Medicare Open Enrollment And Long-Term Care Planning In Fall 2025

It’s always time for seniors in New York to take care of their health, but now it’s especially time to look at their Medicare options. Medicare open enrollment 2025 in New York gives individuals the chance to review their coverage, make changes if needed, and ensure their health and long-term care plans still fit their evolving needs. In this article, we’ll discuss…

• What Medicare open enrollment means.
• How it differs from Medicaid in terms of paying for care post-retirement.
• How an attorney can help you incorporate long-term care planning into your estate plans.

What Is Medicare Open Enrollment In Fall 2025 And Why Is It So Important For Seniors?

Medicare open enrollment is the time each year when seniors can review and change their Medicare Advantage or Part D prescription drug plans. It’s like an upgrade window for your phone, only with much higher stakes.

This period runs from October 15 to December 7, and it’s an important opportunity to make sure your current coverage still meets your needs. Plans, formularies, and deductibles can change each year. If you don’t review your options during this window, you could be locked into a plan that no longer covers your prescriptions or preferred providers for the next year, unless you qualify for a special enrollment period.

What Changes To Medicare Coverage Should Seniors Know About During 2025 Enrollment?

There are a few technical updates coming in 2025. The out-of-pocket cap for Part D prescription drug plans will increase slightly from $2,000 to $2,100. Other thresholds and deductibles are also rising modestly.

New York is also introducing a notable change: the state plans to automatically enroll eligible residents in the Medicare Savings Program based on existing income information. This means some people will receive help with Part D premiums and other costs without needing to file a separate application.

And as always, the details within individual plans can shift. That’s why it’s important to confirm that the coverage you relied on last year still includes your prescriptions and services this year.

How Does Medicare Differ From Medicaid For Long-Term Care Planning?

Medicare is primarily health insurance for seniors. It covers doctor visits, hospital stays, short-term rehabilitation, medical equipment, prescription drugs, and specialist visits. Medicaid, on the other hand, steps in to cover long-term care costs that Medicare does not, such as extended nursing home stays or home health aide services.

In New York, Community Medicaid can cover in-home care, and in very limited cases, assisted living costs. But Medicare typically only pays for up to 100 days of rehabilitation following a hospital stay—and often not in full.

Paul Hyl and Arthur Conte of Hyl Conte Law, PLLC in New York are experienced elder law and estate planning attorneys who have spent years guiding seniors and their families through the complexities of Medicare, Medicaid, and long-term care planning.

Their firm has helped countless New Yorkers protect assets, secure proper care, and avoid costly mistakes during open enrollment and beyond. With compassionate, hands-on support and deep legal insight, they make an overwhelming process manageable and even empowering.

Contact Hyl Conte Law, PLLC today to plan your future with confidence.

Does Medicaid Fill In The Gaps That My Medicare Coverage Would Not Cover?

That’s partially correct, but it depends on the state and the specific program. Medicaid is widely known as health insurance for people with low income, but elder law attorneys often help clients access special Medicaid programs that pay for long-term care, not general health coverage.

When seniors apply for Medicaid through these programs, it’s specifically to cover long-term care expenses such as home aides or nursing home stays. It doesn’t replace their Medicare; it simply supplements it when those needs arise. Essentially, it’s an “as-needed” program. If and when you require those services, you apply for them.

What Types Of Long-Term Care Are Not Covered By Medicare?

Quite a few. Once a person has “plateaued” in rehabilitation—that is, when medical progress has leveled off—Medicare generally stops covering the stay, even if the patient still needs care or doesn’t feel ready to return home. That means if you remain in a facility for custodial care, or you simply need ongoing help rather than medical rehabilitation, Medicare won’t cover those costs.

In short, Medicare focuses on short-term medical needs such as doctor visits, hospitals, specialists, and short rehab stays. Anything beyond that, such as long-term nursing or assisted living, usually requires Medicaid or private payment.

When Should I Consult An Elder Law Attorney About Medicare And Long-Term Care Planning?

Most people begin thinking about Medicare when they turn 65, unless they’re still working and have employer coverage. At that point, they must decide between Medicare Advantage Plans, which are usually low-cost ($0 or minimal premiums) but with more restrictions on coverage, or Medicare Supplement Plans, generally higher monthly cost, but broader and more flexible coverage. That decision typically coincides with retirement, whether that’s at 65, 68, or 70.

Our office often brings in Medicare specialists to guide clients through those choices. From our side, we focus on long-term care planning, making sure clients can qualify for Medicaid if they ever need it in the future. The ideal time to start these conversations is around retirement—or even earlier, around age 55 or 60. My rule of thumb:

The best time to plan was yesterday. The next best time is now.

Early planning gives you more options and prevents rushed, costly decisions in an emergency.

Notes From The Field : Emotionally Challenging Conversations & Planning For Future Care Needs

One case that stands out involved a wife and her adult children meeting with me about her husband, who was in a nursing home. Medically, he was well enough to go home, but when he had lived there before, he fell back into unhealthy habits with a poor diet, missed medications, and frequent hospital stays. At 86, his wife simply couldn’t manage his care alone. So, while it felt unnecessary to keep him in the nursing home, everyone ultimately agreed it was the safest decision.

These discussions are the hardest—when the person doesn’t want to stay, but going home could mean ending up back in crisis within weeks. Believe it or not, many clients actually become healthier in nursing homes because they receive medications consistently and eat balanced meals. At home, it’s all too easy to slip into old habits.

I’ve seen this in my own family as well. My wife’s grandfather went through a cycle of poor diet and repeated hospital stays before his family finally made the difficult choice for long-term care. It’s never easy, but sometimes it’s the right call.

Still Have Questions? Ready To Get Started?

For more information on Medicare open enrollment 2025 in New York, an initial consultation is your next best step. Get the information and legal answers you are seeking by calling (631) 483-7796 today.