Medicare Savings Programs in New York

If you're new to these programs, start with how Medicare Savings Programs work. This page covers New York: the state's higher limits, where to apply, and what changed.

In New York, the state can pay the $202.90 that comes out of your Social Security check each month. If you've been stretching what's left of that check to cover rent and food, this can help. With QMB, the state also pays your copays at the doctor, the specialist and the hospital. 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 have Medicare and live in New York.
• You make less than $2,494 a month if you live alone, or $3,375 as a couple. That's the limit for the Qualifying Individual (QI) program, and the QMB limit is lower.
• Your savings don't matter, because New York doesn't count them.

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.

What each program pays for in New York

These limits, from the New York State Department of Health (DOH), include the $20 the state does not count. If you pay for a Medigap or dental plan, that cost comes off your income too.

What happened to SLMB in New York?

In 2023, New York folded SLMB into QMB and raised the QMB limit from 100% to 138% of the poverty level. The new limit covers everyone SLMB used to cover, and QMB pays more. QI went up too, from 135% to 186%. If you think you were missed, call the Medicaid Helpline at 1-800-541-2831.

Does New York count my savings?

New York does not count your savings for these programs, and it hasn't had a savings limit since April 1, 2008. Your bank account, your home and your car don't count. Full Medicaid is different: in 2026 its savings limit is $33,038 for one person. See Medicare and Medicaid in New York.

How to apply

1. Get your papers together to send with the form. You'll need copies of your Medicare card (front and back), your Social Security letter, and an ID with your address and age.
2. Fill out form DOH-4328 and sign the back, or it won't count. You can print it from the state's Medicare Savings Program page.
3. Send it in by mail to your county Department of Social Services, or to HRA in New York City. You can also apply online through NY State of Health, and there's no interview.
4. Get free help if you want it. The Health Insurance Information, Counseling and Assistance Program (HIICAP) gives free Medicare counseling at 1-800-701-0501. In New York City, the HRA Medicaid Helpline is 1-888-692-6116.
5. Wait for the answer. The county has 45 days to decide. Once you're approved, the $202.90 stops coming out of your check. Social Security also pays back what you're owed, but that can take a while.
6. Check your start date, so you know when the help begins. QMB has no back months, but once you're approved, the state pays the $202.90 starting the month after you applied. Help with copays starts the month after you're approved. QI can pay back up to three months, but only in the same calendar year. If you apply in January, there are no back months.
7. Renew every year, because if you don't send back the renewal form, the $202.90 comes out of your check again.

If you are turned down or hear nothing

If you're denied, or have no answer after 45 days, you can ask for a fair hearing. Call the state at 1-800-342-3334, or ask online at otda.ny.gov.

What a Pair Team advocate does

Most people who call us about Medicare costs have more going on. Often it's a renewal letter from HRA, or no way to get to the specialist. This is what we do:

• Figure out if QMB or QI fits you, in one phone call.
• Help you fill out the DOH-4328, send it to your county or HRA, and follow up until you have an answer.
• Help you fix copay bills you should not have gotten, and get your money back if you paid.
• Help with what usually comes with it: Extra Help for prescriptions, Medicaid, 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

Can I have QI and Medicaid at the same time?

You cannot have QI and Medicaid at the same time, so you have to pick one. But you can have QMB and Medicaid together. If you have Medicaid with a spenddown, you can't get QMB either, so ask HIICAP which choice saves you more.

I am married. Which limit do I use?

If you're married, you use the couple limit. New York counts every married person as a household of two, even if only one of you has Medicare.

What if I have to pay for hospital insurance (Part A)?

If you have to pay for hospital insurance (Part A), QMB can pay for it. First, sign up for Part A at Social Security on the condition that QMB pays. Then apply for QMB with your county or HRA.

I applied for Extra Help through Social Security. Do I still need this form?

You may not need this form, because Social Security tells New York who applied for Extra Help. The state then has to check those people for these programs. Since April 2026, the state does that check itself instead of your county. If you haven't heard back, send the DOH-4328 yourself.

Will New York want the money back from my estate?

New York can't take this money back from your estate. Federal law does not let states take back what a Medicare Savings Program paid for your Medicare costs.

Sources

• Medicare Savings Program 2026 income limits, New York State Department of Health
• Medicare Savings Program (MSP), New York State Department of Health
• How to Apply for NY Medicaid, 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
• 18 NYCRR 360-7.8, Payments of Medicare premiums, New York regulations (LII)
• Social Security Act section 1902(e)(8), SSA
• Estate Recovery, Medicaid.gov
• Medicare Savings Programs, Medicare.gov
• Medicare Savings Programs (MSP) in New York, NY Health Access (NYLAG)
• Medicare Savings Programs in New York, Medicare Interactive
• What is the Medicare Savings Program?, Legal Services NYC