Navigating Medicare can be confusing. Here's how New Yorkers can get help

Turning 65 comes with a lot of changes, and for many, it also comes with a crash course in Medicare.

New York resident Kerry Pollock is turning 65, and she is already trying to navigate the system, which some say is cumbersome and confusing. She is just one of the 98,000 residents who will be trying to make sense of the plans, premiums and deadlines.

Pollock said she thought it was going to be a simple process. But as her healthcare enrollment time approached, she started to receive "solicitations in the mail and phone calls." She said she realized how little she understood about it.

Pollock reached out to her peers and even contacted insurance brokers who she thought could help. But it was all still confusing.

Breakdown of Medicare parts

People turning 65 who've received Social Security income can enroll in the months leading up to their birthday. For older adults already enrolled, fall enrollment runs now through Dec. 7.  

Part A of Medicare covers inpatient hospital care, nursing facility care, hospice and some home health services. For many, there isn't a monthly premium because they paid Medicare taxes through their years of work.

Part B is for doctor's visits and outpatient care, testing and medical equipment. That comes with a premium, starting at about $203 every month.

These two parts are in the red, white and blue card residents get in the mail when they turn 65. 

Fred Riccardi, president of the Medicare Rights Center in New York, says A and B don't cover vision, dental, hearing care or any prescription drugs. 

"When they first enroll into Medicare they don't realize how these costs add up. It's sticker shock," he said. "So there's your monthly Medicare premium, then you may have an additional premium if you're enrolled in a private plan, you may have a premium for a supplement plan and then you have copayments et cetera, and it adds up."  

Part C, known as the Medicare Advantage Plan, is the private insurance plan that covers A and B plus prescription drugs.

While some plans may offer zero premiums, there are still deductibles, copays, coinsurance and network restrictions. Also, not all doctors are in network. 

Those who don't want the advantage plan can add Part D, which covers prescription drugs, to Parts A and B. But that, too, comes with a price. 

Fall enrollment is crucial, advocates say

Medicare advocates say fall enrollment is for older adults already registered for Medicare, but it is still important. 

It is crucial for switching plans and managing prescription drug coverage, mainly because drug lists, premiums, pharmacies and networks can change every year. 

"Prior to Part D, people were either forgoing taking prescription drugs or paying out of pocket," Riccardi said.

There are also additional supplemental plans like Medigap to help with out-of-pocket costs, but there's an additional monthly premium.

For seniors living on a fixed income, those costs can quickly add up.

"How can anyone, after they're retired, afford to pay $500 a month and more for health insurance and prescription drugs?" Bisram asked. 

"These challenges are real for folks," Riccardi said. 

Services offer help with navigating Medicare

Sandra O'Neill, a director at Family and Children's Association on Long Island, runs a program that assists people who have Medicare questions.

The Health Insurance Information Counseling and Assistance Program, or HIICAP, provides free counselors. In 2025, her office helped nearly 2,000 people with Medicare on the phone alone, including family caregivers. 

"We help their plans for medications, we help them pick out supplements and help them sign up, we enroll them here in the office, we do counseling by phone," she said.   

During open enrollment, 300 to 400 calls come in daily, she said. 

"Medicare is very confusing. People with English as a second language, first of all, a lot of them don't understand," she said. "As we age in place, we have 80-, 90-, and 102-year-olds calling about their Medicare."

Pollock got help from a HIICAP counselor who helped her weigh the best plans for her situation and sign her up.

"If I had known about this organization two months ago, I might have been saying it was a simple process," she said. 

Experts say there are ways to navigate the Medicare maze. Residents should open and read Medicare mail to review coverage plans and take a close look at prescription drugs.

They should also check to see if current providers will be in-network and ask for help if they are struggling to pay for costs.