In New York, a Medigap insurance company has to accept your application any time of year, and it can’t turn you down or charge you more because of your health. Most states only guarantee that during a one-time window when you first get Medicare Part B. That New York rule, plus community rating, changes how and when people here can shop for a Medicare Supplement (Medigap) policy, whether you live in Manhattan, the Bronx, Long Island, Westchester, the Hudson Valley, Albany, Syracuse, Rochester, or Buffalo.
This article is educational. Instant Health Help is a licensed health insurance agency, and our agent, Lobsang Rivas, is licensed in New York. We are not Medicare, CMS, the New York State Department of Financial Services (DFS), or an insurance company, and we do not quote prices or name plans or companies here. Check New York’s rules on the DFS Medicare page.
The short answer
- Year-round acceptance. DFS says New York law and regulation require any insurer writing Medigap insurance to accept a Medicare enrollee’s application at any time throughout the year.
- No health-based denials or rates. DFS says insurers may not deny you a Medigap policy or charge different premium rates because of your health status, claims history, medical condition, or whether you are getting health care services.
- Community rated. Under New York Insurance Law, Medigap must be community rated: everyone covered under the same policy form pays the same rate, without regard to age, sex, health status, tobacco use, or occupation.
- Under 65 counts too. DFS says these protections apply whether you have Medicare because of age or disability, and also to people with End-Stage Renal Disease.
How that compares with the federal rule
Medicare.gov explains that under federal law you get a 6-month Medigap Open Enrollment Period that starts the first month you have Part B and are 65 or older. It is one time only and doesn’t repeat every year. Outside that window, federal law lets companies deny you or charge more based on medical underwriting, unless you have a guaranteed issue right. Medicare.gov adds that you may have more rights under state law. New York is one of those states. See Medicare.gov’s ready to buy Medigap page.
What community rating means for you
Community rating means a company sets one rate for everyone on the same policy form, instead of raising your price because you are older or have a health condition. It does not mean every company charges the same. Rates can still differ by company, by plan letter, and by region of the state, and they can change over time. DFS publishes a comparison of Medigap premiums by region on its Medicare page. We don’t quote prices here.
Plan letters are standardized. Medicare.gov says policies with the same letter offer the same basic benefits no matter which company sells them. DFS notes that not every company offers every plan letter, so check which companies sell the letter you want where you live.
What year-round enrollment doesn’t change
- There may be a waiting period for pre-existing conditions. DFS says Medigap policies may have up to a six month waiting period before pre-existing conditions are covered. Insurers must reduce it by the time you had other creditable coverage, such as job-based coverage, Medicaid, or a Medicare Advantage plan, as long as you had no break in coverage of more than 63 days.
- You need both Part A and Part B, DFS says, to be eligible for Medigap.
- Medigap only works with Original Medicare. Medicare.gov says you can’t have Medigap and a Medicare Advantage plan at the same time, and you can’t use Medigap to pay Medicare Advantage costs.
- Medigap doesn’t include drug coverage. Medicare.gov says Medigap policies sold today don’t include prescription drug coverage, so most people pair Medigap with a separate Medicare drug plan (Part D).
In a Medicare Advantage plan and thinking about Medigap?
New York’s year-round rule lets you apply for Medigap any time, but leaving a Medicare Advantage plan still follows Medicare’s calendar:
- Annual enrollment, October 15 to December 7. You can switch from Medicare Advantage to Original Medicare and join a Medicare drug plan, with changes starting January 1.
- Medicare Advantage open enrollment, January 1 to March 31. If you are already in a Medicare Advantage plan, you can drop it, go back to Original Medicare, and join a separate drug plan.
Line up the Medigap policy and the drug plan so they start the same day your Medicare Advantage coverage ends. Medicare.gov says a company can sell you a Medigap policy while you’re in a Medicare Advantage plan only if you are switching back to Original Medicare. See how Medigap works on Medicare.gov.
Already have Medigap and want to switch?
Because New York insurers must accept applications all year, you can shop for a different policy or company at any time. Medicare.gov’s advice still applies: don’t cancel your current policy until the new one is approved and in place. Medicare.gov says you get 30 days after you get a new Medigap policy to decide whether to keep it, and you pay both premiums for any month you have both. Ask whether a waiting period would apply to the new policy. See changing Medigap policies.
Have EPIC? If you are in EPIC, New York’s senior drug program, DFS suggests contacting EPIC about your options before you change drug coverage.
Spend winters away?
Medicare.gov says Original Medicare lets you use any doctor or hospital that takes Medicare, anywhere in the U.S., and Medigap works alongside it. That flexibility is one reason some New Yorkers who spend part of the year in Florida or elsewhere choose Original Medicare with Medigap. Medicare.gov also says some Medigap policies cover emergency care outside the U.S.
Where to get unbiased help in New York
New York’s Health Insurance Information Counseling and Assistance Program (HIICAP) has trained counselors in local offices for the aging who answer questions about Medicare, Medicare Advantage, drug coverage, and Medigap. Call the HIICAP helpline at 1-800-701-0501 or see the HIICAP page.
Someone in your house under 65?
If a spouse or adult child needs their own plan, New York residents apply through NY State of Health, not HealthCare.gov, and open enrollment begins November 1. 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 or the official NY State of Health enrollment page.
How we help
We are licensed in New York and can help you compare Medicare options, including Medigap and Medicare 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 look at your doctors, prescriptions, current coverage, and where you spend your time, explain the trade-offs in plain English, and leave the decision to you.
Thinking about a change?
Have your Medicare card, your current plan or policy information, 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: Bear Mountain Bridge, Hudson River by Fran Trudeau, CC BY 2.0, cropped with text added.
