Medicare & Medicaid in New York (NY)
2026 healthcare costs, coverage, and spending data for New York.
$12,273
Spending/Capita
5,097,885
Medicare Enrollees
6,880,512
Medicaid Enrollees
5.6%
Uninsured Rate
Medicare Premiums in New York
Part B Premium
$185/mo
Part D Premium (Avg)
$26/mo
Medigap Premium (Avg)
$267/mo
Medicaid Expansion: Yes - New York expanded Medicaid under the ACA
Procedure Costs in New York
Hospital
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| Liver Transplant | $186,277 | $149,022 | $37,255 |
| Kidney Transplant | $132,435 | $105,948 | $26,487 |
| Coronary Artery Bypass Graft (CABG) | $91,001 | $72,801 | $18,200 |
| Heart Valve Replacement | $81,320 | $65,056 | $16,264 |
| Spinal Fusion | $62,046 | $49,636 | $12,409 |
| Defibrillator Implantation (ICD) | $54,133 | $43,307 | $10,827 |
| Total Knee Replacement | $43,563 | $34,851 | $8,713 |
| Total Hip Replacement | $34,764 | $27,811 | $6,953 |
| Pacemaker Implantation | $29,076 | $23,261 | $5,815 |
| Laminectomy | $25,800 | $20,640 | $5,160 |
| Hip Fracture Repair | $24,680 | $19,744 | $4,936 |
| Lumbar Disc Surgery | $23,813 | $19,051 | $4,763 |
| Sepsis Treatment | $23,622 | $18,898 | $4,724 |
| Mastectomy | $21,440 | $17,152 | $4,288 |
| Stroke Treatment (Acute) | $21,433 | $17,146 | $4,287 |
Outpatient
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| TURP (Prostate) | $8,903 | $7,122 | $1,781 |
| Arthroscopic Knee Surgery | $7,724 | $6,179 | $1,545 |
| Lithotripsy (Kidney Stones) | $6,074 | $4,859 | $1,215 |
| Dialysis Access Surgery | $5,897 | $4,718 | $1,179 |
| Nasal Polyp Removal | $5,607 | $4,486 | $1,121 |
| Endoscopic Sinus Surgery | $5,586 | $4,469 | $1,117 |
| Tonsillectomy | $5,022 | $4,017 | $1,004 |
| Adenoidectomy | $4,818 | $3,855 | $964 |
| Bunionectomy | $4,584 | $3,667 | $917 |
| Septoplasty | $4,447 | $3,557 | $889 |
| Ganglion Cyst Removal | $4,166 | $3,333 | $833 |
| Pilonidal Cyst Surgery | $4,058 | $3,246 | $812 |
| Bronchoscopy | $4,035 | $3,228 | $807 |
| Hemorrhoid Surgery | $3,827 | $3,062 | $765 |
| Cataract Surgery (Outpatient) | $3,662 | $2,929 | $732 |
Imaging
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| PET Scan | $3,662 | $2,930 | $732 |
| Nuclear Stress Test | $2,429 | $1,943 | $486 |
| CT Angiography | $1,807 | $1,446 | $361 |
| MRI Spine (Lumbar) | $1,705 | $1,364 | $341 |
| MRI Brain | $1,584 | $1,267 | $317 |
| MRI Spine (Cervical) | $1,271 | $1,017 | $254 |
| Bone Scan | $1,200 | $960 | $240 |
| MRI Hip | $1,196 | $957 | $239 |
| CT Scan Abdomen/Pelvis | $1,133 | $906 | $227 |
| MRI Knee | $1,118 | $894 | $224 |
| MRI Shoulder | $1,109 | $887 | $222 |
| CT Scan Chest | $1,071 | $857 | $214 |
| CT Colonography (Virtual) | $851 | $681 | $170 |
| Fluoroscopy | $717 | $574 | $143 |
| CT Scan Head | $637 | $509 | $127 |
Physician/Office
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| Sleep Study Consultation | $390 | $312 | $78 |
| Allergy Testing | $277 | $222 | $55 |
| Annual Wellness Visit | $264 | $264 | $0 |
| Shingles Vaccination | $243 | $243 | $0 |
| Psychiatry Visit | $231 | $185 | $46 |
| Mammogram (Screening) | $197 | $197 | $0 |
| Office Visit (New Patient) | $180 | $144 | $36 |
| Wound Care Visit | $179 | $143 | $36 |
| EKG (Electrocardiogram) | $179 | $143 | $36 |
| Physical Therapy Session | $177 | $142 | $35 |
| Vision Exam (Diabetic) | $172 | $137 | $34 |
| Bone Density Test (DEXA Scan) | $163 | $130 | $33 |
| Office Visit (Established Patient) | $159 | $128 | $32 |
| Mental Health Counseling | $159 | $127 | $32 |
| Occupational Therapy Session | $159 | $127 | $32 |
Laboratory
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| Blood Type and Crossmatch | $60 | $48 | $12 |
| Blood Culture | $59 | $47 | $12 |
| BNP (Heart Failure Marker) | $53 | $42 | $11 |
| Thyroid Panel (TSH) | $47 | $38 | $9 |
| Lipid Panel | $42 | $34 | $8 |
| Glucose Tolerance Test | $42 | $33 | $8 |
| Vitamin D Level | $40 | $32 | $8 |
| Iron Studies (Ferritin) | $39 | $31 | $8 |
| Comprehensive Metabolic Panel | $38 | $31 | $8 |
| PSA (Prostate-Specific Antigen) | $38 | $30 | $8 |
| Hemoglobin A1C | $37 | $30 | $7 |
| Pap Smear Lab Processing | $35 | $28 | $7 |
| B12 Level | $34 | $28 | $7 |
| Troponin Level | $33 | $26 | $7 |
| Complete Blood Count (CBC) | $33 | $26 | $7 |
Compare New York With Other States
Frequently Asked Questions
How much does Medicare spend per person in New York?
In 2026, the average Medicare spending per beneficiary in New York is $12,273.
How many people are enrolled in Medicare in New York?
New York has approximately 5,097,885 Medicare beneficiaries.
Did New York expand Medicaid?
Yes, New York expanded Medicaid under the Affordable Care Act.
What is the uninsured rate in New York?
The uninsured rate in New York is 5.6%.
What is the average Medigap premium in New York?
The average Medigap (Medicare Supplement) premium in New York is $267 per month.