If you're turning 65 in New York or helping a parent sort out Medicare, you're facing four parts, hundreds of plan choices, and costs that reset every January. The standard Part B premium for 2026 is $202.90 a month, the Part D donut hole is gone for good, and New York gives you a Medigap protection most states don't: you can buy or switch a supplement plan any month of the year, with no health screening.
This guide walks through every piece of Medicare as it works for New Yorkers in 2026, what it costs, the options unique to this state, and how to get help paying for it.
In This Guide
- Key Takeaways
- Original Medicare: Parts A and B
- Medicare Advantage in New York (Part C)
- Medicare Part D: Prescription Drugs
- Medigap in New York: Buy or Switch Any Month
- Help Paying for Medicare in New York
- If You Have Both Medicare and Medicaid
- Medicare Enrollment Periods
- Free Medicare Help: New York HIICAP
- Frequently Asked Questions
About these numbers: The premiums and deductibles below come from CMS for calendar year 2026, effective January 1. Medicare costs change every year. For the most current figures, contact Medicare at 1-800-633-4227 (1-800-MEDICARE) or New York HIICAP at 1-800-701-0501.
Original Medicare: Parts A and B
Original Medicare is run directly by the federal government, and it comes in two parts.
Part A (Hospital Insurance)
Part A covers inpatient hospital stays, limited skilled nursing facility care, hospice, and some home health care.
| Cost | Amount |
|---|---|
| Monthly premium | $0 for most people (40+ quarters of work history) |
| Hospital deductible | $1,736 per benefit period |
| Hospital coinsurance, days 61-90 | $434 per day |
| Lifetime reserve days | $868 per day |
| SNF coinsurance, days 21-100 | $217 per day |
The hospital deductible went up $60 from 2025. A benefit period starts the day you're admitted and ends 60 days after you leave. Get readmitted after that, and the deductible applies again.
Part B (Medical Insurance)
Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and mental health care. It doesn't cover routine dental, vision, or hearing.
- Monthly premium: $202.90 (higher if your income is above $109,000 single or $218,000 married, under the income-related adjustment)
- Annual deductible: $283
- After the deductible: you pay 20% of the Medicare-approved amount for most services
Part B is technically optional, but nearly everyone signs up. Delay past your enrollment window without other creditable coverage and you'll owe a late penalty of 10% for every 12 months you could have had it, for as long as you keep Part B.
Medicare Advantage in New York (Part C)
Medicare Advantage plans are an alternative to Original Medicare, sold by private insurers. They cover everything Parts A and B do, and most bundle in Part D drug coverage along with extras like dental, vision, and hearing.
For 2026, the average Medicare beneficiary nationally can choose from about 32 Medicare Advantage plans with drug coverage. New York is a crowded market: roughly 218 Medicare Advantage plans are offered across the state from about 27 companies, and every Medicare-eligible New Yorker has access to at least one plan with no monthly premium beyond Part B. The exact lineup depends heavily on your county, so a downstate resident in Brooklyn or Queens sees a very different set of plans than someone in the North Country or the Southern Tier.
How These Plans Work
- You keep paying your Part B premium ($202.90) on top of any plan premium, though many plans charge $0 extra.
- Plans run on networks (HMO, PPO, or HMO-POS). Confirm your doctors and hospitals are in-network before you enroll.
- Every plan caps your annual out-of-pocket spending. Original Medicare has no such cap.
- Extras vary widely. Compare the dental, vision, hearing, and transportation benefits, not just the premium.
Use the Medicare Plan Finder at medicare.gov to compare plans by ZIP code. Enter your doctors and prescriptions and it shows which plans cover them and your estimated cost. Some New York plans were discontinued for 2026, so if your current plan is leaving your area you'll get a Special Enrollment Period to pick a new one, and most affected enrollees have other options to move to.
Medicare Part D: Prescription Drugs
Part D covers outpatient prescription drugs. You can get it as a standalone plan paired with Original Medicare, or built into a Medicare Advantage plan.
The Inflation Reduction Act eliminated the old coverage gap, the donut hole, so that higher-cost middle stage is gone. Part D now moves through three phases:
- Deductible: you pay full price until you meet your plan's deductible (up to $615 in 2026).
- Initial coverage: you pay copays or coinsurance while your plan and drug makers cover the rest.
- Catastrophic: once your out-of-pocket spending reaches $2,100, you pay $0 for covered drugs the rest of the year.
That $2,100 cap is the number that matters most in Part D. It was $2,000 in 2025 and rises with inflation. The base premium is $38.99 a month, though actual plan premiums vary, and increases are capped at 6% a year through 2029. People who qualify for Extra Help often pay much less, sometimes nothing.
Not sure which Part D plan fits your prescriptions? Chat with Brevy's care navigator at brevy.com.
Medigap in New York: Buy or Switch Any Month
Medigap policies are sold by private insurers to fill the gaps in Original Medicare: the deductibles, coinsurance, and copays. They work only with Original Medicare, never with Medicare Advantage.
New York offers the federally standardized plans, labeled A, B, C, D, F, G, K, L, M, and N. Plans C and F are closed to anyone who became Medicare-eligible on or after January 1, 2020. Plan G is the popular choice for people newly eligible: it covers the Part A deductible, Part A and Part B coinsurance, and skilled nursing coinsurance, leaving only the $283 Part B deductible on you.
New York's Year-Round Rule
Here's where New York stands apart from most of the country. Under state law, any insurer that sells Medigap must accept your application at any time throughout the year, and it cannot deny you a policy or raise your premium because of your health status, claims history, medical condition, or whether you're already getting care. That's the word from the New York Department of Financial Services, which regulates these plans.
In most states, your one clean shot at a Medigap plan is the federal Medigap Open Enrollment Period, the six months that start when you're 65 and enrolled in Part B. Miss it and insurers can screen your health and turn you down. New York throws that window open all year. You can pick up a plan late, switch carriers, or move to a different plan letter any month, no health questions asked.
New York also uses community rating, which means an insurer charges every buyer of a given plan the same premium regardless of age, gender, or health. A 78-year-old pays the same rate as a 66-year-old for the same Plan G from the same company. That protection comes at a price: New York Medigap premiums tend to run higher than in states that let insurers charge the young and healthy less. Premiums still vary from one carrier to the next, so it pays to compare.
Medigap or Medicare Advantage?
You can't hold both. Choose Medigap and you stay on Original Medicare with the freedom to see any provider who takes Medicare nationwide, at a higher monthly premium. Choose Medicare Advantage and you trade some of that freedom for a network and a lower upfront cost. New York's year-round rule takes the sting out of choosing Medigap, since you're never locked into one carrier or one plan for life.
Help Paying for Medicare in New York
If you're on a fixed income, two programs can cut your Medicare costs sharply, and New York's rules are unusually generous on one of them.
Medicare Savings Programs
New York runs its Medicare Savings Programs through the state Medicaid program. They pay some or all of your Medicare premiums and cost-sharing based on income.
- QMB pays your Part A premium (if you owe one), your Part B premium, and your Medicare deductibles, coinsurance, and copays. It's the most valuable tier, one of the most valuable forms of help for many people.
- SLMB and QI pay your Part B premium, which alone saves you $202.90 a month.
Two features make New York stand out. First, the state set no asset test for these programs, so your savings and other resources don't count against you, only your income does. Most states still impose a resource limit. Second, New York's income limits sit well above the federal floor, so the cutoff is higher here than in much of the country. The exact 2026 limits are tied to the federal poverty level and adjust each year, so confirm the current figures with the New York State Department of Health or a HIICAP counselor before you rule yourself in or out.
Extra Help for Part D
Extra Help, also called the Low-Income Subsidy, pays Part D premiums, deductibles, and copays for people with limited income and resources.
- Resource limits: $16,590 for an individual, $33,100 for a married couple
- If you qualify for QMB, SLMB, or QI, you're automatically enrolled in Extra Help
Apply through Social Security at ssa.gov or call 1-800-772-1213.
If You Have Both Medicare and Medicaid
Many people who have Medicare also qualify for Medicaid, and New York has built specific plans to coordinate the two for people who need long-term care. The main integrated option is a Medicaid Advantage Plus (MAP) plan, which pairs a Medicare Advantage Dual Eligible Special Needs Plan with a Medicaid Managed Long-Term Care (MLTC) plan from the same company. One organization then runs your doctors, drugs, hospital care, and long-term services with a single set of member materials. To join a MAP plan you also enroll in that company's matching Medicare D-SNP, and since January 2025 the two have to share the same parent organization.
If your needs are more intensive, the PACE program is another fully integrated option for nursing-home-eligible adults 55 and older who can still be served safely at home. For the full picture, see our guides to Medicaid Advantage Plus in New York and Managed Long-Term Care.
Medicare Enrollment Periods
Miss a deadline and you can face coverage gaps or permanent penalties. The key dates:
| Period | Dates | What you can do |
|---|---|---|
| Initial Enrollment | 7 months around your 65th birthday | Sign up for Parts A, B, and D; pick MA or Medigap |
| Annual Open Enrollment | Oct 15 - Dec 7 | Switch MA plans, move between MA and Original Medicare, change Part D |
| MA Open Enrollment | Jan 1 - Mar 31 | Switch MA plans or drop MA for Original Medicare (if already in MA) |
| General Enrollment | Jan 1 - Mar 31 | Sign up for Part B if you missed your initial window (coverage starts the month after you enroll) |
| Medigap (most states) | 6 months from age 65 + Part B | Buy any Medigap plan at the standard rate, no health screening |
Changes you make during Annual Open Enrollment take effect the following January 1. That's when most people review their plan and switch. Remember that New York's Medigap rule overrides that last row: here you can buy or switch a supplement plan any month, not just in the six-month federal window.
Free Medicare Help: New York HIICAP
You don't have to figure this out by yourself, and you don't have to pay a broker to help. New York's Health Insurance Information, Counseling and Assistance Program, or HIICAP, gives free, unbiased Medicare counseling. It's run by the New York State Office for the Aging and delivered locally through county Offices for the Aging, with more than 700 trained counselors across the state.
A HIICAP counselor can help you:
- Understand your Medicare options and what each part covers
- Compare Medicare Advantage, Part D, and Medigap plans side by side
- Apply for Medicare Savings Programs and Extra Help
- Sort out billing problems, denials, and appeals
- Work out how Medicare fits with Medicaid if you have both
Call 1-800-701-0501, say your county, and you'll be routed to your local HIICAP office.
Frequently Asked Questions
Most people pay $0 for Part A. The standard Part B premium is $202.90 a month with a $283 annual deductible. Part D premiums vary by plan (the base is $38.99), and many Medicare Advantage plans charge no extra premium. Your total depends on the plan you pick and the care you use.
Yes. New York requires Medigap insurers to accept your application any month of the year and bars them from charging more or turning you down based on your health. Most states only guarantee that during your first six months on Medicare, so the freedom to switch year-round is a real advantage of buying Medigap in New York.
Apply for a Medicare Savings Program through New York's Medicaid program, and apply for Extra Help with Part D through Social Security at 1-800-772-1213. New York has no asset test for its Medicare Savings Programs and higher-than-federal income limits, so it's worth checking even if you have some savings. A HIICAP counselor (1-800-701-0501) can walk you through both applications for free.
If you need long-term care, you can enroll in a Medicaid Advantage Plus plan that coordinates your Medicare and Medicaid benefits through one organization. Medicaid also keeps paying for costs Medicare doesn't, like long-term care and many in-home services. PACE is another fully integrated option if you're nursing-home-eligible but want to stay at home.
Learn More
- Medicaid Advantage Plus in New York
- Managed Long-Term Care in New York
- PACE in New York
- New York Medicaid: Programs and Coverage
- Caregiver Support in New York
Find personalized help comparing your Medicare options in New York at brevy.com.
The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.