New York Medicare Savings Programs pay some or all of a low-income Medicare beneficiary's premiums and cost-sharing through the state Medicaid program. The broadest tier, QMB, eliminates the Part B premium and every Medicare deductible and copay.
What Are 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. They are not budget items states can skip: QMB, SLMB, and QI are mandatory eligibility groups under Title XIX of the Social Security Act, so every state plan, including New York's, must cover them.
New York State Medicaid administers these programs through the Department of Health (DOH). Applications in New York City are handled by the Human Resources Administration (HRA); applications outside the five boroughs go through the Local Department of Social Services (LDSS) in each county. Enrollment can also be started through NY State of Health, the official health plan marketplace.
MSPs use the SSI-related income methodology, not the MAGI rules that govern marketplace coverage. Two disregards reduce what counts as income: a $20/month general income disregard applied to unearned income first, and a $65 + half of remaining earned income disregard for working seniors. The income bands below reflect the $20 disregard.
QMB: Qualified Medicare Beneficiary
QMB is the broadest tier. Enrollment pays:
- The Medicare Part A premium (applicable only if you have fewer than 40 work quarters; most seniors qualify for premium-free Part A)
- The Medicare Part B premium ($202.90/month in 2026 per CMS)
- The Part A inpatient hospital deductible ($1,736 in 2026)
- The Part B annual deductible ($283 in 2026)
- All Medicare coinsurance and copays on every covered service
2026 New York QMB income limits: at or below $1,350/month for a single person, or at or below $1,823/month for a couple. These figures reflect 100% of the Federal Poverty Level with the $20 general income disregard applied.
Resource limit: $9,950 for one person, $14,910 for a couple. The primary residence and one vehicle are excluded from this count entirely.
For a single New York senior on Social Security, QMB can mean more than $3,000 per year in saved premiums, deductibles, and copays. Every QMB enrollee is also automatically deemed eligible for full Part D Extra Help.
| Household size | Monthly income limit | What QMB pays |
|---|---|---|
| Single | $1,350 | Part A + Part B premiums + all cost-sharing |
| Couple | $1,823 | Part A + Part B premiums + all cost-sharing |
SLMB: Specified Low-Income Medicare Beneficiary
SLMB pays one benefit: the Medicare Part B premium. At the 2026 standard rate of $202.90/month, that is worth $2,434.80 per year.
2026 New York SLMB income limits: $1,351 to $1,616/month for a single person, $1,824 to $2,188/month for a couple.
Resource limit: same as QMB: $9,950 single, $14,910 couple.
SLMB does not pay deductibles or copays, but for a beneficiary with relatively few medical claims, the Part B premium elimination is the dominant cost. SLMB also confers automatic Part D Extra Help, which reduces generic prescription copays to $5.10 and brand-name copays to $12.65, with a $0 deductible and $0 premium on a benchmark plan.
| Household size | Monthly income range | What SLMB pays |
|---|---|---|
| Single | $1,351-$1,616 | Part B premium only |
| Couple | $1,824-$2,188 | Part B premium only |
QI: Qualifying Individual
QI pays the Part B premium only, the same as SLMB, but at a higher income band: $1,617 to $1,816/month for a single person, $2,189 to $2,457/month for a couple (2026 figures).
Two structural differences from QMB and SLMB:
- First-come, first-served. QI is funded through a capped federal allotment. New York allocates enrollment on a first-come, first-served basis, with a preference for prior-year QI enrollees. QMB and SLMB are entitlements with no enrollment cap; QI is not.
- Mutually exclusive with full Medicaid. Anyone eligible for a full-benefit Medicaid category cannot be on QI. They would instead qualify for QMB-Plus or SLMB-Plus, which layer full Medicaid on top of MSP cost-sharing protection.
Like SLMB, QI enrollment triggers automatic Part D Extra Help.
| Household size | Monthly income range | What QI pays |
|---|---|---|
| Single | $1,617-$1,816 | Part B premium only (capped allotment) |
| Couple | $2,189-$2,457 | Part B premium only (capped allotment) |
Full Comparison: New York 2026 Medicare Savings Program Income Limits
| Program | Single monthly income limit | Couple monthly income limit | What it pays |
|---|---|---|---|
| QMB | up to $1,350 | up to $1,823 | Part A + Part B premiums + all cost-sharing |
| SLMB | $1,351-$1,616 | $1,824-$2,188 | Part B premium only |
| QI | $1,617-$1,816 | $2,189-$2,457 | Part B premium only (capped allotment) |
Income limits reflect 100% FPL (QMB), 100-120% FPL (SLMB), and 120-135% FPL (QI) with the $20 general income disregard applied. Resource limit for all three: $9,950 single / $14,910 couple.
What Counts as a Resource and What Does Not
The resource test is less restrictive than it first appears because major assets are excluded:
Excluded (don't count):
- Primary residence, regardless of value
- One vehicle, regardless of value
- Household goods and personal effects
- Prepaid burial arrangements and a burial fund up to $1,500 per person
Counted:
- Checking and savings account balances
- Stocks, bonds, certificates of deposit, mutual funds
- A second vehicle or second home
- Non-exempt cash-value life insurance above the threshold
Many New York seniors assume their home bars them from qualifying. It does not. A QMB applicant in a paid-off home can qualify as long as their bank and investment balances fall within the $9,950 limit.
The QMB Billing Prohibition
Federal law (42 USC section 1396a(n)(3)(B)) prohibits any Medicare provider from billing a QMB enrollee for Medicare cost-sharing. This covers Original Medicare and Medicare Advantage providers alike, whether or not they participate with New York Medicaid.
In plain terms: if you are a QMB enrollee and receive a bill for a Medicare deductible, coinsurance, or copay, do not pay it. The provider is prohibited from collecting it.
If you receive such a bill:
- Tell the provider you have QMB and cite federal law.
- Show your Medicaid eligibility notice or Medicare card with QMB indicator.
- Call 1-800-MEDICARE (1-800-633-4227) to file a complaint.
- Contact the New York State Health Insurance Information, Counseling and Assistance Program (HIICAP) at 1-800-701-0501 for free help disputing the bill.
A provider who billed a QMB enrollee must recall the bill from collections and refund any amount already collected.
Part D Extra Help / Low-Income Subsidy
Every QMB, SLMB, and QI enrollee in New York is automatically deemed eligible for full Part D Extra Help (also called the Low-Income Subsidy). No separate application is required.
Under the 2026 Part D benefit structure:
- $0 Part D premium on a benchmark plan
- $0 annual deductible
- $5.10 per generic prescription
- $12.65 per brand-name or preferred multi-source drug
- $0 in copays after the $2,100 annual out-of-pocket cap
For a senior filling six prescriptions per month, Part D Extra Help can represent $1,500 to $2,500 in annual drug-cost savings on top of the Part B premium savings from SLMB or QI.
CMS receives the deeming information from New York each month after MSP enrollment. If you are not already in a Part D plan, CMS will auto-assign you to a zero-premium benchmark plan. You can switch to any other Part D plan during the annual open enrollment period without losing LIS status.
How to Apply for New York Medicare Savings Programs
New York offers several application pathways:
1. NY State of Health (NY's official marketplace) Apply online at nystateofhealth.ny.gov. NY State of Health accepts applications for Medicaid including MSPs year-round. This is generally the fastest route for applicants who are comfortable with an online application.
2. HRA in New York City Residents of the five boroughs apply through the Human Resources Administration. Apply online via ACCESS HRA, by phone at 718-557-1399, or in person at an HRA office. HRA has a dedicated Medicaid enrollment division experienced in MSP cases.
3. LDSS (Local Department of Social Services) outside NYC Upstate and Long Island residents apply through their county LDSS. Locate your county office at the DOH office directory. Bring your Medicare card, Social Security number, proof of income, and bank statements.
4. Through SSA (Social Security Administration) Applying for Part D Extra Help at your local Social Security office using Form SSA-1020 generates a federal referral to New York Medicaid. SSA is required by federal law (42 USC section 1320b-14) to forward the application to the state, using your SSA filing date as the protected date.
5. Free help through HIICAP New York's Health Insurance Information, Counseling and Assistance Program (HIICAP) provides free, unbiased Medicare counseling and can assist with MSP enrollment. Reach HIICAP statewide at 1-800-701-0501 or find a local counselor through the HIICAP directory.
Documents to Gather Before You Apply
- Medicare card (showing your Medicare Beneficiary Identifier / MBI)
- Social Security card or proof of Social Security number
- Most recent SSA benefit award or COLA letter
- Recent bank and investment account statements
- Pension or annuity statements, if applicable
- Proof of New York residency (utility bill, lease, or mortgage statement)
Determination Timeline and Effective Dates
New York must process non-disability MSP applications within 45 days under 42 CFR section 435.912. Disability-related cases have a 90-day deadline.
- QMB: coverage begins the first day of the month after the month DOH approves the application. Federal law (42 USC section 1396a(e)(8)) prohibits retroactive QMB coverage. Apply early.
- SLMB and QI: up to three months of retroactive coverage is available under 42 CFR section 435.915 if you were eligible during those months. Apply even before you have every document ready; your filing date is the protected date.
After approval, DOH sends a written notice. For QMB, a state buy-in notice goes to CMS, which stops deducting the Part B premium from your Social Security check the following month. For SLMB/QI, any previously deducted premiums for retroactive months are refunded by SSA as a lump sum.
New York-Specific Notes
New York coordinates its MSP program with the state's robust Medicaid long-term care ecosystem. QMB enrollees who later develop 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 MSP operate compatibly.
New York also has a Pooled Income Trust program that allows Community Medicaid applicants with excess income to qualify for home care by depositing surplus income into a trust. This mechanism is distinct from the MSP programs described here but is relevant for seniors who qualify for both MSP and Community Medicaid.
For seniors with income between the MSP limits and the Community Medicaid threshold of $1,836/month, the MSP programs represent the primary federal benefit available. Above $1,836, the Medicaid Excess Income (spend-down) program and Pooled Income Trusts become relevant.
Frequently Asked Questions
A New York Medicare beneficiary with monthly income at or below $1,350 (single) or $1,823 (couple) and countable resources at or below $9,950/$14,910. The primary home and one vehicle are excluded from resources. QMB pays Part A and Part B premiums plus all Medicare cost-sharing.
Yes. An applicant with income at or below $1,836/month (the 2026 Community Medicaid threshold) may qualify for both QMB (income at or below $1,350) and Community Medicaid, which provides home-based personal care services. The two benefits are compatible.
Yes. QI is funded through a federal allotment that is capped each year. New York enrolls QI applicants on a first-come, first-served basis, with a preference for applicants who were enrolled in QI the prior year. QMB and SLMB are federal entitlements with no enrollment cap.
No. All QMB, SLMB, and QI enrollees are automatically deemed eligible for full Part D Extra Help. New York forwards the deeming information to CMS monthly. If you are not in a Part D plan, CMS will auto-assign you to a zero-premium benchmark plan.
Do not pay. Federal law prohibits any Medicare provider from billing QMB enrollees for Medicare cost-sharing. Contact 1-800-MEDICARE and HIICAP at 1-800-701-0501 for free help disputing the bill.
Yes, for up to three months if you were eligible during that window. QMB has no retroactive coverage: it begins the month after approval. File SLMB and QI applications as early as possible to protect the retroactive window.
Learn More
- New York Medicaid Eligibility and Income Limits
- How to Apply for New York Medicaid
- New York Managed Long Term Care
- Understanding the Personal Needs Allowance
- Medicaid Estate Recovery Explained
Find personalized help applying for New York Medicare Savings Programs at brevy.com.
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.