Enrolling in a Medicare Savings Program or Medicaid in New York: A Practical Guide (2026)

The Main Programs Available in New York

1) Qualifying Individual (QI)

The QI program is designed to help with one big monthly Medicare cost:

• Covers your Medicare Part B premium

• May provide up to three months of retroactive reimbursement for Part B premiums (only for premiums paid up to three months before your MSP effective date, and within the same year as that effective date)

• You cannot have both QI and Medicaid at the same time

2) Qualified Medicare Beneficiary (QMB)

The QMB program is one of the most protective MSP options because it helps with more than just premiums:

• Pays Medicare premiums

• Protects you from being billed for Medicare cost-sharing (deductibles, coinsurance, and copays). Providers are not allowed to charge you for Medicare-covered services if you’re in QMB—whether you use Original Medicare providers or in-network providers in your Medicare Advantage plan.

• You can have both QMB and Medicaid

3) Medicaid

Medicaid is health coverage for eligible New Yorkers with limited income and assets. If you have both Medicare and Medicaid:

• Medicare pays first for services it covers

• Medicaid may help cover Medicare cost-sharing, including coinsurance and copayments

• Medicaid may cover services Medicare typically doesn’t, such as certain dental and/or vision care

• You may also qualify for QMB, which can pay your Part B premium

• If your income is above the standard limits but you still need help, you may qualify through a Medicaid spend-down (your local Medicaid office can explain how this works)

Denied? You Have the Right to Appeal

If you’re denied and told you don’t qualify for an MSP in New York, you have the right to request a fair hearing to challenge the decision.

New York 2026 Monthly Income Limits and Asset Limits

Gross monthly income limits (New York)

Asset limits (New York)

Important notes:

• New York may exclude certain health insurance premiums from your income when determining MSP eligibility. For example, if you pay for Medigap or other secondary insurance, you may be able to subtract that premium from your gross monthly income to qualify.

• Sometimes part of your Part D premium can also be deducted.

• However, the Part B premium ($202.90) taken from your Social Security cannot be used as an income disregard.

Income limits are tied to the Federal Poverty Level (FPL), which is updated each year (typically in February or March). Until updated figures are released, eligibility is based on the current listed limits.

How to Apply for a Medicare Savings Program in New York

If you meet the income guidelines and live in New York, you can apply in a few ways:

• Medicare Rights Center can help you apply: 800-333-4114

• Click here to apply for MSP online.

• Or contact your local Medicaid office (Department of Social Services) to request an application by mail or apply in person

• To locate your local office, call the Medicaid Helpline: 800-541-2831

Good to Know: MSP Enrollment Can Trigger Extra Help Automatically

If you enroll in an MSP, you will automatically receive Extra Help, the federal program that helps pay costs associated with Medicare prescription drug (Part D) coverage.

Documents You’ll Likely Need for Your Application

When you apply, you’ll usually need to submit a signed application plus copies of items such as:

• Social Security card

• Medicare card

• Proof of identity/status (birth certificate, passport, or green card)

• Proof of address (for example, an electric or phone bill)

• Proof of income (such as an SSA award letter, tax return, or pay stub)