New York Medicare Savings Programs (MSPs)

Medicare isn’t free. You’ll still have some costs, such as monthly premiums, deductibles, and co-pays. If you live in New York and have low income, you may qualify for a Medicare Savings Program (MSP) to help pay for some or all of these “out-of-pocket” expenses.

MSPs can make Medicare more affordable for people who are already enrolled—or getting ready to sign up.

What are the Medicare Savings Programs?

The Medicare Savings Programs (MSPs) are state-run Medicaid programs that help people with low income pay for their Medicare costs. These costs include:

• Premiums: Money you pay to keep your Medicare plan

• Deductibles: Money you pay before Medicare pays for your care

• Copays: A set fee you pay to visit your regular doctor or a specialist

There are four MSPs, each with different eligibility rules. Older adults and younger adults with disabilities who may not qualify for full Medicaid may still be able to enroll in one of the MSPs.

MSPs are available in every state, but not every type of MSP is offered in every state. Most MSPs are run by a state’s Medicaid office. In New York, MSPs are handled by the New York Department of Health, which runs the Medicaid program.

What are the types of Medicare Savings Programs offered in New York?

There are two main types of MSPs available in New York, including:

• Qualified Medicare Beneficiary (QMB): This program has the lowest income limit and covers Medicare Part A and Part B premiums, deductibles, and copayments for those eligible.

• Qualifying Individual (QI): QI has slightly higher income limits. It’s a limited program and available on a first-come, first-served basis. For those eligible, QI covers the Medicare Part B premium.

Special Needs Plan (SNP)

You may also want to find out if you qualify for a Special Needs Plan (SNP). SNPs are a special type of Medicare Advantage plan for people who need extra help paying for and managing their care.

You may qualify for an SNP if you meet one of the following conditions:

• You have both Medicare and Medicaid (including QMB).

• You have a serious and disabling chronic medical condition.

• You live in a nursing home, or you live at home but have high care needs and could qualify for a nursing home.

Different SNPs are available in different areas of the country. Learn more by contacting Health Insurance Information, Counseling, and Assistance (HIICAP) at 1-800-701-0501.

Can I get help paying for my prescription drugs in New York?

Once you're enrolled in a Medicare Savings Program, you will be signed up for the Medicare Part D Extra Help program. If you meet the guidelines for Extra Help, you will have a low (or no) deductible and a low (or no) premium.

In general, you will pay much less for your prescriptions with Extra Help. You can learn more about this program and even apply on our website.

How do I know if I'm eligible for an MSP in New York?

You must either be enrolled in Medicare or expect to enroll soon. Each program has its own income limit (the most you can earn in a month to qualify):

Qualified Medicare Beneficiary Program (QMB):

Family size Maximum monthly income

Individual $ 1,856

Couple $ 2,509

Source: Medicare.gov

Qualifying Individual (QI):

Family size Maximum monthly income (between 121-135% FPL/+ $20 disregard)

Individual $ 2,494

Couple $ 3,375

Source: Medicare.gov

If you need help with your Medicare costs, you should apply for the MSPs—

even if you think your income might be too high. Certain types of income are not counted, and the only way to know for certain if you qualify is to apply.

How do I apply for the Medicare Savings Programs?

Follow the steps below to apply for the New York MSPs.

1. Gather important documents

Before you apply, it may be helpful to gather the following information to make your application process easier:

• The amount of income you get from jobs and other sources

• Asset information, such as bank and investment account balances

• Medicare numbers, Social Security numbers, and birth dates of everyone applying or in your household

2. Complete an application

The quickest and easiest way to apply for the Medicare Savings Programs and other public assistance benefits is online through the Access HRA website. All your personal information is kept 100% private and protected by special security technology.

Apply on Access HRA

Apply by mail

Download an application form and mail the completed form to your local Department of Social Services (LDSS) or Human Resource Administration (HRA). Find an office near you.

Apply by phone

Call the NYS Medicaid Helpline at 1-800-541-2831 (Mon.-Fri. 8 a.m. – 8 p.m., Sat. 9 a.m. – 1 p.m.).

How can I get help with my application?

• Contact your local LDSS county office.

• Visit a Benefits Enrollment Center (BEC), if there’s one near you.

• See if there’s one in your area. If you have questions about Medicare, contact HIICAP at 1-800-701-0501.

NCOA also has a HelpLine you can call to get free support. Call 1-800-794-6559 anytime Monday–Friday, from 8 a.m. to 7 p.m. EST.