I’m on Marketplace Coverage in New York and Turning 65 in 3 Months

Will I Lose My Essential Plan Health Coverage—And What Do I Do Next If I’m Retiring?

Turning 65 is a major milestone—and it comes with some big decisions about your health insurance. If you’re currently on the Essential Plan in New York through the Marketplace (NY State of Health), your coverage will end once you reach 65. So what happens next, especially if you’re planning to retire?

Here’s exactly what you need to know—and how to get free expert help from a licensed broker at AffordableCareAgents.com, a national network of over 500 licensed Medicare specialists.

1. You Will Lose Your Essential Plan at 65

The Essential Plan in New York is available only to individuals ages 19 to 64. It’s a low- or no-cost plan designed for those who don’t qualify for Medicaid.

However, once you turn 65, you are no longer eligible. Your Essential Plan will end the last day of the month before your birthday month. You will likely receive a notice about this from the state and may be referred to your local Department of Social Services or Medicaid office.

Bottom line: The Essential Plan ends automatically—so you must take steps to enroll in Medicare and avoid a coverage gap.

2. Understand Your Medicare Enrollment Window

You have a 7-month Initial Enrollment Period (IEP) for Medicare:

• It starts 3 months before the month you turn 65
• Includes your birthday month
• And ends 3 months after

📅 Example: If your birthday is October 10, your IEP runs from July 1 to January 31.

To avoid a gap in coverage or a late enrollment penalty, you should enroll in:

• Medicare Part A (hospital insurance)
• Medicare Part B (medical insurance)

Preferably before your birthday month.

3. Cancel Marketplace Coverage—But Time It Right

For most people turning 65 in New York, the Essential Plan will end automatically—usually at the end of the month before your birthday month. However, if you’re on a Qualified Health Plan (QHP) through the Marketplace (not the Essential Plan), the Marketplace may or may not automatically terminate your coverage when Medicare begins.

Here’s what could happen:

• If the Marketplace is aware of your Medicare enrollment, they might automatically drop your plan.
• If not, you’ll need to manually cancel it to avoid:
  • Losing tax credits
  • Paying for overlapping coverage
  • Risking IRS repayment at tax time

What If Your Income Is Low?

If your income is limited, you may qualify for Medicaid at age 65. In New York, Medicaid is available to:

• Individuals with monthly income under $1,732 (single) or $2,351 (married)*
• Applicants within certain asset guidelines

To apply for Medicaid, you can:

• Contact your local Department of Social Services (LDSS)
• Visit a HRA office (if you live in New York City)
• Or work with one of our partner agencies that offer over-the-phone applications—fast, secure, and free.

📞 At AffordableCareAgents.com, our network includes licensed advisors and partner agencies who can walk you through Medicare and Medicaid eligibility, coverage options, and applications—step by step.

4. Retiring at 65? Here’s What to Consider

If you’re planning to retire at 65:

• Sign up for Medicare Parts A & B during your IEP
• Decide between:
  • Medicare Advantage (Part C)
  • Original Medicare + Medigap (Supplement) + Part D drug plan
• Get help comparing options—there are dozens of plans in New York alone, and the right one depends on your doctors, prescriptions, and budget

You only get one Medigap Open Enrollment Period (the 6 months after you enroll in Part B), so make your choices wisely.

5. 4-Step Checklist to Avoid Mistakes

6. Why Use AffordableCareAgents.com?

Navigating Medicare is confusing—but you don’t have to do it alone.

AffordableCareAgents.com is a trusted network of over 500 licensed brokers across all 50 states. They:

• Offer free consultations
• Explain your local plan options
• Help you avoid penalties and gaps
• Find plans that include your doctors and prescriptions

And there’s no cost to work with them.

7. Talk to a Licensed Medicare Advisor—At No Cost to You

Ready to simplify the process? Just fill out the quick form below to connect with a licensed Medicare specialist from AffordableCareAgents.com who understands the transition from Marketplace to Medicare in New York.

✅ No fees, no pressure—just honest guidance tailored to you.

📞 Speak to a live Medicare advisor now: (347) 560-9396

🧾 Medicare Disclaimer

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.