Medicare in New York: 2025 Guide
New York is home to approximately 3.8 million Medicare beneficiaries, with Medicare Advantage penetration around 55% — highest in New York City and surrounding metro counties. New York stands apart from nearly every other state in the country for two significant reasons: it requires community rating for Medigap (Medicare supplement) policies, and it operates the EPIC program, one of the most generous state pharmaceutical assistance programs in the nation. These state-specific rules can substantially affect the cost and value of coverage options for New York Medicare beneficiaries.
- Medicare enrollees: ~3.8 million
- Medicare Advantage penetration: ~55%
- Average MA plans available: 50+ per county in New York City metro area
- State SHIP program: NY HIICAP (Health Insurance Information, Counseling and Assistance Program)
- SHIP phone: 1-800-701-0501
Medicare Advantage Plans in New York
The New York City metropolitan area — including the five boroughs, Long Island, and Westchester County — offers one of the most competitive Medicare Advantage markets in the country, with 50 or more plan options available during Annual Open Enrollment. Major carriers operating in New York include UnitedHealthcare, Humana, Aetna, EmblemHealth, MetroPlus, VNS Health Plans, and Fidelis Care (a Centene subsidiary). Many plans in downstate New York carry $0 monthly premiums and offer extra benefits including dental, vision, and hearing coverage.
Upstate New York presents a different picture. In counties outside the major metropolitan areas — particularly rural areas in the Southern Tier, North Country, and Western New York — plan options are more limited, sometimes fewer than 15–20 choices per county. In these areas, the cost advantages of Medigap community rating (see below) make Original Medicare plus a supplement plan particularly attractive compared to Medicare Advantage.
New York's large Medicaid program, known as Medicaid Managed Care, serves a significant dual-eligible population. Dual Eligible Special Needs Plans (D-SNPs) are widely available in downstate New York and provide coordinated Medicare and Medicaid benefits for eligible beneficiaries. The Fully Integrated Duals Advantage (FIDA) program was a previous New York initiative to coordinate these benefits; New York continues to work on improving care integration for dual eligibles through managed long-term care plans and other mechanisms.
Medicare Savings Programs in New York
New York administers Medicare Savings Programs through the New York State Department of Health, with eligibility processed through local Departments of Social Services. New York uses the standard federal income thresholds for the core MSP programs: QMB at or below 100% of the federal poverty level, SLMB between 100–120% FPL, and QI between 120–135% FPL. However, New York's expanded Medicaid program covers many individuals who fall above MSP thresholds but still have limited incomes, providing additional protection beyond what the narrowly defined federal savings programs offer.
New York has also been proactive in enrolling eligible beneficiaries in Medicare Savings Programs. The state participates in data-sharing initiatives that can automatically enroll some eligible individuals, and county DSS offices actively screen Medicaid applicants for MSP eligibility. Beneficiaries enrolled in QMB have particular protections: Medicare providers cannot legally bill QMB enrollees for Medicare cost-sharing (deductibles, copays, and coinsurance), and if you are billed, you have the right to dispute those charges.
To apply for Medicare Savings Programs in New York, contact your local county Department of Social Services, call the NY State Health Department, or apply through the NY State of Health marketplace. HIICAP counselors (1-800-701-0501) can also help screen for eligibility and assist with applications.
State Pharmaceutical Assistance Programs
New York operates EPIC — the Elderly Pharmaceutical Insurance Coverage program — one of the most comprehensive State Pharmaceutical Assistance Programs in the country. EPIC is administered by the New York State Office for the Aging and is designed to help Medicare-eligible New Yorkers age 65 and older with prescription drug costs beyond what Part D covers.
EPIC has two tiers based on income. For individuals with annual income up to $20,000 (or couples up to $26,000), EPIC operates as a fee program with annual enrollment fees based on income, then covers most drug costs after the Part D deductible is met. For individuals with income between $20,001 and $75,000 (or couples up to $100,000), EPIC provides a deductible-based benefit that kicks in after a set annual deductible. EPIC coordinates with Medicare Part D, functioning as secondary coverage and helping to fill gaps in Part D coverage. Importantly, EPIC-eligible individuals are also likely eligible for the federal Extra Help program, which EPIC enrollment may facilitate. To apply for EPIC, call 1-800-332-3742 or visit the Office for the Aging website. HIICAP counselors can also assist with EPIC enrollment.
Finding Medicare Help in New York
NY HIICAP — the Health Insurance Information, Counseling and Assistance Program — is New York's SHIP, providing free and unbiased Medicare counseling statewide. HIICAP is administered by the New York State Office for the Aging and operates through a network of local Area Agencies on Aging and community organizations across all 62 New York counties. HIICAP counselors can help with plan comparisons, enrollment questions, EPIC applications, Medicare Savings Program applications, billing disputes, and appeals.
To reach HIICAP statewide, call 1-800-701-0501. New York City also has its own robust Medicare resources through NYC Aging (formerly the Department for the Aging), which operates local HIICAP sites throughout the five boroughs. Given New York's linguistic diversity, many HIICAP offices provide services in languages beyond English, including Spanish, Mandarin, Cantonese, Korean, and others, particularly in NYC.
Frequently Asked Questions: Medicare in New York
Plan availability varies significantly across New York's 62 counties. In New York City — especially Manhattan, Brooklyn, Queens, the Bronx, and Staten Island — and in Nassau and Westchester counties, beneficiaries typically have access to 50 or more Medicare Advantage plans during Annual Open Enrollment. The Buffalo and Rochester metro areas generally offer 20–35 plans. Upstate rural counties, including those in the Adirondacks, Southern Tier, and North Country, may have only 10–20 plan options. New York's community-rating rule for Medigap (see below) makes Original Medicare plus a supplement plan a particularly cost-effective alternative worth comparing against MA options, especially in upstate counties with fewer MA choices.
Yes — New York's EPIC (Elderly Pharmaceutical Insurance Coverage) program is one of the best state pharmaceutical assistance programs in the country. EPIC is available to New Yorkers age 65 and older with annual income up to $75,000 (individual) or $100,000 (couple). EPIC works alongside Medicare Part D as secondary coverage, helping to pay drug costs that Part D leaves uncovered. There are two tiers: a fee program for lower-income enrollees and a deductible program for higher-income enrollees. To apply, call 1-800-332-3742 or contact a HIICAP counselor at 1-800-701-0501 who can help you enroll in both EPIC and federal Extra Help if you qualify.
New York is one of a very small number of states (along with Connecticut and Massachusetts) that requires community rating for Medigap (Medicare Supplement) insurance. Community rating means that insurers must charge all enrollees the same premium for a given Medigap plan, regardless of age. In most states, Medigap premiums rise significantly as you age — a 75-year-old might pay two to three times what a 65-year-old pays for the same plan. In New York, that same 75-year-old pays the same rate as a 65-year-old (from the same insurer for the same plan). This makes Medigap relatively less expensive for older New Yorkers compared to other states, but somewhat more expensive for newly-eligible 65-year-olds. New York also has guaranteed issue rights for Medigap — insurers cannot deny coverage or charge more based on health conditions — making Medigap accessible even if you have pre-existing conditions. HIICAP counselors can help you compare the value of Medigap versus Medicare Advantage given these unique New York rules.
Explore Your New York Medicare Options
Compare costs, coverage types, and how to maximize your benefits as a New York Medicare beneficiary.