New York's Medicare Savings Programs (MSP) are state-administered programs that pay some or all of your Medicare premiums, deductibles, and cost sharing. Unlike many states, New York has expanded its income thresholds well above the federal minimums and eliminated the asset test for the two most common tiers, so more Medicare beneficiaries qualify than they might expect. In 2026, roughly one in four Medicare enrollees in New York is eligible for at least the QI tier.
Covered below: the 2026 income limits for all four New York MSP tiers, the state-funded EPIC drug program, how to apply using form DOH-4328 and free HIICAP counseling, documents required, and common denial reasons. Note that MSP income counting uses MAGI-adjacent rules (gross income minus health insurance premium deductions), not the traditional MAGI formula used for ACA subsidies. For broader Medicaid eligibility in New York, see New York Medicaid income limits. For national MSP context, see Medicare Extra Help eligibility.
Quick Answer: What the New York MSP Pays in 2026
Yes, if your 2026 monthly income is at or below $2,494 (single) or $3,375 (couple), you qualify for at least the QI tier of New York's Medicare Savings Programs. New York eliminated the asset test for QMB and QI in 2023, so savings accounts and investments no longer disqualify you from these tiers. Enrollment automatically triggers Extra Help (the Low-Income Subsidy), which eliminates Part D deductibles and caps drug copays in 2026.
New York MSP Income Limits by Program Tier (2026)
New York offers four MSP tiers in 2026, each with different income ceilings and benefit levels. All tiers use the standard $20 monthly income disregard and allow you to subtract health insurance premiums (Medigap, Part D, dental) from your gross income before comparing to the limit. These New York limits are significantly higher than the federal minimums because the state adopted expanded thresholds starting in 2023.
New York Medicare Savings Programs by tier 2026| MSP Tier | Single Income Limit (2026) | Couple Income Limit (2026) | What It Pays | Asset Test |
|---|
| QMB (Qualified Medicare Beneficiary) | $1,856/month | $2,509/month | Part A+B premiums, deductibles, coinsurance, copays. Providers cannot bill you. | None |
| QI (Qualifying Individual) | $2,494/month | $3,375/month | Part B premium ($202.90/month in 2026) + automatic Extra Help. Cannot combine with full Medicaid. | None |
| QDWI (Qualified Disabled Working Individual) | $2,660/month | $3,607/month | Part A premium only. For disabled workers under 65 who returned to work and lost premium-free Part A. | $4,000 / $6,000 |
| Full Medicaid (Dual Eligible) | $1,856/month | $2,509/month | All MSP benefits plus dental, vision, transportation, long-term care, and zero cost sharing. | $33,038 / $44,796 |
SLMB is no longer a separate New York MSP tier. It was absorbed into the expanded QI range when New York raised its thresholds in 2023. The QMB and QI limits include the $20 monthly income disregard. Premiums for Medigap, Part D, dental, and vision plans are also subtracted from income before applying the limit.
Source: NY State Department of Health MSP 2026, NY HIICAP Notebook 2026 Module 9
QMB: The Most Comprehensive New York MSP Tier
QMB (Qualified Medicare Beneficiary) is the broadest New York MSP tier and the one that eliminates the most out-of-pocket cost. To qualify in 2026, your monthly countable income must be at or below $1,856 if single or $2,509 if you are a couple. New York eliminated the asset test for QMB in 2023, so there is no longer a limit on savings, checking accounts, stocks, or other financial assets for this tier.
QMB pays the Medicare Part B premium ($202.90/month in 2026), the Part A premium if you pay one, and all covered deductibles, coinsurance, and copays for Medicare-covered services. Federal law prohibits providers from billing QMB enrollees for Medicare cost sharing. If a provider bills you for copays or coinsurance after you show your Medicaid card, you can report the billing violation to the NY State Medicaid Fraud Control Unit or the federal Centers for Medicare and Medicaid Services.
QI: New York's Expanded Part B Premium Assistance Tier
QI (Qualifying Individual) is New York's second-tier MSP, covering individuals with monthly income above the QMB limit up to $2,494 and couples up to $3,375 in 2026. New York's QI limit is well above the federal floor of 135% FPL because the state expanded the program in 2023 to eliminate a gap that had previously left many moderate-income Medicare beneficiaries without assistance. Like QMB, the QI tier has no asset test in New York.
QI pays the Medicare Part B premium of $202.90 per month in 2026, saving you $2,434.80 per year. QI enrollment also automatically qualifies you for the federal Extra Help program, which eliminates the Part D drug plan deductible and caps generic drug copays at a few dollars per prescription. One limitation: QI cannot be combined with full Medicaid. If your income drops below the QMB limit, you should apply for full Medicaid rather than remaining in QI. Additionally, QI funding is appropriated annually by Congress on a first-come, first-served basis. New York enrollees must reapply each year, but the state historically has not run out of QI slots.
New York EPIC Program: Drug Cost Help Beyond MSP
New York's EPIC (Elderly Pharmaceutical Insurance Coverage) program is a state-funded supplement designed for New Yorkers age 65 or older who earn too much for Medicaid but still struggle with prescription drug costs. EPIC is entirely separate from MSP and covers individuals with annual income up to $75,000 and married couples up to $100,000 in 2026.
EPIC has two benefit structures in 2026. The Fee Plan serves individuals with annual income up to $20,000 or married couples up to $26,000. Fee Plan members pay an annual enrollment fee ranging from $8 to $300 based on income and pay small drug copays of $3, $7, $15, or $20 depending on drug cost. EPIC also pays the Medicare Part D monthly premium (up to $58.82 per month in 2026, the benchmark amount) for Fee Plan members with income up to $23,000 if single or $29,000 if married. The Deductible Plan serves individuals with annual income from $20,001 to $75,000 or couples from $26,001 to $100,000. Deductible Plan members pay an annual deductible ranging from $530 to $3,215 based on income, after which EPIC covers drug costs. To qualify for EPIC, you must be a New York resident age 65 or older, enrolled in or eligible for Medicare Part D, and not enrolled in Medicaid.
Is New York a Medicaid Expansion State?
Yes. New York is a full Medicaid expansion state and expanded coverage under the ACA in 2014. For low-income Medicare beneficiaries, this means that those who qualify for both Medicare and Medicaid (dual-eligibles) can enroll in full Medicaid through the same DOH-4328 application process, with Medicaid covering all remaining cost sharing and additional services (dental, vision, transportation, personal care) that Medicare does not cover.
New York also operates the Essential Plan, a zero-premium health plan for residents with income between 138% and 200% of the federal poverty level. The Essential Plan is available for people under 65 who do not qualify for Medicare. Once a person turns 65 and qualifies for Medicare, the Essential Plan ends and the person transitions to Medicare plus MSP if income-eligible.
Common Reasons New York MSP Applications Get Denied
New York's Department of Social Services must process MSP applications within 45 days. Most denials are administrative rather than income-based and can be corrected quickly. If you receive a denial notice, you have the right to appeal within 60 days at a state fair hearing. Call HIICAP at 1-800-701-0501 immediately if you receive a denial, as counselors can often identify the documentation gap and help you correct it without a formal appeal.
- Income too high: countable monthly income exceeds the QI limit ($2,494 single / $3,375 couple after disregards and premium deductions)
- Missing documentation: the most frequent fixable denial. Bring your Medicare card, a recent Social Security letter, and a utility bill or lease to prove New York residency.
- Unsigned application: the DOH-4328 signature block is on the back of the form. Unsigned applications are returned without processing.
- Not enrolled in Medicare: MSP requires active enrollment in Medicare Parts A and B. If you are near 65 and not yet enrolled, contact Social Security (ssa.gov) to enroll first.
- QDWI asset test failure: unlike QMB and QI, the QDWI tier retains an asset limit of $4,000 for individuals and $6,000 for couples, excluding your primary home and one vehicle.
How to Appeal a New York MSP Denial
New York gives denied applicants the right to a state fair hearing. Request the hearing within 60 days of your denial notice by calling the New York Office of Temporary and Disability Assistance (OTDA) at 1-800-342-3334 or by mailing a written request. You may request continuation of benefits during the appeal period if you were previously enrolled. In many cases, submitting a missing document directly to your county DSS office resolves the issue faster than a formal hearing. HIICAP counselors at 1-800-701-0501 can attend the hearing with you and are well-versed in MSP appeal procedures.
Frequently Asked Questions
What is the income limit for New York Medicare Savings Programs in 2026?
For 2026, New York's MSP income limits are: QMB tier up to $1,856/month (single) or $2,509/month (couple); QI tier from $1,857 to $2,494/month (single) or $2,510 to $3,375/month (couple); QDWI tier up to $2,660/month (single) or $3,607/month (couple). These limits include the standard $20 monthly income disregard. New York also lets you subtract health insurance premiums (Medigap, Part D, dental) from your gross income before comparison.
Does New York have an asset or resource test for Medicare Savings Programs?
New York eliminated the asset test for QMB and QI applicants in 2023. Your savings accounts, checking accounts, stocks, bonds, and other financial assets are not counted for these two tiers. The QDWI tier retains a resource limit of $4,000 for individuals and $6,000 for couples. Full Medicaid dual-eligibility has a higher asset limit of $33,038 for individuals and $44,796 for couples, with your home and personal belongings excluded.
What does the QMB program pay for in New York?
QMB (Qualified Medicare Beneficiary) pays the Medicare Part B premium ($202.90/month in 2026), the Part A premium if you pay one, and all Medicare-covered deductibles, coinsurance, and copays. Providers are legally prohibited from billing QMB enrollees for cost sharing. QMB also automatically enrolls you in Extra Help (Low-Income Subsidy) for Part D prescription drug costs.
What is the EPIC program in New York and who qualifies?
EPIC (Elderly Pharmaceutical Insurance Coverage) is New York's state-funded prescription drug assistance program for residents age 65 or older. It covers individuals with annual income up to $75,000 and married couples up to $100,000. The Fee Plan (income up to $20,000 single / $26,000 married) has small annual fees and drug copays of $3 to $20. The Deductible Plan (income $20,001-$75,000 single / $26,001-$100,000 married) requires an annual deductible of $530 to $3,215. You must be enrolled in Medicare Part D and not enrolled in Medicaid to qualify for EPIC.
How do I apply for New York Medicare Savings Programs?
Apply using form DOH-4328, available from the NY Department of Health website. Submit the signed form with your Medicare card, proof of identity, proof of New York residency, and proof of income to your county Department of Social Services. NYC residents apply through HRA at 1-888-692-6116. For free help, call HIICAP at 1-800-701-0501. Processing takes up to 45 days and MSP has no enrollment window so you can apply any time of year.
Does enrolling in New York's MSP automatically give me Extra Help for Part D?
Yes. Enrollment in any New York MSP tier (QMB, QI, or QDWI) automatically qualifies you for the federal Extra Help program (also called the Low-Income Subsidy or LIS) for Medicare Part D prescription drug coverage. Extra Help eliminates the Part D deductible and caps drug copays. You do not need to apply for Extra Help separately once enrolled in MSP.
What is the difference between QMB and QI in New York?
QMB has the lower income limit (up to $1,856/month single in 2026) and the broader benefit: it pays Part B premiums, Part A premiums, deductibles, coinsurance, and copays, and providers cannot bill you for cost sharing. QI has the higher income limit (up to $2,494/month single in 2026) and pays only the Part B premium. QI also cannot be combined with full Medicaid, while QMB can overlap with Medicaid dual-eligibility. Both tiers have no asset test in New York.
Can I get QI if I am already on Medicaid in New York?
No. The QI (Qualifying Individual) program cannot be combined with full Medicaid enrollment. If your income is low enough to qualify for both Medicaid and QI, you should apply for full Medicaid (dual-eligibility) instead, which provides broader benefits including dental, vision, and zero cost sharing. Contact your local Department of Social Services or HIICAP at 1-800-701-0501 to determine the best program for your income level.
