If you’re a New York resident navigating Medicare, you have consumer protections that most Americans can only dream about.
Seriously.
While seniors in Florida, Texas, and California face age-based premium increases and medical underwriting that can lock them out of Medigap coverage, New York law gives you rights that fundamentally change how Medicare works
The problem? Most New Yorkers don’t even know these protections exist.
I’ve been helping Long Island seniors with Medicare since 2007, and I still meet people shocked to learn they have guaranteed issue rights year-round, or that their Medigap premiums won’t skyrocket at age 75.
This article explains New York’s two massive Medicare advantages – community rating and guaranteed issue rights – and exactly how to use them to your benefit.
What Makes New York Different: The Two Big Protections
New York State law provides two critical protections for Medicare beneficiaries that most states don’t have:
1. Community Rating (Age Can’t Increase Your Medigap Premiums)
New York requires all Medigap (Medicare Supplement) insurance companies to use community rating for premiums.
What this means: A 65-year-old pays the exact same premium as an 85-year-old for the same Medigap plan from the same company.
Your Medigap premium does NOT increase just because you get older.
2. Guaranteed Issue Rights (You Can Switch Medigap Plans Anytime)
New York provides year-round guaranteed issue rights for Medigap plans.
What this means: You can switch from Medicare Advantage to Medigap – or from one Medigap plan to another – at any time, for any reason, without answering medical questions.
No health screening. No denials based on pre-existing conditions. No waiting periods.
These two protections working together create flexibility that revolutionizes Medicare planning for New Yorkers.
Let’s break down exactly how each one works.
Community Rating Explained: Why Age-Based Pricing Is Banned in New York
How Medigap Pricing Works in Most States
In 47 states, insurance companies can use attained-age rating for Medigap policies.
Here’s how it works elsewhere:
Age 65: Plan G costs $150/month Age 70: Same plan now costs $180/month Age 75: Same plan now costs $220/month Age 80: Same plan now costs $280/month Age 85: Same plan now costs $320/month
Your premium increases every year just because you’re getting older – even if you never file a single claim.
By the time seniors in other states reach their 80s, many can no longer afford their Medigap premiums and are forced to switch to Medicare Advantage – often with health conditions that make network restrictions problematic.
How Medigap Pricing Works in New York
New York law prohibits age-based pricing.
Insurance companies must use community rating, which means everyone in the community pays the same rate regardless of age.
Real example in New York:
Plan G from ABC Insurance Company costs $372/month.
- 65-year-old pays: $372/month
- 70-year-old pays: $372/month
- 75-year-old pays: $372/month
- 80-year-old pays: $372/month
- 85-year-old pays: $372/month
Same premium. Period.
Do Medigap Premiums Ever Increase in New York?
Yes – but NOT because of age.
Your Medigap premium can increase when:
✓ The insurance company raises rates for EVERYONE
- Due to medical inflation
- Higher claims across all policyholders
- Increased healthcare costs generally
✓ You switch to a different plan
- Moving from Plan N to Plan G
- Switching carriers
✗ Your premium will NEVER increase just because you had a birthday
The Long-Term Financial Impact
Let’s compare two identical seniors over 20 years of Medicare coverage:
Senior in Florida (attained-age rating):
- Age 65-75: Averages $180/month = $21,600
- Age 75-85: Averages $280/month = $33,600
- Total 20-year cost: $55,200
Senior in New York (community rating):
- Age 65-85: $372/month (with 4% annual increases for inflation)
- Total 20-year cost: $110,000 (with inflation adjustments)
Wait – New York looks more expensive!
Here’s the catch: The New York senior has predictability and can plan accurately. The Florida senior might face 40-50% premium increases between age 65 and 85, forcing difficult decisions about dropping coverage.
Plus, New York rates start higher because they’re averaging costs across all ages – but they don’t accelerate upward as you age.
Why This Matters for Long Island Seniors
- Predictable retirement budgeting You can project Medicare costs without worrying about age-based shocks
- You won’t be priced out in your 80s When you’re most likely to need comprehensive coverage, you can still afford it
- No forced switches due to premium increases You’re not pushed into Medicare Advantage at 78 because Medigap became unaffordable
- Peace of mind You know the rules won’t change based on your birthday
Guaranteed Issue Rights Explained: You’re Never Locked In
This is the protection most New Yorkers don’t know they have – and it’s absolutely game-changing.
How Medigap Enrollment Works in Most States
In most of the country, you have one guaranteed opportunity to get Medigap coverage:
6-month Medigap Open Enrollment Period – starts the month you’re 65 AND enrolled in Medicare Part B.
During these 6 months:
- Insurance companies must sell you any Medigap plan they offer
- They can’t charge more based on health conditions
- They can’t deny you coverage
- No medical underwriting
After those 6 months end, you need medical underwriting to get Medigap.
What is medical underwriting? The insurance company:
- Reviews your health history
- Can deny you coverage based on pre-existing conditions
- Can charge higher premiums based on your health
- Can make you wait months for coverage of pre-existing conditions
Real scenario in most states:
John chooses Medicare Advantage at age 65 to save on premiums. At age 68, he’s diagnosed with heart disease and wants to switch to Medigap for better coverage.
Insurance companies either:
- Deny him coverage entirely
- Charge him 200-300% higher premiums
- Exclude coverage for his heart condition for 6-12 months
He’s effectively trapped in Medicare Advantage.
How Guaranteed Issue Rights Work in New York
New York provides guaranteed issue rights YEAR-ROUND for all Medigap plans.
This means:
- You can switch from Medicare Advantage to Medigap anytime
- You can switch from one Medigap plan to another anytime
- Insurance companies CANNOT ask about your health
- Insurance companies CANNOT deny you coverage
- Insurance companies CANNOT charge more based on health conditions
- Coverage starts immediately with no waiting periods
Same scenario in New York:
John chooses Medicare Advantage at age 65. At age 68, he’s diagnosed with heart disease and wants comprehensive Medigap coverage.
He applies for Plan G. The insurance company:
- Cannot ask about his heart disease
- Cannot deny him coverage
- Must charge him the same rate as a healthy 68-year-old
- Must cover his heart condition from day one
He switches successfully. No questions asked.
New York’s Specific Guaranteed Issue Situations
New York provides guaranteed issue rights in these situations (among others):
✓ Switching from Medicare Advantage to Medigap
- Any time, any reason
- No medical questions
✓ Switching from one Medigap plan to another
- Want to move from Plan N to Plan G? No problem.
- Want to switch carriers for a lower rate? Go ahead.
✓ First enrolling in Medigap after Part B
- Even if you missed the 6-month window
- Even years later
✓ Moving to New York from another state
- New York residents get guaranteed issue rights
- Even if you had Medicare Advantage in your previous state
✓ Losing employer coverage
- Retiring and losing retiree coverage
- Switching from employer plan to Medicare
The One Limitation: You Still Pay Standard Rates
While you have guaranteed issue rights, you don’t get special pricing.
If you’re 75 and switching from Medicare Advantage to Medigap, you’ll pay the standard community rate (same as any other 75-year-old in New York) – but you won’t pay MORE due to your health conditions.
In states without guaranteed issue rights, that same 75-year-old might:
- Be denied entirely
- Pay 2-3x the standard rate
- Face exclusions for pre-existing conditions
New York’s protection is huge.
How These Two Protections Work Together
Community rating + guaranteed issue rights create a unique Medicare environment:
Scenario 1: The Cost-Conscious 65-Year-Old
Sarah turns 65 and chooses Medicare Advantage to save money.
Premium: $0/month She’s healthy, rarely sees doctors, saves $400+/month compared to Medigap.
At age 72, she develops diabetes requiring frequent specialist care.
Medicare Advantage copays add up:
- $40 per specialist visit × 12 visits = $480
- Diagnostic tests: $150 each × 4 = $600
- Annual out-of-pocket approaching $3,000
She decides to switch to Medigap Plan G.
In most states: She’d face medical underwriting. With diabetes, she’d likely be denied or charged 200%+ premiums.
In New York: She applies for Plan G. No medical questions. Standard rate of $372/month. Coverage starts immediately. Diabetes covered from day one.
She switches successfully and now has predictable costs.
Scenario 2: The Snowbird Switcher
Michael has Medicare Advantage covering Northwell in Huntington.
He starts spending winters in Florida. His NY-based Medicare Advantage plan doesn’t cover non-emergency care in Florida.
He needs dual-state coverage.
In most states: If he developed health conditions, he’d be stuck in Medicare Advantage. Switching to Medigap (which works everywhere) would require passing medical underwriting.
In New York: He switches to Medigap Plan G for nationwide coverage. No medical questions. Standard community rate. Now fully covered in both New York and Florida.
Scenario 3: The Premium Shopper
Linda has Medigap Plan G with Carrier A paying $395/month.
She discovers Carrier B offers Plan G for $372/month – identical coverage, just lower rate.
In most states: Switching requires new medical underwriting. If she’s developed health conditions, she’d be denied or charged higher rates.
In New York: She switches to Carrier B. No medical questions. Saves $23/month ($276/year). Takes 15 minutes.
This is unique to New York.
Common Questions About New York’s Medicare Protections
Q: If I can switch anytime, why not just start with Medicare Advantage and switch to Medigap later if I need it?
A: You can do this – but consider the trade-offs:
Advantages of starting with Medicare Advantage:
- Save money on premiums while healthy
- Keep the option to switch later
Disadvantages:
- You’ll pay copays during MA years
- When you switch to Medigap, you start at current community rates (which may have increased)
- You might develop preferences for certain doctors who aren’t in MA networks
- Switching mid-year means waiting for Annual Enrollment (Oct 15-Dec 7)
Strategic approach: If you’re young (65-67), healthy, and price-sensitive, starting with Medicare Advantage and keeping the Medigap option open is viable in New York. Just understand you’ll eventually pay higher premiums when you switch to Medigap at an older age.
Q: Do ALL Medigap plans in New York use community rating?
A: Yes. New York law requires it for all Medicare Supplement plans.
Every insurance company must use community rating. No exceptions.
Q: Can insurance companies charge me more for Medigap because I smoke or have health conditions?
A: No.
In New York, insurance companies cannot:
- Charge higher premiums based on tobacco use
- Charge higher premiums based on health conditions
- Charge higher premiums based on gender
- Charge higher premiums based on age (community rating)
Everyone pays the same rate for the same plan from the same company.
Q: Are there any times when I DON’T have guaranteed issue rights in New York?
A: New York’s guaranteed issue rights are very broad, but there are timeframes:
You can switch Medigap plans during:
- Annual enrollment (October 15 – December 7)
- Your birthday month each year
- Within 30 days of certain qualifying events
Practical reality: Most switches happen during annual enrollment for simplicity, but New York provides more flexibility than federal law requires.
Q: If I move to New York from another state, do I immediately get these protections?
A: Yes, once you’re a New York resident.
If you move to New York and establish residency, you gain:
- Community rating for any new Medigap plan
- Guaranteed issue rights to enroll in Medigap
This is valuable for retirees moving to New York to be near family.
Q: Does New York’s guaranteed issue apply to Medicare Advantage too?
A: No, guaranteed issue rights apply to Medigap plans.
Medicare Advantage plans have their own enrollment rules set by federal law:
- Initial enrollment when first eligible
- Annual enrollment (October 15 – December 7)
- Special enrollment periods for certain situations
However, New York’s guaranteed issue rights mean you can LEAVE Medicare Advantage for Medigap anytime – which is more flexibility than most states offer.
Q: Can I have both Medigap and Medicare Advantage?
A: No. You can have one or the other, not both.
If you enroll in Medicare Advantage, your Medigap policy is suspended. If you later drop Medicare Advantage, you can re-enroll in Medigap (using New York’s guaranteed issue rights).
Q: If Medigap premiums are community-rated, why do different companies charge different amounts?
A: Community rating means everyone pays the same within each company – but companies can charge different amounts from each other.
Example:
- Carrier A Plan G: $372/month (everyone pays this)
- Carrier B Plan G: $395/month (everyone pays this)
- Carrier C Plan G: $360/month (everyone pays this)
All three use community rating (everyone at that company pays the same), but the companies set different price points.
This is why shopping around matters in New York – and why guaranteed issue rights letting you switch carriers is so valuable.
How to Use New York’s Protections Strategically
Strategy 1: Start with Lower Costs, Keep Flexibility
For healthy 65-year-olds:
Consider starting with:
- Medicare Advantage ($0-50/month) OR
- High Deductible Plan G ($90/month with $2,950 deductible)
Benefits:
- Lower monthly costs while healthy
- Can switch to standard Plan G later using guaranteed issue rights
- Save thousands in early Medicare years
When to switch to standard Plan G:
- When health changes and you’re seeing doctors frequently
- When you start traveling more and want nationwide coverage
- When copays become burdensome
New York’s advantage: This strategy only works well in New York because you can switch later without medical underwriting.
Strategy 2: Shop Rates Annually
For current Medigap enrollees:
Every year during annual enrollment:
- Compare your current Medigap rate to other carriers
- If you find Plan G for $20-30/month less, switch
- Use guaranteed issue rights to move without medical questions
Example: Your current Plan G: $395/month Competitor Plan G: $365/month Annual savings: $360
Takes one application. No medical underwriting. Identical coverage.
New York’s advantage: In other states, switching carriers requires medical underwriting. In New York, it’s like switching car insurance.
Strategy 3: Optimize for Your Situation Changes
Scenario: You become a snowbird
Currently: Medicare Advantage covering Northwell/NYU Langone in Huntington Change: Start spending 4 months in Florida
Action: Switch to Medigap for nationwide coverage Timing: During annual enrollment Process: Simple application, no medical questions
New York’s advantage: You can adapt your coverage as life changes without being locked in.
Strategy 4: Try Medicare Advantage Risk-Free
For those unsure which path to choose:
Year 1: Enroll in Medicare Advantage to test it
- Experience network restrictions
- See if copays work for you
- Understand prior authorization process
If you don’t like it:
- Switch to Medigap during next annual enrollment
- No penalty, no medical questions
- Not stuck with a choice you regret
New York’s advantage: Medicare Advantage becomes a trial, not a permanent commitment.
What This Means for Huntington and Long Island Seniors
Living on Long Island – specifically in Huntington and Suffolk County – you face:
High healthcare costs (30% above national average)
- Makes out-of-pocket maximums on Medicare Advantage more impactful
- Makes Medigap’s $0 out-of-pocket more valuable
Complex multi-system provider networks
- Northwell, NYU Langone, Catholic Health
- Medigap’s nationwide coverage eliminates network juggling
High cost of living
- Suffolk County property taxes already strain budgets
- Flexibility to optimize Medicare costs matters
Snowbird population
- Many Huntington retirees winter in Florida
- Ability to switch to nationwide coverage is crucial
New York’s protections give you:
✓ Flexibility to choose what’s right NOW without being locked in forever
✓ Ability to adapt as health changes, budget changes, or life circumstances change
✓ Protection from age-based premium increases that would otherwise accelerate in your 80s
✓ Power to shop rates and switch carriers without penalty
✓ Safety net if you choose Medicare Advantage and later decide it’s not working
The Bottom Line: Use Your New York Advantage
If you live in New York, you have Medicare protections that 94% of Americans don’t have.
Community rating protects you from age-based premium increases that devastate seniors in other states.
Guaranteed issue rights mean you’re never locked into a Medicare choice that’s not working.
Together, these protections create flexibility and security that fundamentally change how you should think about Medicare planning.
Don’t assume you need to:
- Choose Medigap at 65 “just to be safe”
- Stick with Medicare Advantage forever if you start with it
- Keep a Medigap plan you’re overpaying for because switching is hard
You have options. You have time. You have protection.
Use it.
