Medicare Plans in New York: Coverage and Costs (2026)

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 federal law doesn't: you can buy or switch a supplement plan any month of the year, with no health screening.1,2,3

In This Guide

• Key Takeaways
• Original Medicare: Parts A and B
• Medicare Advantage Plans 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 Help with Medicare Plans in New York: HIICAP
• Frequently Asked Questions

About these numbers: The premiums and deductibles below come from CMS for calendar year 2026, effective January 1.1 Medicare costs change every year, and CMS posts each year's figures at medicare.gov/basics/costs. To reach a person about your own coverage, call 1-800-MEDICARE (1-800-633-4227), staffed 24 hours a day, 7 days a week, except some federal holidays; TTY users call 1-877-486-2048.6 For free one-on-one help in New York, call HIICAP at 1-800-701-0501.5

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.7

The hospital deductible went up $60 from 2025.1 A benefit period starts the day you're admitted and ends once you've gone 60 days in a row without inpatient hospital care or skilled care in a nursing facility.1 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.8 It doesn't cover routine dental, vision, or hearing.9

• Monthly premium: $202.90 (higher if your income is above $109,000 single or $218,000 married filing jointly, under the income-related adjustment)1
• 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 qualifying for a Special Enrollment Period or a Medicare Savings Program 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.10

Medicare Advantage Plans in New York (Part C)

Medicare Advantage plans are an alternative to Original Medicare, sold by private insurers. They must cover all the medically necessary services Parts A and B cover, except hospice, which Original Medicare keeps paying for, and most bundle in Part D drug coverage along with extras like dental, vision, and hearing.11

For 2026, CMS lists 218 Medicare Advantage plans available across New York, down from 241 in 2025, and every Medicare-eligible New Yorker has access to at least one plan, including at least one with no monthly premium beyond Part B. The average Advantage plan premium in the state changed from $39.59 a month in 2025 to $40.49 in 2026.12

More than half of New Yorkers on Medicare are now in a Medicare Advantage or other Medicare health plan rather than Original Medicare. As of March 2026, CMS counted 4,040,019 people with Medicare in the state: 2,155,594 were enrolled in Medicare Advantage and other health plans, and 1,884,425 stayed in Original Medicare.12 The balance looks very different depending on where you live. In Monroe County (Rochester), 134,160 of 175,447 beneficiaries were in Medicare Advantage and other health plans; in Suffolk County, out on Long Island, it was 100,057 of 334,561.12

What matters for you is your county's lineup, not the statewide total. KFF's analysis of the CMS landscape files, which counts only plans open to general enrollment and leaves out special-needs, employer, PACE, and cost plans, counts 141 such plans in New York for 2026, and finds that the average New Yorker on Medicare can choose from 32 of them, offered by an average of 10 insurers.12 The plans you can join depend on where you live, because you have to live in a plan's service area to enroll in it.13 The Medicare Plan Finder lets you compare the plans offered in your area side by side.14

How These Plans Work

• You keep paying your Part B premium ($202.90) on top of any plan premium, though some plans have a $0 premium of their own. Some plans go further and help pay all or part of your Part B premium.1,11
• Plans run on networks (HMO, PPO, or HMO-POS). Confirm your doctors and hospitals are in-network before you enroll.
• Every plan caps what you pay out of pocket each year for in-network Part A and Part B services (drug costs don't count toward it). Original Medicare has no yearly out-of-pocket limit unless you have supplemental coverage, like Medigap, Medicaid, or employer, retiree, or union coverage.11,1
• Extras vary widely. Compare the dental, vision, hearing, and transportation benefits, not just the premium.

Some New York plans were discontinued for 2026. If your plan's contract isn't renewed or it leaves your area, you get a Special Enrollment Period to switch to another plan.15 KFF names two insurers whose terminations each affected more than 100,000 enrollees and involved New York. That 100,000 threshold is KFF's own cut, so the pair is not a full list of the insurers that dropped New York plans: Highmark Health terminated plans affecting 148,000 enrollees across four states (Delaware, New York, Pennsylvania, and West Virginia), and Lifetime Healthcare, Inc. terminated plans affecting 106,000 enrollees in New York. KFF reports that all of the Medicare beneficiaries in those two insurers' terminated plans have other Medicare Advantage drug plans available to them in 2026, but it cautions that Advantage networks vary a lot, even between plans sold by the same insurer, so a forced switch can cost you your doctors unless you move to Original Medicare instead.12

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.2 Part D now moves through three phases:

1. Deductible: you pay full price until you meet your plan's deductible (up to $615 in 2026).16
2. Initial coverage: under the standard benefit you pay 25% coinsurance on covered drugs.2
3. Catastrophic: once your out-of-pocket spending reaches $2,100, you owe no cost sharing for covered drugs the rest of the calendar year.2

That $2,100 cap is the number that matters most in Part D.2 It was $2,000 in 2025, and the 2026 figure is the one specified in CMS's CY 2026 Rate Announcement. The national base beneficiary premium is $38.99 a month for 2026, with growth capped at 6% a year through 2029 under the Inflation Reduction Act.17 Actual premiums vary by plan.1 People who qualify for Extra Help often pay much less, sometimes nothing.18

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 with Original Medicare, and a Medigap policy can't pay a Medicare Advantage plan's copays, coinsurance, deductibles, or premiums.11

Insurers in New York sell the federally standardized plans, labeled A, B, C, D, F, G, K, L, M, and N, and every policy with the same letter offers the same basic benefits whichever insurer sells it.19 Plans C and F are closed to people who both turned 65 and got Part A on or after January 1, 2020.19,20 If you had Medicare through a disability or end-stage renal disease before 2020, or were eligible then but haven't enrolled, you may still be able to buy C or F.19,20 Plan G covers everything Plan F does except the annual Part B deductible, so that $283 stays with you.3,1

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.3 The rule covers New Yorkers on Medicare because of a disability or end-stage renal disease, not only those 65 and older, but you must be enrolled in both Part A and Part B to buy a policy.3 Your health can still affect when the policy starts paying: it may make you wait up to six months before covering a pre-existing condition, and the insurer has to shorten that wait by the time you had other creditable coverage without a break of more than 63 days.3 Time on Medicare itself counts only if you apply within six months of being both 65 and enrolled in Part B.3

Under federal law alone, your one clean shot at a Medigap plan is the Medigap Open Enrollment Period, the six months that start when you're 65 and enrolled in Part B, and it doesn't repeat.3 Miss it and, absent a state rule, 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, and your health can't be used to turn you down or charge you more.

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.3 A 78-year-old pays the same rate as a 66-year-old for the same Plan G from the same company in the same part of the state. Premiums still vary by insurer, plan letter, and region, so it pays to compare.3

Medigap or Medicare Advantage?

While you're in a Medicare Advantage plan it's illegal for anyone to sell you a Medigap policy unless you're switching back to Original Medicare.11 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.4

New York has three Medicare Savings Programs: QMB, QI, and QDWI, a narrow one that pays only the Part A premium for some disabled workers under 65 and, unlike the other two, has a resource limit.4

• QMB is the more valuable level. It pays your Part A premium (if you owe one), your Part B premium, and your Medicare deductibles, coinsurance, and copays.4
• QI pays the Part B premium only, which alone saves you $202.90 a month.1 You have to have Part A to qualify, and QI can't be combined with Medicaid.4 The premium is not the whole benefit, though: enrolling in either QMB or QI automatically qualifies you for Part D Extra Help too, described below, with no separate application.4

Two features make New York stand out. First, the state set no asset test on QMB or QI, so your savings and other resources don't count against you, only your income does.4 The federal resource limit is just $9,950 for an individual and $14,910 for a couple, and New York is one of the states that has used its authority to disregard resources and drop the test.4 Second, New York's income limits sit well above the federal floor. For 2026 the New York State Department of Health sets QMB at 138% of the federal poverty level and QI at 186%, and because Medicaid subtracts a $20 income disregard first, the monthly figures to check your gross income against are $1,856 for one person and $2,509 for a couple under QMB, and $2,494 and $3,375 under QI.4 Other deductions can apply on top of that, so income a little above those numbers doesn't automatically rule you out. Apply, or ask a HIICAP counselor, before you decide you don't qualify.

How to Apply for a Medicare Savings Program

Extra Help for Part D

Extra Help, also called the Low-Income Subsidy (LIS), helps pay Part D premiums, deductibles, and copays for people with limited income and resources. Your plan deductible drops to $0, and your premium is covered up to a regional benchmark, so if you pick a pricier plan you pay the difference.18

• Income limit (2026): up to about $1,995 a month for an individual, $2,705 for a married couple, the figures for the 48 contiguous states and DC (Alaska and Hawaii run higher). The limit rises if you support family members who live with you, and some income doesn't count, so apply even if you're a bit over.18
• Resource limits: $18,090 for an individual, $36,100 for a married couple; the lower limits of $16,590 and $33,100 apply only if you tell Social Security none of your resources will go toward funeral or burial expenses. Your home, car, and household goods don't count.18
• If you qualify for QMB or QI, you automatically qualify for Extra Help, with no separate application4

Apply through Social Security at ssa.gov or call SSA at 1-800-772-1213 (TTY 1-800-325-0778).18,21

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.22 One organization then administers your Medicare, Medicaid, long-term care, and drug benefits.22 To join a MAP plan you also have to enroll in that plan's aligned Medicare D-SNP, so both halves of your coverage sit with the same company.22

If your needs are more intensive, the PACE program is another fully integrated option for adults 55 and older who live in a PACE service area, need a nursing home level of care, and can still live safely at home with PACE's help.22 If you have both Medicare and Medicaid but don't need long-term care, New York's IB-Dual program can run your Medicaid and Medicare services through one health plan instead: you stay in your Medicaid managed care plan and join the same company's aligned D-SNP. Not every Medicaid managed care plan offers it, and you don't have to join, but opting out moves you out of your managed care plan into fee-for-service Medicaid.22 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:23

Changes you make during Annual Open Enrollment take effect the following January 1.23 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.3

Free Help with Medicare Plans in 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, provides free, accurate, and objective Medicare counseling.5 The New York State Office for the Aging coordinates HIICAP through its network of 59 area agencies on aging, and more than 700 trained HIICAP counselors work out of local offices for the aging across the state.5

A HIICAP counselor can help you:

• Understand Medicare benefits, options, paperwork, and resources5
• Look at insurance that may help pay costs Medicare alone doesn't, such as Medigap or a Medicare Advantage Plan5
• Review and select a Medicare Part D prescription plan5
• Get information on Medicare Savings Programs, Extra Help, and EPIC5
• Correct billing issues and file complaints and appeals5

Call 1-800-701-0501 and you'll be routed to the HIICAP program in the county where you live.5

Key New York Medicare Contacts

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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.