New York is the fourth-largest Medicare Advantage market in the country, with about 3.9 million total Medicare beneficiaries and roughly 2.1 million enrolled in MA plans in 2026 (53% penetration). That penetration rate is just below the national average of 54%, driven heavily by New York City, where local carriers like Healthfirst, EmblemHealth, and MetroPlus Health Plan have deep roots in community-based care.
New York's average monthly premium of $40 is notably higher than the $14 national MA average — for how the Medigap vs Medicare Advantage tradeoff plays out in NY, compare both routes. Part of that is the cost of care in New York City metro: medical costs are among the highest in the country, and those costs get priced into premiums. Still, $0-premium MA plans exist in every county statewide in 2026. Upstate areas like Western New York (Buffalo) and Central New York (Syracuse) have robust plan options through Excellus BlueCross BlueShield and Independent Health, which hold 5-star CMS ratings.
New York also has some of the strongest consumer protections in the country for Medicare beneficiaries. The state's Department of Financial Services enforces community-rated Medigap pricing (premiums cannot vary by age or health status), and state law provides continuous Medigap open enrollment. For free, unbiased help comparing plans — including options for those who qualify for both Medicare and Medicaid — New York's HIICAP program (Health Insurance Information, Counseling and Assistance Program) runs 59 county offices staffed by nearly 500 trained counselors available year-round.
This guide covers the 2026 New York Medicare Advantage market: how many plans, which carriers, plan types, county-level variance from NYC to upstate rural areas, and how to enroll. The Annual Election Period runs October 15 to December 7, 2026, with coverage effective January 1, 2027.
2026 Medicare Advantage Market Overview in New York
In 2026, New York has 218 Medicare Advantage plans available, with 2,070,000 beneficiaries enrolled (53% MA penetration). The average monthly premium is $40 and the statewide average Star Rating is 3.9.
Top Medicare Advantage carriers in New York (2026)| Carrier | Plans | Avg Star Rating | Avg Premium |
|---|
| UnitedHealthcare | 38 | 4.1 | $35/mo |
| Healthfirst | 20 | 4.5 | $20/mo |
| Aetna | 22 | 4.2 | $42/mo |
| EmblemHealth | 15 | 3.8 | $30/mo |
| Excellus BlueCross BlueShield | 18 | 4.0 | $38/mo |
| Independent Health | 12 | 5.0 | $35/mo |
| WellCare (Centene) / Fidelis Care | 20 | 3.5 | $28/mo |
| Humana | 16 | 3.8 | $45/mo |
| MetroPlus Health Plan | 8 | 3.7 | $15/mo |
Source: KFF Medicare Advantage 2026 Spotlight, CMS Medicare Plan Finder Q4 2025, NerdWallet 2026 NY MA analysis, healthinsurance.org New York Medicare data
Plan Types in New York: HMO vs PPO vs SNP
Medicare Advantage plan-type breakdown in New York| Plan Type | Plans Available | Avg Premium | Best For |
|---|
| HMO | 128 | $32/mo | Lower premiums, willing to use network providers; requires PCP referrals |
| PPO | 62 | $58/mo | Flexibility to see out-of-network providers; no referral required |
| Special Needs Plan (SNP) | 24 | $0/mo | Dual-eligible (Medicaid + Medicare), chronic conditions (C-SNP), or institutional care (I-SNP) |
| PFFS (Private Fee-for-Service) | 4 | $42/mo | Flexibility to use any Medicare-accepting provider; uncommon in NY |
New York has 218 total MA plans in 2026. HMOs dominate at roughly 59% of all plans. SNP enrollment in New York is notably high: about 34% of all NY MA enrollees are in Special Needs Plans, well above the national average, reflecting New York's large dual-eligible population.
Source: KFF Medicare Advantage 2026 Spotlight, CMS Medicare Plan Finder Q4 2025, New York state MA enrollment data
County-Level Variance in New York
New York's Medicare Advantage market splits sharply between New York City metro and the rest of the state. NYC boroughs have the highest plan counts (35+ plans per borough) but also the highest premiums, driven by the cost of care. Upstate counties served by Excellus and Independent Health have fewer choices but strong regional carriers with high Star Ratings. Rural counties in the Catskills, Adirondacks, and North Country have the fewest options.
Plan count and average premium by county in New York| County | Plans Available | Avg Premium |
|---|
| New York County (Manhattan) | 35 | $45/mo |
| Kings County (Brooklyn) | 38 | $42/mo |
| Westchester County | 32 | $44/mo |
| Erie County (Buffalo) | 54 | $38/mo |
| Onondaga County (Syracuse) | 42 | $36/mo |
| Dutchess County | 26 | $48/mo |
Plan counts are approximate from CMS Medicare Plan Finder Q4 2025. Exact plans vary by ZIP code within each county. Run a personalized search at medicare.gov/plan-compare to see your specific options.
Source: CMS Medicare Plan Finder Q4 2025, healthinsurance.org New York county data
What to Look For in a Medicare Advantage Plan in New York
Choosing a Medicare Advantage plan in New York requires looking beyond the monthly premium. New York's diverse geography means what works in Brooklyn may be irrelevant in the Adirondacks. Here is what matters in 2026:
- Provider network. Confirm that your primary care physician, specialists, and preferred hospital are in-network before enrolling. New York City networks are dense but closed; a Healthfirst HMO will not cover out-of-network care except in emergencies. Upstate networks are broader geographically but may have fewer specialists.
- Prescription drug coverage (formulary). Most New York MA plans include Part D drug coverage built in (called MA-PD plans). Verify your specific medications are on the plan's formulary at an affordable tier. The 2026 Part D annual out-of-pocket cap is $2,100, set by the Inflation Reduction Act signed in August 2022.
- Star Ratings. CMS rates MA plans 1 to 5 stars annually on quality of care, member experience, and chronic condition management. Independent Health earned a 5-star rating in 2026, triggering a Special Enrollment Period that lets eligible beneficiaries switch to that plan at any time. Healthfirst holds 4.5 stars. Aim for 4 stars or higher when comparing plans.
- Supplemental benefits (dental, vision, hearing, fitness, transportation). Original Medicare does not cover dental cleanings, eyeglasses, or hearing aids. Most New York MA plans offer some level of these benefits. Compare annual dental coverage limits, hearing aid allowances, and gym membership programs (SilverSneakers, Silver and Fit) across your top plan choices.
- Maximum out-of-pocket (MOOP). The 2026 federal in-network MOOP ceiling for Medicare Advantage is $9,250 (down $100 from $9,350 in 2025). Many New York plans set lower limits. Original Medicare has no MOOP cap. If you expect high medical utilization, prioritize plans with a MOOP below $6,000.
- Prior authorization requirements. MA plans in New York can require prior authorization (PA) for surgeries, specialist referrals, and advanced imaging. CMS publishes prior authorization denial rates annually. If you have a complex condition, review the plan's prior authorization policies before enrolling and check CMS's published denial and appeal data.
- EPIC (Elderly Pharmaceutical Insurance Coverage). New York's state-funded EPIC program helps seniors with incomes up to $75,000 (single) or $100,000 (married) pay for prescription drug costs, including Part D premiums. EPIC works alongside most MA-PD plans. Call 1-800-332-3742 or visit health.ny.gov to check eligibility.
Key Medicare Dates in New York
New York Medicare beneficiaries face several enrollment windows. Missing the wrong one can delay coverage or trigger late-enrollment penalties.
- Annual Election Period (AEP): October 15 - December 7, 2026 — Switch between Original Medicare and MA, change MA plans, or change Part D drug plans. Coverage starts January 1, 2027.
- Medicare Advantage Open Enrollment Period (MA OEP): January 1 - March 31, 2026 — Existing MA enrollees can switch to a different MA plan or return to Original Medicare. One switch only. Not available to those joining MA for the first time.
- Initial Enrollment Period (IEP): 7-month window around your 65th birthday — Starts 3 months before your birthday month, includes the birth month, and ends 3 months after. Enroll in Medicare Parts A and B first, then choose an MA plan or Original Medicare plus Part D.
- 5-Star Special Enrollment Period: December 8, 2026 - November 30, 2027 — Independent Health holds a 5-star CMS rating in New York for 2026. This triggers a year-round SEP allowing any eligible New Yorker in their service area to enroll at any time (one switch per year).
- Special Enrollment Periods (SEPs): Varies by qualifying event — Moving out of your plan's service area, losing employer coverage, qualifying for Medicaid (dual-eligible), or your plan terminating all trigger a 2-3 month SEP. Dual-eligible New Yorkers can switch plans once per quarter in Q1-Q3.
Notable Extras in New York Plans
New York Medicare beneficiaries have access to state-specific programs and protections that go beyond federal Medicare Advantage rules:
- HIICAP (NY's SHIP program): New York's Health Insurance Information, Counseling and Assistance Program (HIICAP) is the state's federally funded Medicare counseling program. Nearly 500 trained volunteer counselors in 59 county offices provide free, unbiased help comparing Medicare Advantage plans, Medigap options, and Part D coverage. Call 1-800-701-0501 to reach your local HIICAP office. New York State Office for the Aging coordinates HIICAP statewide.
- Community-rated Medigap with continuous open enrollment: New York is one of a handful of states that requires Medigap (Medicare Supplement) insurers to use community rating: premiums cannot vary by age or health status. New York law also provides year-round Medigap open enrollment, meaning you can buy a Medigap policy at any time regardless of health, even after leaving a Medicare Advantage plan. This makes the MA-to-Medigap transition far easier in New York than in most other states. The NY Department of Financial Services (DFS) regulates these protections at dfs.ny.gov.
- NY Managed Long Term Care (MLTC) and dual-eligible integration: New York has mandatory Managed Long Term Care (MLTC) enrollment for dual-eligible beneficiaries (those with both Medicare and Medicaid) who need home care for more than 120 days. Within MLTC, the Medicaid Advantage Plus (MAP) plan integrates Medicare and Medicaid into a single coordinated plan, where enrollment in MAP requires simultaneous enrollment in a Medicare Advantage Dual Special Needs Plan (D-SNP). This integration means many dual-eligible New Yorkers receive all their care through a single plan that coordinates home care, community services, Medicare hospital coverage, and Medicaid long-term services. MetroPlus, WellCare/Fidelis, Healthfirst, and VillageCareMAX all offer D-SNP/MAP options in 2026.
- EPIC prescription assistance program: New York's Elderly Pharmaceutical Insurance Coverage (EPIC) program supplements Part D drug coverage for seniors with incomes up to $75,000 (single) or $100,000 (married). EPIC covers Part D premium costs up to $58.82/month and can reduce out-of-pocket drug costs for over 325,000 enrolled seniors. EPIC works alongside most Medicare Advantage-PD plans and is administered by the NY Department of Health. Call 1-800-332-3742 or visit health.ny.gov/epic.
How to enroll in New York Medicare Advantage in 2026
New York Medicare Advantage enrollment follows a five-step process. Confirm your doctors are in the plan's network before you finalize enrollment. Most beneficiaries enroll during the Annual Election Period (October 15 to December 7, 2026) for coverage starting January 1, 2027. Those turning 65 can enroll during their Initial Enrollment Period (the 7-month window around their birthday).
New York enrollees also have free counseling available through HIICAP. Call 1-800-701-0501 to reach a trained counselor in your county before making a plan decision.
- Step 1: Confirm you have Medicare Parts A and B. You must be enrolled in both before joining an MA plan. If you are approaching 65, sign up for Parts A and B during your Initial Enrollment Period through Social Security (ssa.gov) or your local Social Security office.
- Step 2: Compare plans at medicare.gov/plan-compare. Enter your ZIP code to see all MA plans available in your county. Filter by star rating (aim for 4+ stars), monthly premium, and whether your doctors and prescriptions are covered.
- Step 3: Contact HIICAP for free, unbiased counseling. New York's HIICAP program (1-800-701-0501) connects you with a trained counselor in your county who can walk through plan options at no cost. The NYC Department for the Aging also runs HIICAP appointments in all five boroughs.
- Step 4: Enroll in your chosen plan. You can enroll online at the plan's website, by calling the plan directly, by calling 1-800-MEDICARE (1-800-633-4227), or by working with a licensed insurance broker. Have your Medicare card, Social Security number, and current medication list ready.
- Step 5: Review your confirmation and Evidence of Coverage (EOC). After enrollment, your new plan will send a confirmation letter and an Evidence of Coverage document. Read the EOC carefully: it details your copays, network, prior authorization requirements, and covered benefits. Keep it for the plan year.
How to enroll in New York Medicare Advantage in 2026 detail| Step | Action | Where to Go |
|---|
| 1 | Confirm Medicare Parts A and B enrollment | ssa.gov or 1-800-772-1213 |
| 2 | Compare plans by ZIP code | medicare.gov/plan-compare |
| 3 | Get free counseling | HIICAP 1-800-701-0501 |
| 4 | Enroll in your chosen plan | Plan website, 1-800-MEDICARE, or broker |
| 5 | Read your Evidence of Coverage | Mailed by your plan after enrollment |
Documents you will need: Medicare card (or Medicare number), Social Security number, list of current prescriptions (drug name, dosage, frequency), names of your current doctors and preferred hospitals, and payment method for any plan premium.
$0 premium Medicare Advantage plans in New York for 2026
New York Medicare Advantage beneficiaries can find $0-premium plans in every county statewide in 2026, despite the state's higher-than-average overall premium of $40/month. $0-premium plans are most common in New York City and nearby suburban counties where carrier competition is highest. Upstate rural counties have fewer $0-premium options, but at least one is typically available.
New York $0 premium plans still require you to pay the 2026 Part B premium of $202.90/month (unless you have Medicaid, which covers this cost for dual-eligible beneficiaries). A $0 premium plan means no additional monthly cost on top of Part B, not that Medicare is entirely free. Out-of-pocket costs under $0-premium plans can be higher than under plans with monthly premiums.
$0 premium Medicare Advantage plans in New York for 2026 detail| County / Area | Example $0 Premium Carrier | Plan Type | Notes |
|---|
| Manhattan (New York County) | Healthfirst | HMO | Multiple Healthfirst HMO options at $0; strong NYC provider network |
| Bronx / Brooklyn (Kings) / Queens | MetroPlus / WellCare by Fidelis | HMO / D-SNP | $0 premium HMO options; D-SNP plans at $0 for dual-eligible enrollees |
| Westchester County | UnitedHealthcare / Healthfirst | HMO / PPO | $0 HMO and select PPO options in NYC suburban market |
| Erie County (Buffalo) | Independent Health / UnitedHealthcare | HMO | $0 HMO available in Western NY; Independent Health is 5-star rated |
| Onondaga County (Syracuse) | Excellus BCBS / UnitedHealthcare | HMO | $0 HMO available; Excellus 4-star rated in Central NY |
| Dutchess / Hudson Valley | UnitedHealthcare / Humana | HMO | Fewer $0 options upstate; at least one $0 HMO typically available per county |
All plans still require the standard 2026 Part B monthly premium of $202.90. Check your specific ZIP code at medicare.gov/plan-compare for exact $0-premium plan availability. Common denial reasons for MA enrollment: not enrolled in Medicare Parts A and B, living outside the plan's service area, and end-stage renal disease (for most plans other than D-SNPs).
Medicare Advantage vs Original Medicare in New York
New York beneficiaries choosing between Medicare Advantage and Original Medicare face a distinct trade-off. Original Medicare (Parts A and B) plus a Medigap supplement and Part D drug plan gives nationwide provider access and no prior authorization for most covered services. The estimated monthly cost in New York for Medigap Plan G plus Part D typically runs $250 to $400, depending on age and region. In contrast, most New York Medicare Advantage plans bundle hospital, medical, and drug coverage into a single plan with an average premium of $40/month, though $0-premium options exist in every county.
New York's unique Medigap rules change the calculation. Because the state requires community rating and continuous open enrollment for Medigap, New Yorkers can leave a Medicare Advantage plan and buy Medigap at any time, without medical underwriting. That safety net makes trying Medicare Advantage lower-risk in New York than in most states, where leaving MA can lock you into a plan with no path back to affordable Medigap coverage.
New York beneficiaries who split time between New York and a second state (Florida in winter, for example) should consider whether their MA plan's coverage network extends to their other location. Most HMO-based MA plans cover only emergency care out of network. Original Medicare plus Medigap works nationwide with any Medicare-accepting provider, making it better suited for true snowbirds.
How Star Ratings work and what they mean for New York enrollees
New York's CMS Star Ratings for Medicare Advantage plans vary widely across the state's carriers. CMS publishes ratings annually in October, scoring plans 1 to 5 stars on approximately 40 measures: preventive care screenings, management of chronic conditions, member satisfaction scores, access to care, and Part D drug safety. Plans rated 4 stars or higher receive quality bonus payments from CMS that allow carriers to fund richer supplemental benefits.
New York has notable Star Rating variation between regions. Independent Health in Western New York holds a 5-star CMS rating for 2026, the top score and one of only a small number of 5-star plans nationally. Healthfirst, the dominant NYC carrier, holds 4.5 stars. Excellus BlueCross BlueShield in Upstate New York holds 4 stars. The 5-star designation for Independent Health triggers a Special Enrollment Period running December 8, 2026 through November 30, 2027, allowing eligible beneficiaries in Western New York to switch to that plan outside normal enrollment windows.
New York's statewide weighted-average Star Rating is approximately 3.9, slightly above the national average of 3.8. The presence of large urban carriers like EmblemHealth and MetroPlus with lower Star Ratings (3.7-3.8) pulls the state average down from where regional carriers like Independent Health and Healthfirst push it up. When shopping for plans, prioritize individual plan Star Ratings over the state average.
Medicaid integration and dual eligibility in New York
New York has one of the country's most structured systems for dual-eligible beneficiaries (those who qualify for both Medicare and Medicaid). About 34% of all New York Medicare Advantage enrollees are in Special Needs Plans (SNPs), a rate well above the national average, reflecting New York's large low-income senior and disabled population. D-SNPs in New York typically carry $0 premiums, $0 copays for primary care visits, and $0 out-of-pocket costs for formulary prescriptions.
New York's Managed Long Term Care (MLTC) system adds a unique layer. Dual-eligible New Yorkers who need home care for more than 120 days are required to enroll in an MLTC plan. Within MLTC, the Medicaid Advantage Plus (MAP) plan integrates Medicare and Medicaid; enrolling in MAP requires simultaneously enrolling in a Medicare Advantage D-SNP. New York's NY Department of Health coordinates this mandatory enrollment and maintains a directory of participating MAP plans at health.ny.gov.
New York dual-eligible beneficiaries also have expanded enrollment flexibility: they can switch MA plans (or between MA and Original Medicare) once per quarter in Q1, Q2, and Q3 of each year, plus an additional switch during AEP. If a beneficiary loses or gains Medicaid eligibility, that change triggers a Special Enrollment Period. For help navigating dual-eligible options, HIICAP counselors (1-800-701-0501) specialize in these cases.
Frequently Asked Questions
How many Medicare Advantage plans are available in New York in 2026?
New York has 218 Medicare Advantage plans available statewide in 2026, down from 241 plans in 2025. The exact number in your county varies: New York City boroughs typically have 35 or more plans, Erie County (Buffalo) has around 54 plans (highest in the state outside NYC), and rural upstate counties like Dutchess may have 26. Enter your ZIP code at medicare.gov/plan-compare to see your specific options.
What is the average Medicare Advantage premium in New York for 2026?
The average monthly Medicare Advantage premium in New York is approximately $40 in 2026, well above the national MA average of $14. New York's higher cost of care drives premiums up, particularly in New York City. However, $0-premium MA plans are available in every county statewide. You still pay the standard 2026 Part B premium of $202.90/month regardless of which MA plan you choose.
What is HIICAP and how can it help me choose a Medicare Advantage plan in New York?
HIICAP (Health Insurance Information, Counseling and Assistance Program) is New York's federally funded SHIP (State Health Insurance Assistance Program). It operates through the NY State Office for the Aging via 59 county offices and nearly 500 trained volunteer counselors. HIICAP provides free, unbiased help comparing Medicare Advantage plans, Medigap options, and Part D coverage. Call 1-800-701-0501 to reach your county's HIICAP office. NYC residents can also contact the NYC Department for the Aging directly.
When can I sign up for Medicare Advantage in New York?
The main window is the Annual Election Period (AEP) from October 15 to December 7, 2026, for coverage starting January 1, 2027. Other options: your 7-month Initial Enrollment Period around age 65, the MA Open Enrollment Period (January 1 to March 31, 2026) for existing MA enrollees, and Special Enrollment Periods triggered by qualifying life events such as moving or losing employer coverage. Dual-eligible New Yorkers can switch plans once per quarter in Q1-Q3.
Do I qualify for a Special Needs Plan (SNP) in New York?
New York has three types of Special Needs Plans in 2026. Dual Special Needs Plans (D-SNPs) are for people who qualify for both Medicare and Medicaid (dual-eligible). Chronic Condition SNPs (C-SNPs) are for people with specific serious conditions such as diabetes, heart failure, or ESRD. Institutional SNPs (I-SNPs) are for people living in nursing homes or requiring nursing-home-level care. About 34% of all New York MA enrollees are in SNPs. D-SNPs typically have $0 premiums, $0 copays, and minimal drug costs. Call HIICAP or visit medicare.gov to find SNPs in your county.
Which Medicare Advantage carriers operate in New York?
Major carriers statewide include UnitedHealthcare (largest plan count), Aetna, Humana, and WellCare/Fidelis Care. New York City-focused carriers include Healthfirst (highest NYC enrollment), EmblemHealth, MetroPlus Health Plan, and VillageCareMAX. Upstate and Western New York is served by Excellus BlueCross BlueShield (Central/Upstate NY, 4-star) and Independent Health (Western NY, 5-star in 2026). Empire BlueCross BlueShield (Anthem) also offers plans statewide. Kaiser Permanente does not operate in New York.
Can I switch from Medicare Advantage back to Original Medicare in New York?
Yes. New York makes this transition easier than most states. During AEP (October 15 to December 7) or MA OEP (January 1 to March 31), you can return to Original Medicare. The key New York advantage: state law requires community-rated, guaranteed-issue Medigap coverage with continuous open enrollment year-round. This means you can buy a Medigap policy any time after leaving MA without medical underwriting, regardless of health status. This is a major benefit not available in most other states.
How does New York's EPIC program work with Medicare Advantage?
EPIC (Elderly Pharmaceutical Insurance Coverage) is a New York state program that helps seniors with incomes up to $75,000 (single) or $100,000 (married) pay for prescription drug costs. EPIC covers Part D premium costs up to $58.82/month and reduces out-of-pocket drug expenses for over 325,000 enrolled seniors. EPIC works alongside most Medicare Advantage-PD plans. It is administered by the NY Department of Health. Call 1-800-332-3742 or visit health.ny.gov/epic to check eligibility and enroll.
What are the 2026 Part B premium and key Medicare cost figures New York enrollees should know?
In 2026, the standard Medicare Part B premium is $202.90/month and the Part B deductible is $283/year. The Part A inpatient deductible is $1,736 per benefit period. The Medicare Advantage in-network out-of-pocket maximum (MOOP) federal ceiling is $9,250 in 2026 (down $100 from $9,350 in 2025). The Part D out-of-pocket cap is $2,100 for 2026 (set by the Inflation Reduction Act). Insulin is capped at $35/month under all Part D plans. These figures apply statewide in New York as well as nationally.
