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New York · Medicare and Medicaid

Your “default enrollment” letter, in plain English.

In short: if you are on a New York Medicaid plan and Medicare is about to start, your plan may enroll you in its Dual Special Needs Plan (D-SNP). It must mail you a letter at least 60 days before. You can stay in or opt out. This site explains each choice and who to call for free.

Start: what does my letter mean?Read the letter decoder

Free, and nothing is enrolled. You can also call HIICAP, New York’s free Medicare counseling program, at 1-800-701-0501. Mon–Fri, 8:30 a.m.–5:00 p.m.

Example · what the letter usually contains

Date one · effective date: The day Medicare and the D-SNP would start; Usually the first of a month, about 60 days out.
Date two · opt-out deadline: Generally the day before; After that, a request is handled as a disenrollment instead.
Two plan names: Your Medicaid plan today, and the “aligned” Medicare D-SNP from the same company.
How to opt out: Call the plan number printed on the letter, or send a written request.

Not a real notice. Your letter controls; the decoder walks through each line.

Start here

Which one sounds like you?

The numbers that decide the week

Three dates, one line, and a free phone call.

Everything else in a default enrollment letter hangs on these. Each one is cited to the official New York or federal source it comes from.

60 days
How far ahead of your Medicare start date the letter should arrive.: Day before
Generally the last day to opt out: the day before the effective date on the letter.: 120 days
The line of community long-term services that separates IB-Dual from Medicaid Advantage Plus.: $0
What HIICAP counseling costs. Counselors compare plans and sell nothing.

Program rules change. Your official letter controls; if anything here conflicts with it, follow the letter or ask a counselor.

The short version

How a “default enrollment” letter works

Three things to know before you make any call. The full checklist is in the letter decoder.

01
The letter comes early
Your Medicaid plan sends it at least 60 days before your Medicare starts. It names the Medicare D-SNP you would join. Both plans are from the same company.
02
You have a choice
Do nothing and you join the D-SNP on the start date. Opt out before then and you keep Original Medicare or pick another plan. Each path has tradeoffs for your Medicaid coverage.
03
Free counselors can compare for you
HIICAP can check whether your doctors and prescriptions are covered by the D-SNP. New York Medicaid Choice can explain what happens to your Medicaid plan if you opt out.

Read the full letter decoder New to D-SNPs? Start with the basics

Source: the NY Department of Health’s page for dual eligible New Yorkers says your health plan will send a notice at least 60 days before you become eligible for Medicare, that you do not have to join the D-SNP, and that you can opt out by calling your plan or writing to it. Last reviewed: September 28, 2026

Help where you live

Your borough, your county name, your nearest free counselor

The rules are the same across New York. The practical parts change by borough: which county goes on the form, where HIICAP counselors sit, and the mistakes neighbors tend to make.

All boroughs and neighborhoods

Longer reads

Guides for the week after a letter arrives

All posts

September 10, 2026 · 8 min read

Moving between boroughs with a D-SNP: SEPs and what changes

Inside New York City a move usually keeps you in the plan’s service area. Here is what still has to change, and the SEPs you may have anyway.

Straight answers

Questions people ask first

When does the default enrollment letter arrive?

At least 60 days before your Medicare start date, according to the New York State Department of Health. The state’s enrollment broker identifies plan members about 90 to 110 days ahead, and the company’s Medicare plan sends the notice.

What is the deadline to opt out of default enrollment?

Federal rules require the letter to tell you that you can decline up to and including the day before the enrollment effective date. Your letter states the exact date and method. After the start date, a request is treated as a disenrollment instead.

If I opt out of the D-SNP, do I keep my Medicaid managed care plan?

No. The New York State Department of Health says that if you opt out you cannot remain in your Medicaid managed care plan or HARP and will be disenrolled to Medicaid fee-for-service. Your Medicaid continues; the plan membership does not.

Can I change my mind after default enrollment?

Yes. IB-Dual has no lock-in, and since 2025 people with Medicaid can move to Original Medicare plus a drug plan once a month. Going the other way is harder: returning to your Medicaid managed care plan after leaving depends on your plan offering a re-entry pathway.

Official resources

Where the official answers live

Every fact on this site comes from these government programs. We link to them. They do not endorse this site, and this site is not the government. It is not affiliated with or endorsed by Medicare, CMS, or New York State.

Guided help, free

Not sure what your letter is asking? Leave your information and we will help you sort out next steps.

Answer five short questions and get a plain-language summary of what to ask and who to call. Optional callback. It does not enroll you in anything.

You can also call HIICAP, New York’s free Medicare counseling program: 1-800-701-0501. Free, unbiased, and they do not sell plans. Mon–Fri, 8:30 a.m.–5:00 p.m.

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Your “default enrollment” letter, in plain English.

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