigap applications are accepted all year. In most states, the main window to buy a Medicare Supplement (Medigap) policy without health questions is a one time, six month period. New York goes further. The New York State Department of Financial Services says insurers that sell Medigap here must accept an application at any time of year and cannot turn you down or charge you more because of your health. You need both Part A and Part B, and a waiting period of up to six months for pre-existing conditions may apply, which can be reduced if you had other coverage before.
EPIC can help with drug costs. EPIC is a New York State program for income-eligible seniors 65 and older. It helps with out-of-pocket costs for a Medicare Part D drug plan. You can apply any time of year, and you must be in, or eligible for, a Part D plan. See the EPIC page from the New York State Department of Health.
Help with other Medicare costs. Medicare.gov points to Extra Help with drug costs, which you apply for through Social Security, and Medicare Savings Programs, which you apply for through your state. Getting Extra Help can also open a Special Enrollment Period to change your drug coverage.
What Rochester area residents should review
Your Annual Notice of Change. It comes each fall. Read it before you decide to keep your plan.
Your doctors and hospitals. Whether you go to the university medical campus on the south side, a hospital closer to downtown, or an office in Greece, Brighton, Webster, or Canandaigua, confirm directly with the office and the plan. We never assume.
Your county. Choices in Monroe County may differ from Ontario, Wayne, Livingston, Orleans, or Genesee County. Compare with your own ZIP code.
Your prescriptions. Enter every drug you take and your usual pharmacy in Plan Finder.
Under 65 in New York?
New Yorkers under 65 who need their own coverage use NY State of Health, not HealthCare.gov. Open enrollment for Qualified Health Plans starts November 1, and Medicaid, Child Health Plus, and the Essential Plan are open all year for people who qualify. Our agent is certified as a broker with NY State of Health, so we can go through the application with you, compare plans with your doctors and prescriptions in mind, and help you enroll, at no extra cost to you for our help. We are not NY State of Health, and NY State of Health decides what you qualify for. See our New York open enrollment guide or go to NY State of Health.
How we help
We help New Yorkers with Medicare by phone and online, in English or Spanish. Learn more on our New York health insurance help page. We review your doctors, prescriptions, and ZIP code and explain your options in plain English. The choice is always yours.
Questions before December 7?
Have your Medicare card, your drug list, and your doctors’ names nearby, and we will go through it with you.
Call (321) 315-0054 | agent@inshh.com
We do not offer every plan available in your area. Currently we represent 10 organizations which offer 489 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, is available 24 hours a day, 7 days a week, except some federal holidays. Instant Health Help is not connected with or endorsed by the U.S. government or the federal Medicare program.