New York Medicare beneficiaries have access to a range of coverage options, state-specific protections, and free counseling services. This comprehensive New York Medicare guide covers your SHIP office contacts, Medigap plan availability, birthday rule protections, Medicare Savings Program eligibility, Medicare Advantage options, and how to compare plans. Whether you are turning 65, helping a parent navigate Medicare, or re-evaluating your coverage, understanding New York Medicare rules is essential for making informed decisions.
All information in this guide has been verified against official state sources, CMS data, and NAIC reports as of April 2026.
In This New York Medicare Guide:
New York SHIP — Free Medicare Counseling
Every state has a State Health Insurance Assistance Program (SHIP) that provides free, unbiased Medicare counseling. New York’s SHIP program can help you understand your coverage options, compare plans, resolve billing issues, and navigate enrollment periods at no cost.
| SHIP Program | Health Insurance Information, Counseling and Assistance Program (HIICAP) |
| Phone | 1-800-701-0501 |
| Website | https://aging.ny.gov/health-insurance-information-counseling-and-assistance-program-hiicap |
SHIP counselors are trained volunteers and staff who are not affiliated with any insurance company. They do not sell plans. Contact your New York SHIP office before making any major Medicare decisions.
New York Medigap (Medicare Supplement) Plans
Medigap plans in New York help cover out-of-pocket costs not paid by Original Medicare, including the Part A deductible, Part B coinsurance, and skilled nursing facility copays. Medigap plans are standardized by federal law, meaning Plan G from one carrier covers the same benefits as Plan G from another carrier. The difference is premium cost.
Plans available in New York: A, B, C, D, F, G, K, L, M, N (Plans C and F are only available to those who became Medicare-eligible before January 1 2020)
Most popular plan: Plan G is the most popular Medigap plan in New York. Plan G covers all gaps in Original Medicare except the annual Part B deductible ($240 in 2026). Plan N is the most popular lower-premium alternative, with small copays for some doctor visits and ER visits.
Pricing method: New York uses community-rated Medigap pricing. This is the most favorable method for consumers because premiums are the same regardless of age. Your premium will not increase simply because you get older.
The average monthly Plan G premium for a 65-year-old in New York is approximately $354. Plan N averages approximately $300 per month. Actual premiums vary by carrier, age, gender, tobacco use, and zip code. Always compare quotes from at least three carriers.
New York Medigap Switching Rights
New York does not have a Medigap birthday rule. Your primary opportunity to buy or switch Medigap plans without medical underwriting is during your initial Medigap Open Enrollment Period, which lasts 6 months starting when you first enroll in Medicare Part B at age 65 or older.
After your initial OEP closes, you may face medical underwriting if you apply for a new Medigap policy. However, federal law provides guaranteed issue rights in specific situations, such as losing employer coverage or leaving a Medicare Advantage plan during your first year.
New York guaranteed issue protections: New York provides continuous (year-round) guaranteed issue rights for all Medigap plans. Insurers must sell a Medigap policy to any Medicare beneficiary at any time, regardless of age or health status, with no medical underwriting. This far exceeds the federal 6-month OEP. New York also requires Medigap access for under-65 Medicare beneficiaries who qualify due to disability or ESRD.
New York Medicare Advantage (Part C)
Approximately Approximately 3900000 people in New York are enrolled in Medicare. About UNVERIFIED (estimated over 50% based on reports that more than half of NY Medicare beneficiaries choose Medicare Advantage; NY was the only state with greater than 5% MA enrollment growth in 2026) of New York Medicare beneficiaries choose Medicare Advantage plans, with the remainder on Original Medicare with or without Medigap supplement coverage.
Medicare Advantage plans in New York are offered by private insurers as an alternative to Original Medicare. Most MA plans include prescription drug coverage (Part D) and often add dental, vision, and hearing benefits. However, MA plans use provider networks, which can limit your choice of doctors and hospitals.
Key Medicare Advantage considerations in New York:
- Networks matter: HMO plans require you to use in-network providers except in emergencies. PPO plans allow out-of-network care at higher cost.
- $0 premium plans: Many New York MA plans have $0 monthly premiums (you still pay your Part B premium).
- Maximum Out-of-Pocket (MOOP): MA plans cap your annual spending, unlike Original Medicare which has no cap.
- Star ratings: CMS rates MA plans 1-5 stars. Higher-rated plans often have lower costs and better coverage.
Top Medicare Advantage carriers in New York by enrollment:
- Healthfirst
- UnitedHealthcare (AARP)
- Aetna
- Anthem Blue Cross Blue Shield
- Humana
New York Medicare Financial Help Programs
New York offers Medicare Savings Programs (MSPs) that help low-income Medicare beneficiaries pay for premiums, deductibles, and copays. The four programs are:
- QMB (Qualified Medicare Beneficiary): Pays Part A and Part B premiums, deductibles, coinsurance, and copays.
- SLMB (Specified Low-Income Medicare Beneficiary): Pays Part B premiums only.
- QI (Qualifying Individual): Pays Part B premiums (limited funding, first-come first-served).
- QDWI (Qualified Disabled Working Individual): Pays Part A premiums for disabled workers.
New York MSP eligibility: New York expanded QMB to 138% FPL with no asset limits. 2026 monthly income limits — QMB: 1856 individual / 2509 couple (138% FPL); QI: 2494 individual / 3375 couple (186% FPL). SLMB (120% FPL) is effectively subsumed into the expanded QMB threshold. No asset or resource limits apply in New York.
Apply through your local SHIP office or your state Medicaid agency for free help determining eligibility.
Top Medicare Insurance Companies in New York
Top Medigap carriers in New York:
- AARP/UnitedHealthcare
- Anthem Blue Cross Blue Shield
- Mutual of Omaha
- Cigna
- EmblemHealth
When comparing carriers, focus on premium cost (for identical standardized Medigap plans, benefits are the same — only price differs), financial strength ratings from AM Best (A or higher), customer satisfaction ratings, and claims processing speed.
New York Medicare Enrollment Periods
Understanding Medicare enrollment deadlines prevents costly late enrollment penalties:
- Initial Enrollment Period (IEP): 7-month window around your 65th birthday (3 months before, birthday month, 3 months after). Enroll in Parts A and B during this period.
- Medigap Open Enrollment: Continuous/year-round. Unlike most states where the Medigap OEP is limited to 6 months after Part B enrollment, New York allows enrollment or switching at any time with guaranteed issue and no medical underwriting.. During this period, insurance companies cannot deny you Medigap coverage or charge higher premiums based on health conditions.
- Annual Enrollment Period (AEP): October 15 through December 7 each year. Switch between Original Medicare and Medicare Advantage, change MA plans, or add/change Part D drug plans.
- Medicare Advantage Open Enrollment Period (OEP): January 1 through March 31. Switch MA plans or return to Original Medicare (and add a Medigap plan, subject to underwriting).
- Special Enrollment Periods (SEP): Available when you lose employer coverage, move, or qualify for other life events.
Additional New York Medicare protections: Year-round guaranteed issue for all Medigap plans (no limited enrollment window); community-rated Medigap pricing required by state law; insurers must accept all applicants regardless of health status at any time; Medigap access required for under-65 disabled and ESRD Medicare beneficiaries; expanded QMB eligibility to 138% FPL (vs federal minimum of 100%); no asset limits for Medicare Savings Programs; DFS maintains public rate comparison tools at dfs.ny.gov
Compare New York Medicare Plans
Ready to compare Medicare options in New York? Use the official Medicare Plan Finder or contact your local SHIP counselor for free, unbiased help.
Official Sources & Resources
- Medicare.gov: medicare.gov
- New York State Department of Financial Services (DFS): https://www.dfs.ny.gov
- Health Insurance Information, Counseling and Assistance Program (HIICAP): https://aging.ny.gov/health-insurance-information-counseling-and-assistance-program-hiicap
- CMS.gov: cms.gov
- NAIC: naic.org
This New York Medicare guide was last verified against official sources in April 2026. If you notice outdated information, please contact us.