How to choose a Medicare plan in New York

First, the two routes

Every Medicare plan decision is really one decision followed by a smaller one. The big one is which route: Original Medicare with a Medigap plan and a Part D plan, or a Medicare Advantage plan. The smaller one is which plan within that route. People get stuck because they compare a Medigap plan to an Advantage plan on premium alone — which is like comparing a house to a lease by the monthly payment. The Medicare overview shows the two routes side by side; here I'll take you through the questions that decide between them.

The seven questions, in order

1. Which doctors and hospitals do you need to keep?

Write them down — primary care, every specialist, the hospital you'd choose, and any out-of-area doctor (a Florida cardiologist, a child's pediatrician you still see for advice). Then ask of each: is a network acceptable?

• If the answer is "no, I want any doctor who takes Medicare, anywhere in the country" — that is Original Medicare plus Medigap. Medigap has no network; it pays after Medicare pays, wherever Medicare pays.
• If your doctors are local, you're happy to check they're in-network each year, and you can accept a referral or a prior authorization now and then — Advantage stays on the table.

Don't take a plan's directory at face value; call the office and ask "do you accept this plan for 2027?" Directories lag.

2. What prescriptions do you take?

List every drug, dose and pharmacy. Every Part D plan and every Advantage plan with drug coverage has its own formulary and its own pharmacy pricing, and the same drug list can cost $600 a year on one plan and $2,400 on another in the same county. Since 2025 there is a yearly cap on what you pay for covered Part D drugs — $2,100 in 2026 — so the worst case is bounded, but the difference below the cap is real money. This step is where the Medicare Plan Finder is genuinely good: it prices your exact list.

If you take nothing today, still enroll in some drug coverage when you're first eligible. The late-enrollment penalty is permanent, and the cheapest Part D plans in the Capital Region cost less than the penalty would over time.

3. What can your budget carry in a normal month, and in a bad year?

This is the question people usually start with, and it belongs third. Two numbers:

• The normal month. Part B is $202.90 in 2026 for most people (more if IRMAA applies). On top of that: a Medigap premium — in the Albany region, roughly $269 to $482 a month for Plan N and $305 to $667 for Plan G depending on carrier, per the DFS July 2026 table — plus a Part D premium. Or an Advantage premium, often $0.
• The bad year. With Plan G you'd pay the Part B deductible ($283) and little else. With Plan N, add small office and ER copays. With an Advantage plan, copays and coinsurance accumulate up to the plan's maximum out-of-pocket — up to $9,250 in-network in 2026, $13,900 if you also use out-of-network care on a PPO.

The honest comparison is: Medigap premiums for the year versus Advantage's maximum out-of-pocket. If the premium total is more than you'd comfortably pay for a year with a surgery in it, Advantage may be the better trade; if it isn't, Medigap buys you a predictable year.

4. Where will you be?

Snowbirds, people with grandchildren in another state, people who travel abroad. Original Medicare works in all fifty states identically; Medigap follows it. Advantage plans have service areas, and out-of-area care beyond emergencies is either out-of-network (PPO) or not covered (HMO). For travel outside the U.S., Medigap Plans G and N cover 80% of emergency care after a deductible, up to a lifetime limit; Advantage plans vary, and Original Medicare alone covers almost nothing abroad.

5. How do you expect to use health care over the next few years?

Not a prediction — nobody can make one — but a temperament question. Some people want the fewest possible decisions and bills once they're in the system; that points to Medigap. Some people are healthy, cost-conscious, and don't mind managing a network and a formulary for a lower premium and extras like dental or a gym benefit; that points to Advantage. A chronic condition with a settled team of specialists usually tips toward Medigap, because losing a specialist to a network change mid-treatment is the thing people regret most.

6. What does your county actually offer?

Plans are county-specific. Saratoga, Albany, Schenectady and Rensselaer counties each have their own Advantage menu, and the strongest plan in one is sometimes not sold in the next. Medigap plans are standardized statewide — Plan G is Plan G — but premiums differ by region and carrier. So the last comparison is always at your ZIP code, not in the abstract. My county pages describe what each market looks like.

7. Do you qualify for help?

Before you finalize anything: New York's Medicare Savings Programs pay the Part B premium for singles under about $2,494 a month and couples under about $3,375 (2026, and New York has no asset test); Extra Help lowers drug costs; EPIC lowers them further for New Yorkers under $75,000 / $100,000. Qualifying for any of these changes the math — a $200-a-month premium you don't pay is a very different budget. The help paying for Medicare page walks through them.

Which route fits which situation

How to check your answer

1. Run your drug list through the Medicare Plan Finder for both a Part D plan and the Advantage plans you're considering.
2. Call each doctor's office with the plan name; don't rely on the directory.
3. Read the Summary of Benefits for any Advantage plan — specifically the maximum out-of-pocket, the specialist copay, and which services need prior authorization.
4. For Medigap, compare carriers' rate histories, not just this year's premium; the DFS publishes every carrier's community rate by region.
5. Get a second opinion from HIICAP, New York's free counseling program (1-800-701-0501), or from me. I compare the plans I'm authorized to offer in your county, with no fee; if the right answer is a plan I don't sell, I'll say so.

Every year the plans change — an Advantage plan's Annual Notice of Change arrives by September 30 — so the framework is worth re-running each fall even if the answer stays the same. Ask for a comparison whenever you're ready, or pick a time for a call.

I do not offer every plan available in your area. Any information I provide is limited to the plans I do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your State Health Insurance Assistance Program for information on all of your options. Not connected with or endorsed by the U.S. government, the Social Security Administration or the federal Medicare program.