Tag: Social Security Extra Help

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 (*)

(*) 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