Category: Medicare A & B

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Medicare A & B Part D Prescription Drug

Changes to the NY Medicare Savings Program in 2026

If you are enrolled in Medicare Parts A and B and have limited income you may be able to get assistance with your Medicare health care costs through a Medicare Savings Program (MSP) administered through each state’s Medicaid office: https://www.health.ny.gov/health_care/medicaid/program/update/savingsprogram/

If eligible, you will receive help paying the Medicare Part B premium, (currently $202.90) and are automatically enrolled in Extra Help, the federal program that helps with Medicare prescription drug (Part D) costs such as monthly premium, drug deductible and prescription copays.

The Medicare Savings Program has two eligibility levels – with additional benefits available to those with the lower income. You do not choose which program to apply for – you will be enrolled in the level program that corresponds to your income.

2026 New York Monthly Income Limits (*)
Program Individual Couple
QI Up to $2,494 Up to $3,375
QMB Up to $1,856 Up to $2,509

(*) Eligibility is based on your income after subtracting for eligible health insurance premium deductions such as i) Medicare Supplement, ii) Part D drug plan, iii) dental, iv) vision, and iv) long term care premiums. The Part B premium ($202.90) or any IRMAA surcharges deducted from your Social Security award cannot be used to lower your income. 

  • (QI) Once enrolled as a Qualified Individual with individual monthly income at or below $2,474 you will no longer have the Medicare Part B premium deducted from your Social Security check.  And you may receive up to three months of retroactive reimbursement for Part B premiums paid before your MSP effective date and within the same year of the effective date.
  • (QMB) If your individual monthly income is at or below $1,856 you would be enrolled in the Qualified Medicare Beneficiary Program and, like QI, will no longer have the Medicare Part B premium deducted from your Social Security check.
    • This program also pays for Medicare Parts A and B deductible and cost sharing however no retroactive Part B reimbursements are available to QMB enrollees.
  • FYI: If your individual monthly income is at or below $1,856 and your assets are below $33,308 you may apply separately for Full Medicaid you may enjoy the same benefits as QI and QMB plus some additional benefits such as:
    • County based transportation to and from medical appointments.
    • Dental and vision allowances approved by NY State Medicaid

Once approved at the QMB or Full Medicaid level, you may want to consider a Medicare Advantage DUAL (Medicare / Medicaid) plan. On top of the benefits described above, these plans include additional benefits like dental, vision, fitness membership and even an allowance for healthy food. Ask your local agent about the Medicare Advantage DUAL plans we offer for individuals enrolled in QMB or Full Medicaid.

Your local agent can help you with the request. Start by downloading the form below. Then, along with a copy of your Medicare ID card, we’ll need documents to confirm your date of birth, residency and income. If you are paying another health insurance premium, such as i) Medicare Supplement, ii) Part D drug plan, iii) dental, iv) vision, and iv) long term care premiums, you will need to provide some proof of that expense. Your local agent will work with you in getting this to your county’s Department of Social Services and follow up with you during the approval process which can takes up to 45 days.

>> To download application form: click here

Include the following verification documents with your Medicare Savings Program application:

  • A photocopy of the front and back of your Medicare card(s) (red, white and blue card).
  • Proof of Date of Birth, such as State Driver’s license, U.S. Birth Certificate, U.S. passport, Permanent Resident Card (“Green Card”), or NYS Benefit Identification Card.
  • Proof of Residence, such as lease/ letter/ rent receipt with your home address from landlord, utility bill (gas, electric, phone, cable, fuel or water), property tax records or mortgage statement. These documents must be dated within 6 months of when you signed the application.
  • Proof of income, such as paycheck stubs (4 weeks), a letter from employer, pension information indicating amount and frequency of payment, income tax return, award letter for any unearned income benefit such as Social Security, unemployment, or veteran’s benefit, or letter from renter, boarder or tenant.
  • Proof of any other health insurance premium that you pay other than Medicare, such as Medicare Supplement, Medicare Advantage, Part D prescription drug, dental, vision or long term care policy.
  • If you are not a U. S. citizen, you must provide documents indicating your current immigration status such as I-551 Permanent Resident Card (“Green Card”), I-766 Employment Authorization Card.  

Check with New York State Department of Health for an online listing of each county’s Local Department of Social Services:     https://www.health.ny.gov/health_care/medicaid/ldss.htm

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Medicare A & B

Your 2026 Medicare Part B and D Premiums

May Be Increased. Or Eliminated.

The 2026 standard monthly premium for Medicare Part B beneficiaries is $202.90.

However, your 2026 Medicare Parts B and D premiums could be higher or lower – based on your prior or current income.

  • Higher? Yes. If the Modified Adjusted Gross Income (MAGI) on your 2024 tax filing exceeded $109,000 ($218,000 joint) your 2026 Medicare Parts B and D premiums are increased. This will be withheld from your 2026 Social Security benefit. Here is more information about the Income Related Monthly Adjustment Amount (IRMAA) for Parts B and D
  • Lower? Yes. If your current annual income is below 186% of the Federal Poverty Level you will be eligible for the Medicare Savings QI Program, regardless of assets, and will not be paying any Part B premium.

 

  • If you are being charged IRMAA and had a life-changing event that resulted in a reduction in your income, you may be eligible for a reduction in IRMAA. Call Social Security at 1-800-772-1213 for instructions on how to file an appeal via the SSA-44 form.
  • Plan ahead. Assuming the law is not changed, check with your financial planner or tax preparer to confirm whether your 2025 tax filing will trigger a 2027 IRMAA.
  • Or, if your current monthly income is below $2,426 individual / $3,279 couple one of our agents listed below and we can review whether you are eligible for the Medicare Savings QI Program.

 

Questions?

Our licensed, independent and certified agents are available to answer your questions about Parts A, B, IRMAA and other Medicare topics. Send us a note below to request an individual consultation.

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Medicare Medicare A & B Medicare supplement Part C Medicare Advantage Part D Prescription Drug

About the 2026 Medicare Annual Enrollment

Annual Enrollment Period

The Medicare Annual Enrollment Period, from October 15th through December 7th, is when Medicare beneficiaries can enroll in or change their Medicare Advantage (Part C) or Medicare Prescription Drug (Part D) plan to take effect January 1.

Some Important Tips to Consider if you are now enrolled in a Medicare Advantage (Part C) Plan:
  • You can leave your Medicare Advantage plan and enroll in another Medicare Advantage plan offered in your county. [We offer several]
  • Even if you decide to stay with your current Medicare Advantage plan, make sure your doctors and preferred hospitals are still in your network, especially if your plan is a HMO. 
  • You can leave Medicare Advantage and return to Original Medicare and purchase a Medicare Supplement (aka Medigap) policy. For New York State residents, acceptance is guaranteed and the continuous coverage transfer means no pre-existing condition limitations apply.
Some Important Tips to Consider if you HAVE ORIGINAL MEDICARE AND a Medicare SUPPLEMENT Plan:
  • The Annual Enrollment Period applies to your Part D drug plan only.
  • New York State residents can change their Medicare Supplement plan at any time of the year and without medical underwriting. An example could be changing from one company to another or changing from one plan (Plan F, Plan G, Plan N or High Deductible) to another. 
  • You can leave your Medicare Supplement (Medigap) plan and join a Medicare Advantage plan during the Annual Enrollment Period. There is no underwriting to move to a Medicare Advantage plan. You will be automatically accepted as long as your permanent address is within the coverage area.
  • Unless your prescription drugs are covered through the Veterans Administration, most individuals with Original Medicare and a Medicare Supplement plan also add a Medicare Part D prescription drug plan. We recommend updating your medication list and confirming – through your personal account at medicare.gov – which Part D drug plans will cover your prescriptions at the lowest annual out of pocket costs – that includes premium, deductible and prescription copay costs.

Our team of licensed, independent and certified agent advisors, from Long Island to the North Country, offer a no-obligation complimentary consultation to help you compare Medicare plans in your coverage area.

So, reach out to local agent by phone, an online note or book an appointment directly to his or her calendar and learn more about your Medicare plan options.

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Medicare Medicare A & B

Medicare Tips: Part B

Unlike Medicare Part A, which covers inpatient care in a hospital, skilled nursing or hospice facility, Part B covers through outpatient care, services from doctors and other providers, durable medical equipment and many preventative screenings.

  • Individuals already receiving Social Security benefits are automatically enrolled in Parts A and B effective the first day of the month you turn 65.
    • At age 65, individuals choosing to delay their Social Security benefit need to contact Social Security, online or your local office, to activate Parts A and B.
    • Individuals receiving Social Security Disability benefits are automatically enrolled in Parts A and B after 24 months.
    • At age 65, those covered through their individual or spouse’s currently employed group health plan (20 or more employees) may delay Part B WITHOUT PENALTY until they, or their spouse, are no longer employed and the employer coverage ends.
  • The standard Part B premium amount in 2026 is $202.90.
    • If your 2024 Adjusted Gross Income was above a certain amount, you may pay more – an Income Related Monthly Adjustment.
    • If your current monthly income is below a certain amount, you may be eligible for the Medicare Savings Program which will subsidize the Part B premium.
  •  Paying the Part B premium
    • If you receive Social Security benefits, your Part B premium (and the IRMAA adjustment, if applicable) will be deducted from your monthly Social Security payment.
    • If you are enrolled in Medicare Parts A and B and have deferred the Social Security benefit, Medicare sends a bill for the Part B premium and, if applicable, any IRMAA adjustment, which can be paid by check or online.

 

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Medicare A & B

Switching Medicare Supplement (Medigap) policies

Medicare Supplement Plan

Reasons Why New Yorkers Switch Their Medicare Supplement (Medigap) Policies:

As a reminder, Medicare Supplement, also known as Medigap, are policies designed primarily to supplement (or fill the gap) Medicare benefits. You simply present your red, white and blue Medicare card to the provider or facility along with the Supplement / Medigap card to help with out-of-pocket costs; such as deductible and co-insurance amounts with Original Medicare Part A and Part B.

Currently, there are 10 standardized Medigap plans, each represented by a letter (A, B, C, D, F, G, K, L, M, N; both Plans F and G offer a high-deductible version). These plans are available in most states. While premiums will vary from state to state the standardized benefits of each lettered plan remain the same despite the insurance company or location. For example, Plan F benefits are the same in Florida as they are in New York.

Q: Is there an Annual / Open Enrollment Period?

Most people buy their Medicare Supplement / Medigap policy during the six month period after they first enroll in Medicare. After that, in many states, Medigap insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the Medigap policy.

Q: So How Do New York State Residents Have More Protection?

New York State laws and regulations continue this open enrollment period. A person enrolled in Medicare Parts A and B may purchase a Medigap policy at any time. Insurers may not consider an applicant’s health status, claims experience, or age. Laws in New York also prohibit insurers from basing Medigap premiums on age and charging a higher premium as they grow older. Also,

Q: But What About Pre-Existing Conditions; Are They Covered?

Medigap insurers may impose up to a six-month waiting period to be covered for any preexisting conditions a person may have. Federal law and New York State regulation define a preexisting condition as any condition for which medical advice was given or treatment was recommended by or received from a physician within six months before the effective date of coverage.
Under New York State regulation, the waiting period may be either reduced or waived entirely, depending upon whether an individual has had previous health insurance coverage. Medigap insurers are required to reduce the preexisting condition waiting period by the number of days an individual was covered under some form of “creditable” coverage so long as there were no breaks in coverage of more than 63 calendar days. Translation: If you are switching from a “creditable” plan that you have held consecutively for six months, New York regulation requires the new Medicare Supplement / Medigap plan to reduce or waive the six month pre-existing condition waiting period.

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