New York Medicare Savings Program: Eligibility, How to Apply, What It Pays
What New York's Medicare Savings Program Actually Covers
The $202.90 monthly Part B premium takes a real bite out of a Social Security check. New York's Medicare Savings Programs — administered through the state Medicaid system — can eliminate that deduction entirely. For qualifying seniors, the state picks up the tab.
New York runs two MSP categories in 2026:
QMB (Qualified Medicare Beneficiary) — for individuals up to 138% of the federal poverty level ($1,856/month gross including the $20 disregard) or couples up to $2,509/month. QMB pays the Part B premium, Part A premium if needed, and all Medicare deductibles, copays, and coinsurance. Doctors and hospitals cannot bill QMB members for cost-sharing — period.
QI (Qualifying Individual) — for individuals earning $1,857–$2,494/month or couples $2,510–$3,375/month. QI pays the Part B premium only, but that is still $2,434.80 a year back in the senior's pocket.
New York also eliminated the SLMB category in 2023. Anyone who would have fallen into SLMB (100–120% FPL) now gets full QMB, which is better coverage.
No Asset Test in New York
This is the fact that changes everything for families who assumed their parent earns too much or has too much saved.
New York dropped the MSP asset test in 2008. Bank accounts, retirement savings, home equity — none of it counts. Only monthly income matters. The federal standard still imposes a $9,950 individual asset limit, but New York opted out. Most families find this out only after they have already talked themselves out of applying.
2026 Income Limits at a Glance
| Program | Individual | Couple |
|---|---|---|
| QMB (138% FPL) | $1,856/month | $2,509/month |
| QI (186% FPL) | $2,494/month | $3,375/month |
These are gross income thresholds after the standard $20 monthly disregard. Health insurance premiums — including Medigap — may further reduce countable income.
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How to Apply
The core application is form DOH-4328, a two-page form designed specifically for MSP:
- New York City residents apply through ACCESS HRA (online portal or mobile app) or at an HRA Medicaid office
- Upstate and Long Island residents apply at the county Department of Social Services or through NY State of Health online
You need proof of income (Social Security benefit letter, pension stubs), a copy of the Medicare card, and proof of New York residency. Because there is no asset test, you do not need bank statements.
For a non-disability application, the agency has 45 calendar days to decide. If a disability determination is required, the period is 90 calendar days. Once approved, both QMB and QI automatically trigger Extra Help for Part D prescription drug costs — no separate application needed.
What Happens After Approval
The state sends a buy-in transaction to CMS, and Social Security stops deducting the Part B premium. This inter-agency handoff typically takes 60–90 days. During that gap, the premium continues coming out of the check, but once the buy-in processes, Social Security deposits a lump-sum refund covering every deduction back to the MSP effective date.
QMB members also gain billing protections: Medicare providers are federally prohibited from sending cost-sharing bills to a QMB enrollee. If a provider bills anyway, the enrollee can dispute it.
The New York Medicare Savings Programs, Extra Help & EPIC Guide covers the full application process, income worksheets, the Part B refund timeline, and what to do when a provider ignores QMB billing rules.
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