Medicare annual enrollment runs October 15 to December 7, and New York has a few extra pieces worth checking before you decide: EPIC, the state’s Medicare Savings Program, and its own Medigap rules. During these weeks you can join, switch, or drop a Medicare Advantage plan or a Medicare drug plan, or move between Original Medicare and Medicare Advantage. The plan must get your request by December 7 for coverage that starts January 1. This checklist works the same in Manhattan, Brooklyn, the Bronx, Queens, Staten Island, Long Island, Westchester, Albany, Syracuse, Rochester, Buffalo, or the North Country.
This article is educational. Instant Health Help is a licensed health insurance agency, and our agent, Lobsang Rivas, is licensed in New York and certified as a broker with NY State of Health. We are not Medicare, CMS, NY State of Health, the State of New York, or an insurance company, and we do not quote prices or name plans here. Check official dates on Medicare.gov.
The short answer
- Read your plan’s Annual Notice of Change and confirm your doctors, hospital, pharmacy, and drugs for next year.
- If you have EPIC or retiree coverage, check how any change affects it before you switch.
- If money is tight, look at New York’s Medicare Savings Program, which has no resource test.
Step 1: Read your Annual Notice of Change
Your plan mails it each fall. Look for changes to the provider network, the drug list, and rules such as referrals or prior authorization. Then compare in Medicare.gov Plan Finder if anything affects you.
Step 2: Check the network where you actually get care
Medicare.gov says you must live in a plan’s service area to join it, so the plans you can pick in Brooklyn may differ from Suffolk County, Monroe County, or Erie County. Medicare.gov also says to ask your doctors and pharmacies whether they’re in network. A few tips:
- Ask about the exact plan name and about next year, not this year.
- Check the hospital you would use, plus any specialist you see a few times a year.
- Upstate and see a specialist in the city? Or spend winters in Florida? Ask whether the plan covers care where you will actually be. Medicare.gov says you may need to use network doctors for non-emergency care in a Medicare Advantage plan.
Step 3: Retiree or union coverage
Many New Yorkers have retiree coverage from a public or private employer or a union. Medicare.gov says that if you have other health or drug coverage, talk to your benefits administrator or other insurance provider before you join a plan or make any changes. Ask before you sign anything.
Step 4: EPIC and your drug plan
The New York State Department of Health says EPIC (Elderly Pharmaceutical Insurance Coverage) is a state program that helps income-eligible seniors 65 and older with their out-of-pocket Medicare Part D costs. You can apply any time of the year, and you must be enrolled in, or eligible for, a Part D drug plan to get EPIC. EPIC works as secondary coverage after your Part D plan. If you have EPIC, check with EPIC before you change drug coverage. See the EPIC page.
Step 5: New York’s Medicare Savings Program
The Department of Health says New York’s Medicare Savings Program helps people with limited income pay Medicare premiums, and there is no resource test, so people whose savings are too high for Medicaid may still qualify. There are two levels:
- Qualified Medicare Beneficiary (QMB) pays the Part B premium, deductibles, and coinsurance, plus the Part A premium for people who don’t have enough work history to get Part A without a premium.
- Qualifying Individual (QI) pays the Part B premium.
When you enroll, you also get Extra Help with Part D costs automatically. To apply, send the state’s application (form DOH-4328) to your local department of social services, or to the Human Resources Administration if you live in New York City. See the Medicare Savings Program page.
Step 6: Know New York’s Medigap rules
Thinking about leaving Medicare Advantage for Original Medicare plus a Medigap policy? New York’s rules are different from most states. Read our guide to Medigap guaranteed issue in New York before you decide, and remember that Medigap policies sold today don’t include drug coverage, so most people add a separate Medicare drug plan.
Missed the date or something changed?
- Medicare Advantage open enrollment, January 1 to March 31. If you are already in a Medicare Advantage plan, you can switch to another one or go back to Original Medicare and join a drug plan.
- Moving. If you move out of your plan’s service area, Medicare.gov says you get a chance to switch.
- Medicaid or Extra Help. Medicare.gov says you can change your drug coverage once per calendar month, starting the first day of the next month.
See Medicare’s Special Enrollment Periods page.
Where to get unbiased help in New York
The New York State Office for the Aging says HIICAP counselors in local offices for the aging across the state answer questions about Medicare, Medicare Advantage, drug coverage, Medigap, and other insurance. Call the HIICAP helpline at 1-800-701-0501 and you will be routed to your county’s program, or see the HIICAP page.
If you live in Connecticut, Pennsylvania, Vermont, or Massachusetts rather than New York, our agent is not licensed there, so use Medicare.gov or that state’s SHIP counselors through SHIP’s national locator. Our agent is also licensed in New Jersey.
Watch for scams
Medicare.gov says Medicare will never call you to sell you anything or visit you at your home, and it warns against joining a plan over the phone unless you called and asked for help. If someone pressures you, hang up. See Medicare.gov’s fraud page.
Someone in your house under 65?
If a spouse or adult child needs their own plan, New Yorkers apply through NY State of Health. Our agent is certified as a broker with NY State of Health, so we can go through the application with you, compare plans, and help you enroll, at no extra cost to you for our help. We are not NY State of Health, and NY State of Health decides what you qualify for. See our New York open enrollment guide.
How we help
We are licensed in New York and can help you compare Medicare Advantage plans, Medigap policies, and drug plans, and enroll if you decide to. We are not Medicare or the government. We help by phone and online, in English or Spanish. Learn more on our New York health insurance help page. We check your doctors, hospitals, prescriptions, EPIC, and ZIP code, explain the options in plain English, and leave the decision to you. If you are helping a parent, you are welcome on the call too.
Want a second set of eyes before December 7?
Have your Medicare card, your Annual Notice of Change, any EPIC or retiree plan letters, your doctor list, and your drug list ready, and we can walk through it together.
Call (321) 315-0054 | agent@inshh.com
We do not offer every plan available in your area. Currently we represent 10 organizations which offer 489 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, is available 24 hours a day, 7 days a week, except some federal holidays. Instant Health Help is not connected with or endorsed by the U.S. government or the federal Medicare program.
Featured photo: Letchworth State Park in autumn by Daniel Christensen, public domain, cropped with text added.
