New York Medicare Savings Programs 2026: QMB & QI, No Asset Test

New York's Medicare Savings Programs pay the Medicare Part B premium of $202.90 a month in 2026.1 The broader of New York's two benefit levels also covers your Medicare Part A and Part B deductibles, coinsurance, and copays. New York runs these programs through its Medicaid program with two features that make them more generous than the federal floor: no asset limit on either benefit level, and income limits set well above the federal QMB minimum.2

What Are New York Medicare Savings Programs?

Medicare Savings Programs are Medicaid-administered benefits that pay some or all of a low-income Medicare beneficiary's Medicare premiums and cost-sharing. QMB and QI are mandatory Medicaid eligibility groups under section 1902(a)(10)(E) of the Social Security Act, so New York, like every state and the District of Columbia, must cover them.3

New York State Medicaid administers these programs through the Department of Health (DOH). Applications in New York City go through the Human Resources Administration (HRA); applications outside the five boroughs go through the Local Department of Social Services (LDSS) in each county. You can also apply through NY State of Health, the state's official health plan marketplace. Paper Medicare Savings Program applications are mailed to the local Department of Social Services. The statewide Medicaid Helpline is 1-800-541-2831.2

Medicare Savings Programs exist because Medicare itself leaves real cost exposure. In 2026, the Part B standard premium is $202.90 per month, the Part A inpatient hospital deductible is $1,736 per benefit period, and the Part B annual deductible is $283, with 20% coinsurance accruing on most covered services after the deductible is met.1 For a New York resident who qualifies, a Medicare Savings Program pays those costs directly.

New York counts income under the aged, blind, and disabled (ABD) methodology tied to Supplemental Security Income (SSI), not the Modified Adjusted Gross Income (MAGI) rules that govern marketplace coverage.4

New York allows a $20 deduction from an applicant's gross monthly income, so DOH prints each income limit twice, and the difference matters. The plain FPL-percentage figure is the limit applied to your income after deductions. The second figure, printed in a "+ $20" column, is the number to compare your gross monthly income against, and it is the figure used throughout this guide. Other deductions can apply beyond the $20, so income somewhat above these limits does not automatically disqualify you. The Social Security Administration's own guidance is that someone whose income or resources look somewhat higher than a state's limits should still apply.2

QMB: Qualified Medicare Beneficiary

QMB is the more comprehensive of New York's two Medicare Savings Program benefit levels. It pays the Medicare Part A and/or Part B premium, and it covers your Part A and Part B deductibles, coinsurance, and copays.2 It does not cover Part D drug copays; those are handled separately by Part D Extra Help, which QMB enrollment gets you automatically.

The higher figure in each pair is the one to compare your gross monthly income against; the lower one is New York's 138% FPL limit, applied to income after deductions. New York applies no asset limit to QMB.2 Most seniors already have premium-free Part A based on at least 40 quarters of work; QMB pays the Part A premium only for the minority who do not (up to $311 per month with 30 to 39 quarters, or $565 per month with fewer than 30).1

Federal rules deem every QMB enrollee eligible for full Part D Extra Help.2

The QMB Billing Prohibition

Federal law bars any Medicare provider or supplier, including pharmacies, from billing a QMB enrollee for Medicare Part A or Part B cost-sharing, even when Medicaid pays nothing toward it. The prohibition covers Original Medicare and Medicare Advantage providers alike, whether or not they participate with New York Medicaid, under Social Security Act sections 1902(n)(3)(B) and 1866(a)(1)(A).5

If a provider bills you for a Medicare deductible, coinsurance, or copay while you are enrolled in QMB:

1. Do not pay it. Tell the provider you are a QMB enrollee.
2. Show your Medicaid eligibility notice or your Medicare card.
3. Call 1-800-MEDICARE (1-800-633-4227) to report the billing violation.6
4. Contact New York's Health Insurance Information, Counseling and Assistance Program (HIICAP) at 1-800-701-0501 for free help disputing the bill.7

You have no legal liability to make payment to the provider for that service. A provider who bills you anyway is violating its Medicare provider agreement or its obligations under Medicare Part C and may be subject to sanctions, even when Medicaid pays nothing toward the cost-sharing.5

QI: Qualifying Individual

QI pays the Part B premium only, for a New York resident with income above the QMB limit but below 186% FPL. You must already have Medicare Part A to qualify.2

As with QMB, the higher figure in each pair is the one to compare your gross monthly income against, and New York applies no asset limit.2 At the 2026 Part B rate of $202.90 per month, QI returns $2,434.80 over a year to a beneficiary's Social Security deposit.1

Two QI-specific rules matter. First, QI is funded through a capped federal allotment. States select qualifying individuals in the order in which they apply and must limit the number selected so the total stays within the state's allocation, and being selected in one year does not entitle you to assistance the next year, so you must apply again every year to stay in QI. Unlike QMB, QI is not an entitlement: an eligible QI applicant can be turned away for want of funding, while an eligible QMB applicant cannot.8 Second, QI is mutually exclusive with Medicaid: you cannot be eligible for QI and Medicaid at the same time. The QMB benefit level carries no such restriction.2

Like QMB, QI enrollment deems you eligible for full Part D Extra Help.2

What About SLMB in New York?

Federal law defines four Medicare Savings Program groups: QMB, SLMB (Specified Low-Income Medicare Beneficiary), QI, and QDWI (Qualified Disabled and Working Individual). All four are mandatory Medicaid eligibility groups that every state and the District of Columbia must cover.3 New York's Department of Health, however, publishes just two Medicare Savings Program benefit levels on its own MSP page: QMB and QI.2

What matters to you is where New York sets its QMB ceiling. The federal QMB minimum is 100% FPL plus the $20 deduction, which for 2026 is $1,350 a month for an individual and $1,824 for a couple in every state except Alaska and Hawaii. New York's QMB ceiling is 138% FPL, or $1,856 and $2,509.2 In a state that stops QMB at the federal floor, a beneficiary just above it lands in SLMB, which pays the Part B premium only.2 In New York, that same income sits inside QMB, which pays the premiums plus your Part A and Part B deductibles, coinsurance, and copays.

So if you have seen guidance pointing you to "New York SLMB," there is no separate SLMB application to hunt down. File one Medicare Savings Program application through NY State of Health, your county Department of Social Services, or the HRA in New York City, and New York screens you against the benefit levels it runs.2

Full Comparison: New York 2026 Medicare Savings Programs

Both benefit levels use income-only tests with no asset limit, and both deem you eligible for full Part D Extra Help. The dollar limits reset each year when the Federal Poverty Levels update, so confirm the current figures on New York's Medicare Savings Program page or with HIICAP before relying on a specific number.2

New York Has No MSP Asset Test

New York applies no asset limit to either of its two Medicare Savings Program benefit levels. Your savings and checking balances, stocks, bonds, certificates of deposit, mutual funds, a second vehicle, a second home, and cash-value life insurance do not count against eligibility for QMB or QI. Only your monthly income is evaluated.2

Read that as specific to the Medicare Savings Programs, not to Medicaid generally. The same DOH page lists Full Medicaid for Dual Eligibles, which is not one of the two MSP benefit levels, and that category does carry 2026 resource limits of $33,038 for a household of one and $44,796 for a household of two.2

To see how unusual the MSP rule is, compare the federal defaults. The federal Medicare Savings Program resource limits for 2026 are $9,950 for an individual and $14,910 for a couple, and the federal SSI program itself caps countable resources far lower, at $2,000 for an individual and $3,000 for a couple.1,9 The Social Security Administration notes that some states have used their authority to effectively eliminate the resource test for these groups, and New York is one of them.2 A New York applicant with a paid-off home and substantial retirement savings can still qualify for QMB or QI, as long as monthly income falls within the limits.

Part D Extra Help

Enrollment in either New York Medicare Savings Program level qualifies you for full Part D Extra Help, also called the Low-Income Subsidy (LIS): federal rules deem QMB and QI enrollees full-subsidy eligible, so you do not file a separate Extra Help application.2

In 2026, full Extra Help eliminates the Part D deductible entirely.10 It also covers your Part D premium in full if you enroll in a plan at or below your region's low-income benchmark, which Medicare states as a $0 Extra Help plan premium for 2026; if you choose a more expensive plan, you pay the difference between the benchmark and your plan's premium.10 Your copays are capped at $5.10 per generic and $12.65 per brand-name covered drug, and drop to $0 for the rest of the year once your out-of-pocket drug costs reach $2,100.11 For a New York senior filling several prescriptions a month, that can mean hundreds to thousands of dollars in annual drug-cost savings, on top of the Part B premium savings.

One point trips people up. Extra Help has its own federal income limit, below 150% FPL, which is about $1,995 a month for an individual or $2,705 for a married couple in 2026 in the 48 contiguous states and DC (Alaska and Hawaii are higher).11 That is lower than New York's Medicare Savings Program limits, so in New York the Medicare Savings Program is the wider door: if your income is low enough for Extra Help, it is also low enough for QMB or QI, and enrolling in either one gets you the full subsidy automatically. Apply for the Medicare Savings Program first. You can also apply for Extra Help directly with the Social Security Administration (SSA) on Form SSA-1020, at any SSA office or online at SSA.gov. Extra Help isn't available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa.11

How to Apply for New York Medicare Savings Programs

New York offers several application pathways. NY State of Health accepts Medicaid and Medicare Savings Program applications year-round and is generally the fastest route for anyone comfortable applying online.

Once you are approved, New York sets up a state buy-in with CMS under section 1843 of the Social Security Act, and the federal government starts billing the state for your Part B premium instead of deducting it from your Social Security check. Buy-in is established through a state-to-CMS data exchange rather than at the moment of approval, and no published federal figure fixes how long that takes; it varies by state and by case, so you may keep seeing the premium withheld for one or more months after approval. Once buy-in is effective, SSA must refund any premiums deducted for months you are enrolled in buy-in, though the timing of that refund varies. If your premium comes out of a Social Security, RRB, or OPM benefit, that deduction can continue for a month or more, and SSA refunds every month you were covered by buy-in. If instead CMS bills you directly, which it does when you do not receive one of those benefits, keep paying that bill until buy-in is actually in effect: the only exception CMS states to the premium obligation is a state already paying under a buy-in agreement, and unpaid premiums can end your Part B coverage.13

The two benefit levels differ on retroactive coverage. QMB is prospective-only by statute: under section 1902(e)(8) of the Social Security Act it applies to services furnished after the end of the month in which the determination is first made, so it begins the first day of the month after approval and cannot be backdated. QI follows the general Medicaid rule at 42 CFR 435.915 and can be effective up to three months before the month you applied, if you met the eligibility rules in those months.14 File as early as possible to protect that window.

Where to Get Help in New York

New York-Specific Notes

New York coordinates its Medicare Savings Programs with a robust Medicaid long-term-care system. A QMB or QI enrollee who later develops long-term-care needs may qualify for a Managed Long Term Care (MLTC) plan, which provides home-based services through a managed care organization. MLTC and Medicare Savings Programs operate compatibly.

New York's Community Medicaid program is a separate benefit that provides home care and other services, and unlike a Medicare Savings Program it does apply a resource test. On New York's 2026 non-MAGI (SSI-related) standards chart, the Medicaid income level is $1,836 a month for a household of one and $2,489 for a household of two, with a resource limit of $33,038 and $44,796 respectively. Because New York runs a medically needy standard rather than a flat cutoff, income above the level is handled through a spenddown.15 Confirm with your local district which level applies to the specific program you are applying for.

The two can interact. QMB has no restriction against holding Medicaid at the same time, but QI does: you cannot be eligible for QI and Medicaid together.2

Applicants with income above the Community Medicaid level can still qualify for home care by depositing surplus income into a pooled income trust. That mechanism is distinct from the Medicare Savings Programs described here but is often relevant for seniors who qualify for both.

Learn More

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The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.