Help paying for Medicare in New York
New York is one of the more generous states for Medicare cost help — higher income limits than most and no asset test — and many of the people who qualify have never applied, usually because nobody told them. Checking takes ten minutes and costs nothing.
New York has three programs that pay part of Medicare's cost: the Medicare Savings Program (pays the Part B premium, and for QMB all cost-sharing; income up to 186% of poverty, no asset test), Extra Help (federal, cuts Part D costs), and EPIC (state, cuts drug copays to $3 to $20 for people 65+ with income up to $75,000 single or $100,000 married). Most eligible people have never applied. I screen for all three.
The four programs, in plain terms
1. Medicare Savings Programs (MSP)
State-run, Medicaid-funded programs that pay your Medicare costs. Since 2023 New York has two levels, both based on income only:
- QMB (Qualified Medicare Beneficiary) — for incomes up to 138% of the federal poverty level: in 2026, $1,856 a month for a single person or $2,509 for a couple, after the standard $20 disregard. Pays your Part B premium and your Medicare deductibles, copays and coinsurance. Providers can't bill you for Medicare cost-sharing.
- QI (Qualifying Individual) — for incomes from 138% up to 186% of the federal poverty level: in 2026, up to $2,494 a month single or $3,375 for a couple. Pays your Part B premium; you can't have full Medicaid at the same time. (New York folded the old SLMB level into these two when it raised the limits in 2023.)
The dollar limits move every spring when the federal poverty level updates; the percentages don't. If your income is close, apply anyway: some income is disregarded and the county makes the determination, not you.
Getting your Part B premium paid is worth well over $2,000 a year on its own, and it shows up as a bigger Social Security cheque. Both levels also qualify you automatically for Extra Help with Part D.
Why New York is different: in 2023 the state raised the income limits well above the federal minimums (QMB to 138% of poverty, QI to 186%), and New York has no asset test — your savings, home and car are not counted. If you were told "no" before 2023, check again.
2. Extra Help (Low-Income Subsidy)
A federal program run through Social Security that lowers Part D costs: reduced or $0 premium, no deductible, small fixed copays, and no late-enrollment penalty. Since 2024 there's a single full level of help rather than partial tiers. It has both an income limit and a resource limit (bank accounts and investments; your home and car don't count).
3. EPIC — New York's prescription program
The Elderly Pharmaceutical Insurance Coverage program is a New York State benefit for residents aged 65 and over who have Part D. The income limits — $75,000 single, $100,000 married — are far higher than Extra Help's, which is why so many middle-income people miss it.
- Fee Plan — for lower incomes: a small quarterly fee, then EPIC copays at the pharmacy after Part D pays.
- Deductible Plan — for higher incomes: you meet a yearly deductible, then EPIC copays apply.
EPIC is secondary coverage: it pays after any Part D deductible is met, and for lower-income members it can also pay toward the Part D premium. You must have Part D (or creditable equivalent) and not be receiving full Medicaid. It works alongside a standalone Part D plan or a Medicare Advantage plan with drug coverage.
4. Medicare and Medicaid together (dual eligible)
If your income qualifies you for full Medicaid as well as Medicare, you're "dual eligible." Medicaid then covers most of what Medicare doesn't. There are Medicare Advantage plans built for exactly this situation — Dual Eligible Special Needs Plans (D-SNPs) — that coordinate both programs in one plan, often with extra benefits — which vary by plan and can carry their own eligibility rules. Several are available in the Capital Region; I'll tell you which ones I can offer at your address.
Applying doesn't affect your Medicare
Checking eligibility for any of these programs has no downside. You keep your Medicare, your doctors and your plan. If you qualify, your costs go down; if you don't, nothing changes.
Quick self-check
| Program | Who it's for | Counts assets? | Apply through |
|---|---|---|---|
| Medicare Savings Program (QMB / QI) | Income up to 186% of poverty, any age on Medicare | No (NY) | County DSS / NY State of Health |
| Extra Help | Lower income and limited resources | Yes | Social Security |
| EPIC | 65+, income up to $75k / $100k | No | NYS Department of Health |
| Medicaid / D-SNP | Lowest incomes | Rules vary | County DSS; plan via broker |
Dollar limits change every January (the poverty level is re-set each year), so I've deliberately not printed dollar figures for MSP and Extra Help here. Current figures are published at medicare.gov and ssa.gov, and I'll check your numbers against this year's limits on the call.
How I can help
- A ten-minute check of your household income against this year's limits for all four programs.
- If you qualify, help completing the applications and gathering the documents each office wants.
- Re-comparing your Medicare plan once the help is in place — qualifying often opens up better plan choices.
None of this costs you anything. Call or send a message and we'll start with the income check.
- Medicare Savings Programs (NY Department of Health) — QMB/QI limits, no asset test
- HIICAP notebook: Medicare Savings Programs (NY State Office for the Aging)
- Extra Help with Medicare drug costs (SSA)
- EPIC program (NY Department of Health) — $75,000 / $100,000 income limits
- Medicare Savings Programs (medicare.gov)
I do not offer every plan available in your area. Any information I provide is limited to the plans I do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your State Health Insurance Assistance Program for information on all of your options. Not connected with or endorsed by the U.S. government, the Social Security Administration or the federal Medicare program.
Common questions
Short answers to what people ask before they call.
I was told I made too much money years ago. Is it worth checking again?
Yes. New York raised Medicare Savings Program income limits substantially in 2023 and does not count assets at all. Many people turned down before 2023 qualify now.
Does New York count my savings or my house?
No. New York's Medicare Savings Programs have no resource (asset) test — only income is considered. That's different from most states and from the federal Extra Help program, which does have a resource limit.
If I get a Medicare Savings Program, do I automatically get Extra Help?
Generally yes. Enrolling in any Medicare Savings Program qualifies you for Extra Help with Part D automatically, so you get both premium help and lower drug costs from one application.
What is EPIC and who can get it?
EPIC is New York's own prescription help program for residents 65 and over with a Part D plan. Income limits are $75,000 for a single person and $100,000 for a married couple — far above Extra Help's — so many middle-income New Yorkers qualify. For lower incomes it can pay toward your Part D premium; for everyone it reduces copays after the Part D deductible.
Where do I apply?
Medicare Savings Programs are applied for through your county Department of Social Services or NY State of Health; Extra Help through Social Security (ssa.gov); EPIC through the New York State Department of Health. I'll tell you which apply to you and help with the paperwork.
Let's talk it through
A phone call or a message is all it takes. The first conversation is just a conversation.