Medicare and Medicaid in New York
- Last updated
- October 10, 2026
- Read time
- 5 min
Key points
- In 2026, New Yorkers 65 and older can get Medicaid with income up to $1,856 a month, or $2,509 for a couple.
- The 2026 Medicaid savings limit in New York is $33,038 for one person and $44,796 for a couple.
- If your income is higher, the Excess Income program lets Medicaid pay once your medical bills reach a set amount each month.
- New York has three plans that combine both. Medicaid Advantage Plus (MAP) and the Program of All-Inclusive Care for the Elderly (PACE) are for people who need long-term care. Integrated Benefits for Dually Eligible Enrollees (IB-Dual) is for people who don't.
If you're new to this, start with how Medicare and Medicaid work together. This page covers New York: the state's 2026 limits, the spenddown program, its combined plans, and where to apply.
With full Medicaid in New York, the state pays the $202.90 a month Medicare costs you, and most of your copays. Medicaid also pays for home care and rides to medical visits. That can be a big help if getting through the day, or getting to the doctor, has gotten hard. Your county Department of Social Services decides, or New York City's Human Resources Administration (HRA) if you live in the city.
You may qualify if
- You're 65 or older, or have a disability, and live in New York.
- Your income is under $1,856 a month, or $2,509 for a couple.
- Your savings are under $33,038, or $44,796 for a couple. Your home usually doesn't count, and neither does a prepaid funeral plan that can't be canceled.
Not sure you qualify? Apply anyway, because the county makes the call and some of your income may not count. If you would rather not do it alone, a Pair Team advocate can check with you in one call.
Ways to get help in New York when you have Medicare
| Program | Who it is for (2026, one person / couple) | What it pays for |
|---|---|---|
| Full Medicaid | Income up to $1,856 / $2,509. Savings up to $33,038 / $44,796 | The $202.90 a month, your Medicare copays, home care, rides and other Medicaid services |
| Medicaid with excess income (spenddown) | Income over the limit. Same savings limit | Full Medicaid for the rest of the month, once your medical bills reach your excess income |
| Medicare Savings Program only: Qualified Medicare Beneficiary (QMB) or Qualifying Individual (QI) | Income up to $2,494 / $3,375. No savings limit | The $202.90 a month. QMB also pays your copays. See New York Medicare Savings Programs |
These limits are from the New York State Department of Health and include the $20 it does not count.
How does the Excess Income program work?
The Excess Income program works like a monthly deductible. The amount your income is over the limit is your excess income. Once your medical bills for the month reach that amount, Medicaid pays the rest of that month.
The bills can be paid or unpaid, and old unpaid bills count too. You send them to your county office. If you have no bills but need care, you can pay the amount to the county instead. This is called the Pay-In Program.
Ask about a pooled trust too, because money you put into one doesn't count as income, and that can end the spenddown.
What plans combine Medicare and Medicaid in New York?
New York has three plans that combine Medicare and Medicaid, and each gives you both from the same health plan.
- Medicaid Advantage Plus (MAP) is for adults with full Medicaid who need long-term care for more than 120 days.
- PACE is for people 55 and older who need that level of care. It's based at a day center with its own clinic.
- IB-Dual (Integrated Benefits for Dually Eligible Enrollees) is for people who do not need long-term care. It replaced Medicaid Advantage. You keep your Medicaid plan and join its Medicare plan.
New York Medicaid Choice (1-888-401-6582) can tell you what's near you. You can also keep Original Medicare with Medicaid. The Health Insurance Information, Counseling and Assistance Program (HIICAP), New York's free Medicare counseling, can help you compare.
How to apply
- Pick where to apply. If you don't need long-term care, you can now apply through NY State of Health (1-855-355-5777). If you need home care or the Excess Income program, apply at your county Department of Social Services. In New York City, that's HRA: apply online with ACCESS HRA or call 1-888-692-6116.
- Fill out the forms. At the county, the form is DOH-4220. Many people also need Supplement A (DOH-5178A).
- Send proof with your forms. Use copies, not originals, of your ID, income, address and Medicare card, so you keep the originals.
- Wait for the answer. Most decisions come within 45 days, the state says, or 90 if it has to decide about a disability.
- Get free help if you want it. HIICAP counselors are at 1-800-701-0501, and the state Medicaid Helpline is 1-800-541-2831.
If you are turned down
If you're turned down, you can ask for a fair hearing. Call the state at 1-800-342-3334, or ask online at otda.ny.gov.
What changed recently
In 2023, New York raised its Medicaid income and savings limits for people 65 and older. The income limit is now 138% of the poverty level.
What a Pair Team advocate does
New Yorkers who call us about Medicaid are often waiting on home care. Many are also mailing the county spenddown bills every month. This is what we do:
- Figure out which program fits you, in one phone call.
- Help you fill out the DOH-4220, send it to your county or HRA, and follow up until you have an answer.
- Help you gather and send your spenddown bills each month.
- Help with what usually comes with it: paid home care, rides, food, utilities and housing.
An advocate is covered by Medicare if you qualify. It takes two minutes to find out.
Check if you qualify for a Pair Team advocate
Frequently asked questions
Will I get QMB too?
You'll usually get QMB too, because the county should check you for it when you apply for Medicaid and already have Medicare. If QMB would give you a spenddown, you get to choose, and HIICAP can help you decide.
Do I have to send bills for the spenddown every month?
Yes, you send spenddown bills each month you need care. For a hospital stay, you can show six months of bills at once and get six months of Medicaid.
Will Medicaid look at money I gave away?
Yes, for nursing home care, New York Medicaid looks back 60 months at money you gave away. A 30-month look-back for home care was passed in 2020, but it hadn't started as of early 2026. Ask your county before you give money away.
Do I get Extra Help with prescriptions?
Yes, with full Medicaid you get Extra Help with prescriptions automatically, so you don't have to apply for it.
Can I have QI and Medicaid?
You cannot have QI and Medicaid at the same time, so you have to choose one. But you can have QMB and Medicaid together. If you're not sure which to keep, ask HIICAP.
Sources
- Medicare Savings Program 2026 (includes full Medicaid limits for dual eligibles), New York State Department of Health
- How to Apply for NY Medicaid, New York State Department of Health
- Medicaid Excess Income Program, New York State Department of Health
- Integrated Care Plans for Dual Eligible New Yorkers, New York State Department of Health
- Health Assistance, NYC Human Resources Administration
- Request a Fair Hearing, NYS Office of Temporary and Disability Assistance
- HIICAP, NYS Office for the Aging
- Medicaid, Medicare.gov
- Status of the 30-month Lookback for Home Care, NY Health Access (NYLAG)
- Financial Medicaid Eligibility for People Who Are Disabled, Aged 65+ or Blind, NY Health Access (NYLAG)
- Medicare Savings Programs (MSP) in New York, NY Health Access (NYLAG)
About the author
Dr. Nate Favini
Chief Medical Officer
Dr. Nate Favini is Pair Team's Chief Medical Officer. He has led the clinical team since 2023.
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