Medigap in New York works differently — in your favour
In most states a Medicare Supplement can turn you down or charge you more once your first six months are over. Not in New York. Here's what that means, how the plans compare, and when a Supplement is the better answer.
A Medigap policy pays what Original Medicare leaves to you, works with any doctor who accepts Medicare, and has no network. New York is unusual: any Medicare beneficiary can buy any Medigap plan at any time with no health questions, and premiums are community rated, the same for everyone regardless of age. Most New Yorkers choose Plan G or Plan N.
What a Medicare Supplement does
Original Medicare pays most of the bill and leaves the rest to you: the Part A hospital deductible, the Part B deductible and 20% coinsurance, and — because Original Medicare has no out-of-pocket cap — potentially a great deal more in a bad year. A Medicare Supplement, or Medigap policy, is private insurance that pays those leftover amounts.
The plans are standardised by letter. A Plan G from one carrier covers exactly what a Plan G from another carrier covers; the only differences are premium and service. You keep Original Medicare and see any provider in the country who accepts Medicare. The Supplement adds no network, referral or prior-authorization rules of its own — Original Medicare's own coverage rules still apply.
Why New York is different
Three rules set New York apart from most of the country:
- Guaranteed issue, all year. Insurers must accept any Medicare beneficiary who applies, whenever they apply. There is no medical underwriting and no "open enrollment window" that closes on you.
- Community rating. Everyone on a plan pays the same premium regardless of age or health. An 82-year-old and a 65-year-old on the same Plan G with the same carrier pay the same amount.
- Continuous coverage on switching. You can move between carriers or plan letters any month without a health questionnaire, and a Medigap insurer will accept you when you return from Medicare Advantage to Original Medicare — though leaving the Advantage plan itself still has to happen in an enrollment period (AEP, the January–March Advantage open enrollment, or a Special Enrollment Period). One caveat: a waiting period of up to six months for pre-existing conditions can apply; prior creditable coverage reduces or removes it depending on how long and how continuous it was.
The practical consequence: in New York, a Medigap decision is never final. That changes the advice. Elsewhere, people are told to "buy Medigap at 65 or risk never qualifying." Here, you can start with Medicare Advantage while you're healthy and move to a Supplement later, during an enrollment period, if you want to — or the reverse.
Community rating cuts both ways
Because premiums can't be lower for younger, healthier people, New York Medigap premiums at 65 are higher than in states that rate by age. The trade is predictability: no age-based increases waiting for you at 75 or 80.
The plans people actually buy
| Plan | What you still pay | Who it suits |
|---|---|---|
| Plan G | The Part B deductible once a year. Nothing else for Medicare-covered care. | The default choice for most people new to Medicare who want near-zero bills. |
| Plan N | The Part B deductible, up to a small copay at office visits and at the ER, and any "excess charges" from doctors who don't accept Medicare's rate (New York caps these at 5% above the Medicare rate for most services). | People who want a meaningfully lower premium and don't mind small copays. |
| High-deductible G | Medicare still pays its share; you pay the Medicare cost-sharing until you've met the plan's yearly deductible, then the plan pays. | People comfortable self-insuring the first couple of thousand dollars for a much lower premium. |
| Plan F | Nothing. | Only available if you were eligible for Medicare before 2020. Usually not worth switching into now. |
| Plans A, B, K, L | Varies — less coverage than G or N. | Niche situations; I'll tell you if one applies. |
Medigap or Medicare Advantage?
This is the real question, and the answer is different for different households. Roughly:
- Choose Medigap if you want to see any doctor without checking a network, you have (or expect) an ongoing condition with regular specialist care, you travel or split the year between states, or you'd rather pay a known monthly amount than deal with bills and approvals.
- Choose Medicare Advantage if your doctors are in one local system, you're healthy and budget-focused, and you value bundled drug, dental and vision coverage more than provider freedom.
I'll show you the total yearly cost of each path for your actual situation — premium plus expected out-of-pocket — rather than the premium alone. More on Medicare Advantage.
Getting quotes
Because plans are standardised, shopping Medigap is mostly about premium and the carrier's rate-increase history. I compare the carriers I'm appointed with in your ZIP code and show you the same plan letter side by side. If you already have a Supplement, a quick re-quote every year or two is worth doing — you can switch any month. Guides: what to do when your premium goes up, how to switch, Plan G vs Plan N, and moving to New York with an existing policy.
You'll also need a Part D plan for prescriptions; I compare those at the same time. And if money is tight, check whether you qualify for help before deciding anything.
- Protections for Medicare beneficiaries residing in New York (NY DFS) — community rating, year-round acceptance
- Compare Medigap plan benefits (medicare.gov)
- NY Public Health Law §19 — reasonable charges for Medicare beneficiaries — 5% excess-charge cap
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.
Common questions
Short answers to what people ask before they call.
Can I be turned down for a Medigap plan in New York?
No. New York requires Medigap insurers to accept any Medicare beneficiary who applies, at any time of year, regardless of health history. There's no six-month window to worry about and no medical underwriting.
Does my premium go up as I get older?
New York uses community rating, so insurers charge the same premium to everyone on a given plan regardless of age. Premiums can still rise over time for everyone on the plan, but you won't be singled out for turning 75 or for a diagnosis.
Which Medigap plan is most popular?
Plan G is the most common choice for people new to Medicare — it covers everything except the Part B deductible. Plan N is a lower-premium alternative that adds small copays for office and ER visits. Plan F is only available to people who were eligible for Medicare before January 1, 2020.
Does a Medigap plan cover prescriptions?
No. You pair it with a standalone Part D plan. The two together are the classic alternative to Medicare Advantage.
Can I switch from one Medigap plan to another?
Yes — in New York you can switch companies or plan letters any month, again with no health questions. It's worth a quote comparison every year or two, because premiums for the same plan letter vary between carriers.
Let's talk it through
A phone call or a message is all it takes. The first conversation is just a conversation.