You got a New York default enrollment letter. What to do in the first 7 days

The letter is usually a few pages long, comes from your Medicaid managed care plan or HARP (not from Medicare or a government office), and says something like: you will be enrolled in our Medicare Dual Eligible Special Needs Plan when your Medicare starts, unless you tell us you do not want that. New York calls this “default enrollment.” The plan is required to send it at least 60 days before your Medicare start date, so you have time. Here is how to use the first week of it without panicking or deciding anything on day one.

Day 1: find the two dates and put the letter somewhere safe

Everything else depends on two dates. The first is the effective date: the day your Medicare begins and the day the D-SNP would begin with it. It is usually the first of a month. The second is the opt-out deadline. Under the federal default enrollment rules, you can generally decline up to the day before the effective date, but read your own letter for the exact date and the exact way the plan wants to hear from you (a phone call to a specific number, a written request, or both).

Write both dates on the envelope or on your calendar. Then do nothing else today. Nobody has to decide on day one.

Day 2: figure out which of the two letters you got

New York uses two versions of the notice. The standard version says you will stay in your current Medicaid managed care plan or HARP and join the company’s Medicare D-SNP. The state calls that combination IB-Dual (Integrated Benefits for Dually Eligible Enrollees). It is for people who do not need more than 120 days of community-based long-term services and supports.

The long-term-services version says you will be moved into a Medicaid Advantage Plus (MAP) plan along with the company’s D-SNP. That version goes to people who already receive, or are expected to need, 120 days or more of long-term services such as home care. Which version you got changes who will manage your home care afterward, so it is worth knowing before you call anyone. Our letter decoder walks through the wording, and D-SNP vs. MAP explains the difference in more depth.

Day 3: check three things against the plan’s Medicare network

A D-SNP is a Medicare Advantage plan with a network. The plan sending you the letter is the same company as your Medicaid plan, but the Medicare network is a separate list. Before you form an opinion, check three things:

1. Your primary care doctor and your most important specialist. Search the D-SNP’s Medicare provider directory (the letter or the plan’s website will point to it), or ask the plan by phone: “Is Dr. X in the D-SNP network for the Medicare plan named in this letter?”
2. Your pharmacy. D-SNPs include Part D drug coverage and have pharmacy networks too.
3. Your prescriptions. Ask whether each drug is on the D-SNP’s formulary and whether any need prior authorization.

You do not need perfect answers. You need to know whether there is a problem worth raising with a counselor.

Day 4: call HIICAP

HIICAP is New York’s free, unbiased Medicare counseling program. Counselors do not sell plans and are not affiliated with any of them. Call 1-800-701-0501, say your county when the recording asks (in New York City, say your borough), and tell the counselor: “I am on Medicaid managed care and got a default enrollment letter for a D-SNP. Can you help me compare staying in it with Original Medicare plus a drug plan, for my doctors and my prescriptions?” Have the letter, your Medicare card or Social Security award letter, and your drug list in front of you.

In the five boroughs you can also get an in-person appointment: call NYC Aging Connect at 212-244-6469 and ask for HIICAP. Our borough pages list the community counseling sites NYC Aging publishes.

Day 5: understand what “opting out” actually changes

This is the part most people get wrong. Opting out of the D-SNP does not simply leave your Medicaid as it is. The New York State Department of Health’s own FAQ says it plainly: you do not have to join, but if you opt out you will not be able to remain in your Medicaid managed care plan or HARP, and you will be moved to Medicaid fee-for-service. Fee-for-service Medicaid still works, but it is a different way of getting Medicaid services, and if you need home care later it is arranged through Managed Long Term Care rather than through your current plan.

So the real comparison is not “D-SNP vs. nothing.” It is “aligned D-SNP plus my current Medicaid plan” vs. “Original Medicare (or another Medicare Advantage plan) plus Medicaid fee-for-service.” New York Medicaid Choice, the state’s enrollment broker, can explain the Medicaid side of that; call 1-800-505-5678.

Day 6: decide, and act only if you are opting out

If you stay, you do not have to do anything. The letter says so. The D-SNP starts on the effective date, you keep your Medicaid plan, and one company coordinates both. Read the D-SNP’s welcome packet when it arrives and keep checking that your doctors are in network each year.

If you opt out, follow the letter’s instructions exactly and before the deadline. Call the plan number on the letter or send the written request it describes. New York Medicaid Choice can connect you with your plan if you have trouble reaching it. Then ask HIICAP to help you pick the Medicare coverage you want instead, so there is no gap.

Day 7: write down what you did

Keep the letter, note the date and time of any call, the name of the person you spoke to, and any confirmation number. If you opted out, ask the plan to confirm in writing. If you stayed, note the effective date so you can watch for the new ID card.

What if the effective date already passed?

You still have options. People with both Medicare and Medicaid have monthly opportunities to change certain coverage under federal rules that took effect in 2025: a monthly election into Original Medicare plus a drug plan, and (for people with full Medicaid) a monthly election into an integrated D-SNP aligned with their Medicaid plan. Which one applies to you is specific; ask HIICAP rather than guessing. Our post on SEPs covers the rules in plain language.

Sources

New York State Department of Health, “Integrated Care Plans for Dual Eligible New Yorkers” (FAQ on default enrollment and IB-Dual, revised July 2026) and the IB-Dual Enrollment Guide (February 2026); CMS job aid on the 2025 dual and Extra Help Special Enrollment Periods; NYC Aging HIICAP program page. Full notes and links are on health.ny.gov and aging.ny.gov. Your letter and current official guidance control if anything here differs.