Medicare in New York

New York has a robust Medicare Advantage market, with 2023 plan availability ranging from 28 plans offered in Tompkins County to 59 plans offered in Albany County.² As of March 2023, over 50% of New York’s Medicare beneficiaries were enrolled in Medicare Advantage, while slightly less than 50% were enrolled in Original Medicare.¹ Enrollment in Medicare Advantage plans has been steadily growing over the years,¹¹⁰ and is on track (nationwide) to exceed Original Medicare enrollment within the next few years.¹¹

The Medicare Advantage insurance companies dominating the market in New York are led by UnitedHealth Group, which held 18% of MA market share in 2022. Between late 2019 and early 2022, enrollment in UnitedHealth Group MA plans was virtually unchanged. (See table below).

While Original Medicare does provide fairly comprehensive coverage, it does not cover everything (for example, prescription drugs are not covered) and it doesn’t have a cap on out-of-pocket costs. Under Medicare Part B, that amounts to an unlimited 20% coinsurance. To address the gaps in Original Medicare, most enrollees have some sort of supplemental coverage. Nationwide, over 80% of Original Medicare beneficiaries have supplemental coverage.¹²

For those who have only Medicare Part A and Medicare Part B, Medigap plans (also known as Medicare supplement insurance plans) are designed to pay some or all of the out-of-pocket costs (deductibles and coinsurance) that Original Medicare beneficiaries would otherwise have to pay themselves (in order to have prescription drug coverage, it’s also necessary to buy a Medicare Part D prescription drug plan).

Although Medigap plans are sold by private insurers, the plans are standardized under federal rules.¹³ There are ten different plan designs (differentiated by letters, A through N; not all insurers offer all plans for sale), and the benefits offered by a particular plan (Plan A, Plan G, etc.) are the same regardless of which insurer is selling the plan. So consumers can base their plan selection on premiums and less tangible things like customer service, since the benefits themselves are uniform.

There are 11 insurers licensed to offer Medigap plans in New York.¹⁴ 484,051 people had Medigap plans in New York as of 2022, according to America’s Health Insurance Plans (AHIP) analysis.15

New York has among the strongest Medigap consumer protections in the nation. As long as a person in New York is enrolled in Medicare Part A and Medicare Part B, they can enroll in a Medigap plan at any time, year-round, and premiums do not vary based on the applicant’s age or health status. This is also true for enrollees who are under 65 and eligible for Medicare due to a disability. Premiums do vary from one insurer to another, and from one area to another (2023 premiums are available here; an insurer can only vary the price of a particular Medigap plan based on where enrollees reside).

New York’s rules go far beyond the federal rules, and beyond the rules that most states have imposed on Medigap insurers. (Connecticut is the only other state where Medigap is available year-round, without medical underwriting; several other states offer windows each year when some or all plans are guaranteed-issue). Federal rules do not require an annual open enrollment window for Medigap plans. Instead, federal rules provide only a one-time six-month window when Medigap coverage is guaranteed-issue, starting when the person is at least 65 and enrolled in Medicare Part B. And federal rules don’t guarantee access to Medigap plans at all for people who are under 65 and enrolled in Medicare due to a disability. New York’s rules are much more robust.

Because of the year-round availability, community rating, and lack of medical underwriting, premiums for Medigap enrollees in New York are generally higher than they are in most other states when enrollees are 65.¹⁶ Alaska is a good example of how high Medigap premiums can be for older enrollees in states that allow Medigap insurers to increase premiums over time, as an enrollee ages (referred to as attained-age rating, as opposed to New York’s community rating). Although the rates are higher for newly eligible enrollees, older enrollees pay the same amount as younger enrollees.¹⁷

New York also has fewer Medigap insurers than most high-population states with fewer Medigap regulations. For example, Arizona, which defaults to the federal rules for Medigap plans, had 41 insurers offering policies as of 2023.¹⁸

Although the Affordable Care Act eliminated pre-existing condition exclusions in most of the private health insurance market, those regulations don’t apply to Medigap plans, and New York allows Medigap insurers to conform to federal Medigap regulations for pre-existing conditions. Medigap insurers can impose a pre-existing condition waiting period of up to six months, if an applicant didn’t have at least six months of continuous coverage prior to enrolling. But beyond that, consumers are protected in New York. In most other states, people enrolling after their initial six-month open enrollment window can be denied coverage or charged higher premiums due to pre-existing conditions, and that’s not the case in New York.

Original Medicare doesn’t provide coverage for outpatient prescription drugs. More than 80% of Original Medicare beneficiaries have a supplemental plan,¹², and these plans often include prescription coverage. Medicare enrollees without a supplemental plan can still enroll in a Medicare Part D prescription drug plan. Part D coverage is available through plans called stand-alone Medicare Part D prescription drug plans (PDPs) or as part of a Medicare Advantage plan with integrated Part D prescription drug coverage.

In 2023, insurers in New York are offering 19 stand-alone Medicare Part D prescription drug plans, with premiums starting at $10.90 per month.⁴

As of March 2023, 1,464,538 New Yorkers had stand-alone Medicare Part D prescription drug plans, while another 1,280,489 had Medicare Part D prescription drug coverage integrated with their Medicare Advantage plans.¹

Medicare Part D prescription drug plan enrollment is available during the Medicare Annual Open Enrollment Period each fall (October 15 to December 7), as well as during a person’s initial enrollment period when they’re first eligible for Medicare.

Many Medicare beneficiaries receive financial assistance through Medicaid with the cost of Medicare premiums and services Medicare doesn’t cover – such as long-term care.

Our guide to financial assistance for Medicare enrollees in New York includes overviews of these programs, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.

Need help with your Medicare application in New York, or have questions about Medicare eligibility in New York? These resources provide free assistance and information.

• Contact HIICAP, New York’s Health Insurance Information Counseling and Assistance program.
• Visit the Medicare Rights Center. This website provides helpful information geared to Medicare beneficiaries, caregivers, and professionals.
• Access the New York State Department of Financial Services for helpful information about Medicare.