Medicare is federal and standardized — but how someone gets the most out of it in New York is shaped by state rules most agents elsewhere never deal with. This is the 30,000-foot view before the details.
A + B + Medigap + D
Original Medicare path. Federal Parts A & B, paired with a Medigap supplement to cover the gaps and a stand-alone Part D drug plan. Any provider that accepts Medicare, no networks, predictable costs. This is where NY's guaranteed-issue Medigap rules make you valuable.
Part C
Medicare Advantage path. A private plan bundles A & B (and usually D) with networks, copays, and often extras like dental or vision. Lower upfront cost, more rules. Cannot be combined with a Medigap policy.
Four parts, two of them federal "Original Medicare," two of them private. Keep the lanes clean and the rest of the conversation gets easier.
A Hospital Insurance
Inpatient hospital stays, skilled nursing facility care, hospice, and some home health.
- Premium-free for most (40+ quarters of Medicare-taxed work)
- Paid for via payroll taxes during working years
- Costs hit as deductibles & coinsurance, not monthly premiums
B Medical Insurance
Doctor visits, outpatient care, preventive services, lab work, durable medical equipment.
- Standard premium $202.90/mo (higher with IRMAA)
- $283 annual deductible, then you pay 20% coinsurance
- No out-of-pocket maximum on its own — the reason Medigap exists
C Medicare Advantage
Private plans that bundle A & B, usually D, often with extras. An alternative to Original Medicare.
- Networks (HMO/PPO), copays, and an annual out-of-pocket max
- May add dental, vision, hearing, OTC, fitness
- Cannot pair with a Medigap policy
D Prescription Drugs
Outpatient prescription coverage — stand-alone (PDP) or built into a Medicare Advantage plan.
- Coverage gap ("donut hole") eliminated since 2025
- $2,100 hard cap on out-of-pocket in 2026
- Late enrollment penalty applies if you go without creditable coverage
The numbers that change every year — the part of any refresher that actually goes stale. These are the confirmed 2026 figures.
Miss a window and the client may pay a lifelong penalty. These are the periods to know cold — and which one a client is in usually decides what you can sell them today.
IEP 7-month window around 65
Initial Enrollment Period: the 3 months before the birthday month, the birthday month, and the 3 months after. The clean, no-penalty on-ramp into Parts A, B, and D.
AEP Oct 15 – Dec 7
Annual Enrollment Period (a.k.a. Open Enrollment). Anyone can join, drop, or switch Medicare Advantage and Part D plans. Changes take effect Jan 1. This is the busy season.
MA OEP Jan 1 – Mar 31
Medicare Advantage Open Enrollment. Someone already in an MA plan gets one switch — to a different MA plan or back to Original Medicare (with a Part D plan).
GEP Jan 1 – Mar 31
General Enrollment Period for those who missed their IEP. Coverage now starts the first of the month after enrollment (the old July 1 delay is gone). Part B late penalty may still apply.
SEPs Triggered by life events
Special Enrollment Periods open after qualifying events — losing employer coverage, moving out of a plan's service area, gaining/losing Medicaid or Extra Help, and more. No penalty when used correctly.
Medigap (Medicare Supplement) plans fill the deductibles and coinsurance Original Medicare leaves behind. Benefits are federally standardized by letter — so the only differences between two carriers' Plan G are price and service.
G The workhorse
Covers everything Original Medicare leaves except the Part B deductible. The most comprehensive plan available to those who became Medicare-eligible on or after 1/1/2020, and the most popular sale in NY.
N The value play
Lower premium in exchange for small copays at office and ER visits and the Part B deductible. Appeals to healthier, cost-conscious clients who don't mind minor cost-sharing.
- 10 standardized plans, lettered A through N — benefits identical across carriers
- Plans C and F are closed to anyone newly eligible on/after Jan 1, 2020
- Works only with Original Medicare — never alongside Medicare Advantage
- Federal Medigap Open Enrollment: 6 months from when you're 65+ and enrolled in Part B
- A 6-month pre-existing condition wait can apply without prior creditable coverage
This is where a New York agent earns trust. Three assistance programs can dramatically cut a client's costs — and NY's versions are unusually generous.
EPIC Elderly Pharmaceutical Insurance Coverage
A New York program that wraps around Part D to lower drug costs for residents 65+. It pays toward Part D premiums for lower earners and reduces out-of-pocket drug spending for everyone enrolled.
- Income up to $75,000 single / $100,000 married — strikingly high
- Must be 65+, a NY resident, and enrolled in a Part D plan
- Pays Part D premiums up to the ~$58.82/mo benchmark for lower-income members
- Two tracks: Fee Plan (lower income) and Deductible Plan (higher income)
MSP Medicare Savings Program
A Medicaid-administered program that pays the Part B premium — and for the top tier, deductibles and coinsurance too. Enrolling auto-qualifies the client for Extra Help on drugs.
- No asset/resource limit in New York — qualification is income-only
- Three tiers: QMB (most help), SLMB, and QI
- QMB also bars providers from balance-billing covered services
- Enrolling triggers automatic Extra Help / Low-Income Subsidy
LIS Extra Help (Low-Income Subsidy)
The federal subsidy that slashes Part D premiums, deductibles, and copays for those who qualify. Full-Medicaid and many MSP members get it automatically; others apply through Social Security.
Self-Quiz
Twelve questions on the 2026 numbers, enrollment, Medigap, and New York's programs. Tap an answer to lock it in — the option turns green if you're right, and the explanation appears either way. Your score tallies live up top.
To reset your answers and retake the quiz, just refresh the page.