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New York Medicare cost help
Last updated: 28 September 2026
New York’s Medicare Savings Program can pay the Medicare Part B premium for people who meet the state’s income rules. Qualified Medicare Beneficiary (QMB) can also protect you from Medicare Part A and Part B deductibles, coinsurance, and copayments for Medicare-covered care. New York’s QMB and Qualifying Individual (QI) limits are much higher than the basic federal limits, and New York does not use an asset test for QMB or QI.
Bottom Line
For 2026, New York’s QMB monthly income limit is $1,856 for one person and $2,509 for a couple. QI goes up to $2,494 for one person and $3,375 for a couple. These figures include New York’s standard $20 income disregard. There is no resource test for QMB or QI. If your income is close to a limit, apply instead of ruling yourself out.
The fastest statewide online route is NY State of Health. Paper MSP applications go to your local social services district. New York City residents can also use HRA and ACCESS HRA.
Start Here
- Check the New York limits. Use the state’s 2026 MSP chart, not a national chart.
- Apply even if close. New York uses Medicaid budgeting rules, and some income may not count the way you expect.
- Get free help if needed. HIICAP can screen you, explain notices, and help with QMB billing problems.
| Your situation | Best first step | Why |
|---|---|---|
| You want to apply online | Use NY State of Health | New York now lists MSP applicants among the groups who can apply through the state marketplace. |
| You want a paper application | Use DOH-4328 | The state MSP page directs paper applications to the local social services district. |
| You live in New York City | Use ACCESS HRA or HRA | NYC HRA accepts Medicare Savings Program applications from Medicare beneficiaries and older or disabled residents. |
| You got a QMB bill | Challenge the bill | Federal law bars providers from billing QMB members for Medicare-covered Part A and Part B cost sharing. |
Need Help Right Now?
If you have QMB and received a bill: Do not ignore a collection notice, but do not assume the bill is valid. CMS says Medicare providers and suppliers cannot bill QMB members for Medicare-covered deductibles, coinsurance, or copayments. Ask the provider to check your QMB status and correct the account. The CMS QMB page explains the protection.
If your Part B premium is still being deducted after approval: Keep your MSP approval notice and ask the agency that approved your case whether the Medicare buy-in was sent. The update can take time to reach Social Security.
What Has Changed
For this September 2026 update, the 2026 QMB and QI dollar limits remain the same as the figures New York published in the spring. The main practical update is clearer application routing: New York’s current Medicaid application guidance says Medicare Savings Program applicants can apply through NY State of Health, while paper applications still go to the local social services district. New York City residents can continue to use HRA and ACCESS HRA.
This update also clarifies QDWI. New York’s 2026 HIICAP counselor guide lists $2,680 for one person and $3,627 for a couple for QDWI, and separately says earned-income disregards will likely apply. The federal screening table shows higher effective amounts because it builds in earned-income disregards. A working person with a disability should not self-deny based only on the simple New York table.
There is also a newer processing change. New York’s August 2026 memo list includes a transition of MSP determinations triggered by Social Security Extra Help data into the Medicaid Eligibility Client Management system. This matters if you applied for Extra Help and then receive a separate New York MSP or Medicaid notice.
What New York MSP Pays
A Medicare Savings Program is Medicaid-administered help with Medicare costs. The national Medicare MSP page describes four federal MSP categories, but states can use higher income limits and different counting rules. New York’s rules are more generous than the basic federal QMB and QI limits.
For most older New Yorkers, the two main levels are QMB and QI. New York no longer uses Specified Low-Income Medicare Beneficiary (SLMB) as a separate MSP level. The 2026 HIICAP counselor guide says SLMB was absorbed into New York’s expanded MSP structure in 2023.
New York also has Qualified Disabled and Working Individual (QDWI) for a much smaller group of people under 65 who returned to work and lost premium-free Part A because of work.
If you want a broader explanation before applying, our national MSP guide explains how the program categories work. You can also use our MSP and Extra Help checker as a screening tool. It does not make an eligibility decision.
2026 New York Income Limits
The New York Department of Health lists the following 2026 figures. The state chart shows the regular income amount and then adds the standard $20 general income disregard. The figures below use the final amounts that include that $20 disregard.
| Program | One person | Couple | Resource rule |
|---|---|---|---|
| QMB | At or below $1,856/month | At or below $2,509/month | No resource test |
| QI | $1,857–$2,494/month | $2,510–$3,375/month | No resource test |
| Full Medicaid for dual eligibles | At or below $1,856/month | At or below $2,509/month | $33,038 single; $44,796 couple |
These are screening figures, not a promise of eligibility. The agency applies New York Medicaid income-counting rules. If your income is only a little above a number, ask for a formal budget instead of stopping at the chart.
New York’s MSP program page says there is no resource test for the main MSP programs. That means savings in a bank account, retirement funds, or other assets do not by themselves block QMB or QI. Full Medicaid is different and can have a resource limit.
The standard Medicare Part B premium is $202.90 per month in 2026, according to the CMS 2026 premium notice. If an MSP begins paying Part B, that premium generally stops being withheld from Social Security after the buy-in is processed.
QMB, QI, and QDWI in Plain English
Qualified Medicare Beneficiary (QMB)
What it pays: QMB can pay your Part B premium and, if needed, your Part A premium. It also covers Medicare Part A and Part B deductibles, coinsurance, and copayments for Medicare-covered items and services.
Who may qualify: A Medicare beneficiary whose countable income is within New York’s QMB level. You can have QMB by itself or QMB together with full Medicaid.
Reality check: QMB protection is powerful, but it does not turn a non-covered service into a Medicare-covered service. If a provider bills you, first ask what the charge is for and whether Medicare covered the service.
Our QMB billing guide gives a step-by-step response for improper bills, collections, and refund requests.
Qualifying Individual (QI)
What it pays: QI pays the Medicare Part B premium. It does not pay Medicare deductibles or coinsurance.
Who may qualify: A person with Medicare Part A whose income is above QMB but within New York’s QI range. New York says a person cannot receive QI and Medicaid at the same time.
Retroactive help: The 2026 HIICAP guide says QI may reimburse up to three months of Part B premiums before the MSP effective date, but only within the same calendar year.
Extra Help: MSP enrollment also brings automatic Extra Help for Medicare Part D prescription costs. Our Extra Help guide explains the drug-cost assistance in more detail.
Qualified Disabled and Working Individual (QDWI)
What it pays: QDWI pays the Medicare Part A premium only.
Who may qualify: Generally, a person under 65 who has a disability, is working, and lost premium-free Part A because of returning to work. New York’s 2026 HIICAP guide lists resource limits of $4,000 for one person and $6,000 for a couple.
Income warning: The same New York guide lists $2,680 for one person and $3,627 for a couple as its 2026 QDWI monthly figures, while also saying earned-income disregards likely apply. The federal QDWI screening rules show higher effective limits because earned-income exclusions are built into the federal screening figure. If you work, ask the Medicaid worker to budget your actual earnings. Do not reject yourself from QDWI based on gross wages alone.
If QDWI may fit your situation, our New York disability guide can help you find other disability-related benefits and local services.
Where to Apply in New York
New York now has more than one valid entry point. The current state Medicaid application guide says Medicare Savings Program applicants are among the non-MAGI groups who can apply through NY State of Health. The 2026 MSP page also says paper applications can be printed and mailed to the local social services district.
| Route | Best for | What to do |
|---|---|---|
| NY State of Health | Statewide online application | Apply online or call 1-855-355-5777. TTY: 1-800-662-1220. |
| County DSS | Paper application or existing local case | Use the local DSS directory to find the right county office. |
| NYC HRA | New York City Medicare beneficiaries | Apply through ACCESS HRA, call 1-888-692-6116, or use an HRA Medicaid office. |
New York City’s HRA health page says people with Medicare, people age 65 or older, and people with disabilities can apply through HRA. The ACCESS HRA portal also supports Medicare Savings Program applications.
If you want a paper MSP-only application, use Form DOH-4328. The state’s application instructions explain the documents to send, spouse questions, and signature requirements.
If you already have Medicaid: Do not assume a new online MSP application is always the right route. A September MECM update from New York Legal Assistance Group says people whose existing Medicaid case is still held by LDSS or HRA should apply for MSP through that office. It also reports problems in some cases when a new MSP case was created in the newer state system. If you receive a notice that your Medicaid is closing after an MSP or Extra Help action, contact the office handling your Medicaid and HIICAP promptly, and follow the appeal deadline on the notice.
Our New York portal guide can help if you are unsure which New York benefits website handles a separate program.
How to Apply Without Wasting Time
- Choose the right route. Online applicants can start with NY State of Health. NYC residents can also use ACCESS HRA. Paper applicants should use the local district listed for their county.
- Ask for a full MSP screen. You do not need to decide whether you are QMB or QI. New York budgets the case and assigns the level that fits the rules.
- Report spouse information. If you are married and living with your spouse, the state instructions require both self and spouse information even if only one spouse is applying.
- Sign the application. The paper form has the signature section on the back. An unsigned paper application can delay the case.
- Keep proof of submission. Save a copy, upload receipt, fax confirmation, or mailing receipt.
Documents to gather
- Front and back of your Medicare card.
- Proof of date of birth.
- Proof of New York residence, such as a recent utility bill, lease, rent receipt, property tax record, or mortgage statement.
- Proof of income, including Social Security, pension, wages, veterans benefits, unemployment, rental income, or other regular income.
- Proof of other health insurance premiums you pay, such as Medigap or another health plan premium.
- Current immigration documents if you are not a U.S. citizen.
- Spouse documents when required.
- Any old MSP notice, denial, Medicare bill, or collection notice related to the problem you want fixed.
After Approval: Premiums, Extra Help, and Bills
After MSP approval, the Part B premium may not stop coming out of Social Security immediately. Keep your approval notice. If the deduction continues, ask whether the Medicaid agency sent the Medicare buy-in and whether a refund is expected.
MSP enrollment also gives automatic Extra Help with Medicare Part D drug costs. The official Extra Help page explains 2026 drug-plan costs for people who receive the subsidy.
New York residents age 65 or older may also qualify for the Elderly Pharmaceutical Insurance Coverage program. Check the official EPIC eligibility rules. EPIC and MSP can work together.
If you have QMB, CMS says providers and suppliers must not bill you for Medicare Part A or Part B cost sharing for covered items and services. This protection applies in Original Medicare and Medicare Advantage. If a bill was sent to collections, ask the provider to correct the account and recall the collection if the balance is prohibited QMB cost sharing.
Reality Checks
- A chart is only a screen. Income counting can be more complicated than adding monthly checks. Apply if you are close.
- QMB and QI have no asset test. Full Medicaid and QDWI can still have resource limits.
- QI and Medicaid do not go together. If you already have Medicaid or a spenddown, ask how a QI determination would affect your coverage.
- QMB is not retroactive in the same way as QI. New York’s HIICAP guide says QMB starts in the month after the month of application, while QI can have limited premium reimbursement within the same calendar year.
- SNAP can change later. The HIICAP guide warns that when MSP starts paying Part B, the medical-expense deduction used for SNAP can change at recertification. The loss is not dollar for dollar.
- Full Medicaid is separate. MSP can pay Medicare costs without giving you full Medicaid dental, home care, or long-term care benefits.
Common Mistakes to Avoid
- Using the federal MSP chart instead of New York’s higher 2026 limits.
- Assuming savings make you ineligible for QMB or QI.
- Not applying because income is a little over the chart.
- Leaving spouse questions blank when you are married and living together.
- Sending an unsigned paper application.
- Throwing away the approval or denial notice.
- Paying a QMB cost-sharing bill without checking whether the bill is prohibited.
- Appealing through the wrong system. The appeal route depends on which agency made the decision.
Denied, Delayed, or Overwhelmed
If you were denied: Read the notice before doing anything else. Ask for the exact income budget and the reason for denial. A missing document problem is different from a true income decision.
If LDSS or HRA made the decision: New York’s Office of Temporary and Disability Assistance handles fair hearings. Use the fair hearing request page or call 1-800-342-3334. Follow the deadline printed on your notice.
If NY State of Health made the decision: Use the Marketplace appeal process instead. The NY State forms page includes the appeal request form, and customer service is 1-855-355-5777.
If you hear nothing: The state’s MSP instructions say the local district should send a Notice of Action within 45 days after an application. If you are near or past that point, call the office that has your case and ask whether the application was registered and whether proof is missing.
If you need someone to help you understand the notice before you appeal, HIICAP can help with Medicare-related issues and can point you toward legal assistance when needed.
Backup Options if MSP Is Not Enough
- Extra Help: You can apply for Extra Help separately if MSP is delayed or denied and you still need prescription assistance.
- Full Medicaid: Ask for a Medicaid screen if you need services MSP does not provide, such as some dental care, home care, or long-term services. For help comparing care costs, see our New York home care guide and New York assisted living guide.
- EPIC: New York’s prescription program may help eligible residents age 65 or older with Part D costs.
- HIICAP counseling: A counselor can review Medicare Advantage, Part D, Medigap, MSP, and Extra Help together.
- Other senior benefits: Our New York benefits guide covers food, housing, utilities, home repair, and other assistance. For state-specific tax topics, see our New York senior tax guide.
Official and Local Resources
- New York Medicaid Helpline: 1-800-541-2831.
- NY State of Health: 1-855-355-5777; TTY 1-800-662-1220.
- HIICAP: 1-800-701-0501. The HIICAP program page explains the free Medicare counseling service.
- NY Connects: 1-800-342-9871. The NY Connects page helps older adults and people with disabilities find local long-term services and supports.
- Local aging help: Our New York aging offices guide can help you find the aging agency serving your county.
Phone scripts
Application route:
“I have Medicare and want to apply for the Medicare Savings Program. Should I file through NY State of Health, my local DSS, or HRA? Where should I send my proof?”
Income budget:
“My income is close to the limit. Please budget the case instead of screening me out by phone. Are there any income disregards that apply to me?”
QMB bill:
“I am enrolled in QMB. This bill looks like Medicare cost sharing. Please verify my QMB status, correct the balance, and recall it from collections if needed.”
Delayed case:
“I applied for MSP on [date]. Has my application been registered? What proof is missing? Which office has the case, and when should I expect a written notice?”
Resumen en Español
En Nueva York, el Programa de Ahorros de Medicare puede pagar la prima de la Parte B. QMB también puede cubrir deducibles, coseguro y copagos de servicios cubiertos por Medicare. Para 2026, el límite mensual de QMB es $1,856 para una persona y $2,509 para una pareja. El límite máximo de QI es $2,494 para una persona y $3,375 para una pareja. Nueva York no usa una prueba de recursos para QMB o QI.
Puede comenzar por NY State of Health al 1-855-355-5777. En la Ciudad de Nueva York también puede usar ACCESS HRA o llamar a HRA al 1-888-692-6116. Tenga a mano su tarjeta de Medicare, prueba de ingresos, prueba de domicilio y cualquier aviso o factura que necesite revisar. Si ya tiene QMB y recibe una factura por deducibles, coseguro o copagos de un servicio cubierto por Medicare, pida al proveedor que revise su estado de QMB antes de pagar.
Frequently Asked Questions
Does New York still have SLMB?
Not as a separate current New York Medicare Savings Program. New York’s 2026 HIICAP guide says SLMB was absorbed into the state’s 2023 MSP expansion. Most older applicants are screened for QMB or QI.
Is there an asset limit for QMB or QI?
No. New York does not use a resource test for QMB or QI. Full Medicaid and QDWI can still have resource limits.
Can QMB stop Medicare bills?
QMB protects you from Medicare Part A and Part B deductibles, coinsurance, and copayments for Medicare-covered items and services. It does not erase charges for services Medicare did not cover.
Can I have QI and Medicaid?
No. New York says a person cannot receive QI and Medicaid at the same time. If you already have Medicaid or a spenddown, ask for a budget review before making changes.
How long should an MSP decision take?
New York’s MSP instructions say the local district should send a Notice of Action within 45 days after an application. If you applied through NY State of Health, follow the status and appeal instructions on your Marketplace notice or account.
Does MSP automatically give Extra Help?
Yes. New York and Medicare both state that MSP enrollment gives automatic Extra Help for Medicare Part D prescription drug costs.
About This Guide
Sources: This guide uses official federal, New York State, New York City, Medicare, and other high-trust sources linked in the article.
Editorial note: This guide is produced under the GFS Editorial Standards using official and other high-trust sources. GFS is not affiliated with any government agency and is not a substitute for official agency guidance. Individual eligibility outcomes cannot be guaranteed.
Corrections: Despite careful verification, errors may occur. Email info@grantsforseniors.org with corrections.
Disclaimer: This article is for informational purposes only and is not legal, financial, medical, tax, disability-rights, immigration, or government-agency advice. Program rules, policies, funding, and availability can change. Confirm current details directly with the responsible official program before acting.
Last updated: 28 September 2026 · Next review: 28 January 2027
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