IB-Dual letter explained: what each line means in New York

In short: the IB-Dual letter says your Medicaid plan’s company will also become your Medicare plan (a D-SNP) on the start date, and you keep your Medicaid plan too. You do not have to do anything to stay. If you opt out, you keep Original Medicare or pick another plan, but you leave the Medicaid managed care plan for fee-for-service Medicaid. Each phrase below is translated in the order it usually appears.

The IB-Dual notice is written by a health plan using language approved by the state and by Medicare. It is accurate, but it is not written the way people talk. Below are the phrases that trip people up most, in the order they usually appear, with what each one is really saying. Your letter may use slightly different words; the ideas are the same across plans.

“You are currently enrolled in [our Medicaid managed care plan / HARP]”

This is the setup. Default enrollment only happens to people who are already in a Mainstream Medicaid Managed Care plan or a Health and Recovery Plan (HARP) run by a company that also offers a Medicare D-SNP and has been approved by the state and Medicare to use the process. If you are in Medicaid fee-for-service, or your plan’s default enrollment is listed as suspended on the state’s 2026 chart, you will not get this letter. Not getting one is not a sign that something is wrong. Medicare still starts, and you choose your Medicare coverage yourself; ask the plan or New York Medicaid Choice what happens to your Medicaid plan membership.

“You will become eligible for Medicare on [date]”

This is the effective date, and the whole letter hangs on it. The plan learned it from the state’s enrollment broker, New York Medicaid Choice, which identifies Medicaid plan members who are about to become Medicare-eligible roughly 90 to 110 days ahead. The letter itself must reach you at least 60 days before this date. If the date on the letter looks wrong (for example, you think your Medicare starts a different month), call Social Security or Medicare first, then the plan.

“You will be automatically enrolled in [D-SNP name], our Medicare Advantage Dual Eligible Special Needs Plan”

This is default enrollment. On the effective date, the company’s Medicare D-SNP becomes your Medicare coverage instead of Original Medicare. The D-SNP has its own network, drug formulary, and member ID card. Read our D-SNP overview if the term is new.

“Aligned” or “affiliated”

These words mean the Medicare D-SNP and your Medicaid plan are offered by the same organization, so the state allows the two to be coordinated. It does not mean the two networks are identical. Ask about your doctors on the Medicare side specifically.

“You will remain in your Medicaid managed care plan” / “Integrated Benefits for Dually Eligible Enrollees (IB-Dual)”

This is the part that makes the letter an IB-Dual letter rather than a MAP letter. Normally, when a Medicaid managed care member gets Medicare, New York moves them out of the Medicaid plan. IB-Dual is the exception: if you take the aligned D-SNP, you keep your Medicaid plan too, and one company handles both. The state’s guide describes IB-Dual as a program for people not needing more than 120 days of community-based long-term services. The state calls this template the Non-LTSS Default Enrollment Notice. If your letter instead says your Medicaid coverage “will be enhanced to meet your long term care services and support needs” and names a Medicaid Advantage Plus plan, you have the other version, the LTSS notice; see D-SNP vs. MAP and the side-by-side table in the letter decoder.

“Your HARP services will continue” (or nothing about HARP)

If you are in a HARP, the state’s FAQ says you still receive HARP services under IB-Dual. If your letter does not mention it, ask the plan to confirm, and if you have questions about behavioral health services or changing plans the state directs people to the Office of Mental Health at 1-800-597-8481.

“You do not need to take any action”

True, and important. If you are content to stay, you do not have to call anyone. The enrollment happens on the effective date. What you should still do is read the D-SNP welcome materials when they arrive and check your doctors and prescriptions against the Medicare network and formulary. “No action” is about enrollment, not about paying attention.

“If you do not want to be enrolled, you may opt out by …”

Here the letter tells you how to say no: usually by calling the plan at a listed number or by sending a written request, and it gives a deadline, generally the day before the effective date. The state adds that New York Medicaid Choice can connect you with your plan to opt out if you have trouble. Follow the letter’s method exactly, and get a confirmation.

“If you opt out, you will be disenrolled from [Medicaid plan] and receive Medicaid on a fee-for-service basis”

This is the sentence people skim past and regret. Opting out of the D-SNP also ends your membership in the Medicaid managed care plan or HARP, because IB-Dual requires both halves. Your Medicaid does not end; it continues as fee-for-service, where you use your Medicaid card directly with providers who accept it, and where long-term care (if you ever need it) is arranged through a separate Managed Long Term Care plan or other pathways. Some people are fine with that; some are surprised by it. Ask New York Medicaid Choice what it would mean for you before you opt out.

“You may choose Original Medicare or another Medicare Advantage plan”

Correct. Opting out does not leave you without Medicare; it leaves you with the Medicare choice you make instead. HIICAP can help you compare, for free, and can tell you about Extra Help for drug costs and the Medicare Savings Program if you are not already getting them. Just remember the previous paragraph: “another plan” means an unaligned one, and unaligned means no IB-Dual.

“Compare your current benefits and costs with the D-SNP”

Good letters include a comparison of premiums, cost sharing, and benefits. For most people with full Medicaid, out-of-pocket costs are limited either way, so the useful comparison is networks, drugs, and extras, not premiums. Look for the D-SNP’s extra benefits (dental is required as a supplemental benefit in New York D-SNPs since 2025, and transportation, meals, or an over-the-counter card may be offered) and weigh them against any doctor who is not in network.

“Contact information”

The letter lists the plan’s number and typically Medicare and HIICAP. Use the plan for network questions, HIICAP for an unbiased comparison, and New York Medicaid Choice for the Medicaid side. Our borough and neighborhood pages add the in-person counseling sites NYC Aging publishes.

Two things the letter will not tell you

• You can change later. The state FAQ confirms you may disenroll from the D-SNP after default enrollment by contacting the Medicare plan, and people with both Medicare and Medicaid have monthly opportunities under federal rules since 2025 to move to Original Medicare plus a drug plan, or (with full Medicaid) into an integrated D-SNP aligned with their Medicaid plan. Disenrolling ends the “same company for both” arrangement, so ask what that does to your Medicaid plan first.
• Moving matters. The state notes that if you move to a county where the IB-Dual program is not offered, you will be moved to Medicaid fee-for-service. Inside New York City that is rarely an issue; see our post on moving with a D-SNP.