Income Too High for the Medicare Savings Program in New York
When the Numbers Say No — But Maybe They Shouldn't
Your parent earns $1,880 a month from Social Security. The 2026 QMB income limit in New York is $1,856 for an individual. On paper, they are $24 over. Before you close the browser tab, there are several paths worth checking.
New York already runs one of the most generous MSP programs in the country — QMB covers individuals up to 138% of the Federal Poverty Level, and the state eliminated the asset test entirely in 2008. But the income line is still a line, and families who are $20 or $50 over often assume there is nothing they can do.
Check Whether QI Applies
If your parent's income exceeds the QMB threshold but stays below $2,494 a month (individual) or $3,375 (couple), they qualify for QI — the Qualifying Individual program. QI does not cover deductibles, coinsurance, or copays the way QMB does, but it pays the full $202.90 monthly Part B premium. That is $2,434.80 a year back in their pocket.
QI also triggers automatic full Extra Help for Part D prescription drugs — zero deductible, $5.10 generics, $12.65 brand-name copays, and the Part D late enrollment penalty waived entirely.
For a parent whose income is $1,860 to $2,494, QI is not a consolation prize. It is real money.
Medigap Premiums and MSP Eligibility
New York's standard MSP intake uses the baseline SSI disregards; a Medigap premium is not a standard MSP income deduction. Premiums for supplemental health insurance can be considered in specific non-MAGI Medicaid spend-down calculations and rebudgeting assessments. A $180 Medigap premium therefore does not by itself bring $2,010 in gross income under the QMB limit for MSP eligibility.
If your parent is close to an MSP limit, apply using the MSP income rules and request the district's budget calculation if denied. If they also need full Medicaid, ask the district whether a separate spend-down calculation applies.
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EPIC Covers Higher Incomes
If your parent's income exceeds even the QI limit, New York's EPIC program — the Elderly Pharmaceutical Insurance Coverage program — covers individuals with annual income up to $75,000 and couples up to $100,000. EPIC does not pay the Part B premium, but it provides secondary prescription drug coverage that wraps around Medicare Part D, cutting pharmacy copays to $3–$20 per prescription.
EPIC has two tiers. The Fee Plan (income up to $20,000 single / $26,000 married) charges a small annual fee of $8–$300 and pays the Part D plan premium up to $58.82 a month. The Deductible Plan (income $20,001–$75,000 single) requires an annual deductible before EPIC copays kick in but charges no membership fee.
For a parent whose income is $2,500–$6,000 a month, EPIC is the primary drug-cost relief available.
Apply Anyway — Let the Caseworker Do the Math
If your parent's income is close to the QMB or QI line, submit the DOH-4328 form. There is no application fee and no penalty for being denied. Caseworkers are required to check whether any income disregards bring the applicant under the threshold. The worst outcome is a denial letter that explains the exact budget calculation — which you can then review for errors.
Common intake errors include counting net Social Security (after the Part B deduction) instead of gross, double-counting pension income, or failing to apply the $20 standard disregard. A denial letter with the budget worksheet is your audit trail.
Annual Updates to MSP Income Limits
Every January, Social Security benefits may increase with the Cost-of-Living Adjustment. New York's updated MSP income figures apply retroactively to January 1 once NYSDOH issues its annual standards. If a January or February decision uses the prior limits, check whether the district applied the updated figures.
If your parent got a denial in January or February based on the prior limits, compare the budget with the updated standards and use the Fair Hearing process if needed.
Next Steps
The New York Medicare Savings Programs, Extra Help & EPIC Guide includes income worksheets that walk through the MSP disregards, a document checklist, and side-by-side QMB-vs-QI comparison tables so you can identify the best fit before filing.
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Download the New York — Medicare Savings Program Eligibility Checklist — a printable guide with checklists, scripts, and action plans you can start using today.