What are the changes to the NY Medicare Savings Program in 2026?

Yes, you can lose your Qualified Medicare Beneficiary (QMB) benefits if your income, resources, or household circumstances change and you no longer meet the program's eligibility limits.

Reasons You Can Lose QMB Benefits

• Income Increases: If your monthly countable income rises above the federal or state poverty limits (such as annual adjustments or increases in Social Security), you may exceed the threshold.
• Resource Growth: If your countable assets or resources (like bank accounts or investments) go above the allowable Medicaid resource limits for your state, your eligibility ends.
• Failure to Renew: State Medicaid agencies require periodic renewals or annual reviews. If you do not complete and return the renewal paperwork or fail to provide requested verification documents on time, your benefits can be terminated.
• Change in Residency: If you move to another state, your QMB certification does not automatically transfer, and you must reapply under your new state’s guidelines.

What Happens If You Lose Coverage

• Cost-Sharing Protection Ends: You lose protection from Medicare billing. Providers will once again be legally allowed to bill you for Medicare Part A and Part B deductibles, coinsurance, and copayments.
• Premium Payments Resume: Medicaid will stop paying your Medicare Part B (and Part A, if applicable) premiums, meaning those deductions will return to your monthly Social Security check.
• Extra Help Changes: You may also lose automatic enrollment in the Part D Low-Income Subsidy (Extra Help) for prescription drugs, raising your medication costs.

To qualify for a Medicare Savings Program (MSP) in New York, you must be eligible for Medicare and meet specific gross monthly income limits, with no resource or asset limit.

Income Limits (2026 Guidelines)

New York has different benefit levels depending on your household income (which include a standard $20 income disregard):

• Qualified Medicare Beneficiary (QMB):
  • Single: Up to $1,856 per month
  • Married Couple: Up to $2,509 per month
  • Covers: Medicare Part A and Part B premiums, coinsurance, and deductibles.
• Qualifying Individual (QI-1):
  • Single: Up to $2,494 per month
  • Married Couple: Up to $3,375 per month
  • Covers: Medicare Part B premium only (requires Part A).

Key Rules

• No Asset Test: New York does not look at your savings, bank accounts, or home value to determine MSP eligibility.
• Extra Help: Enrolling in any NY MSP automatically qualifies you for the federal Extra Help program for prescription drug (Part D) costs.
• Late Penalties Waived: Enrollment automatically eliminates any Medicare Part B late enrollment penalties for life.

Required Documents to Apply

When submitting an application (such as form DOH-4328), you will need:

• A copy of your Medicare card (front and back)
• Proof of gross income (Social Security letters, pension statements, pay stubs)
• Proof of identity/date of birth
• Proof of New York residence
• Records of any other health insurance premiums you pay

No broad groups of people are losing traditional Medicare in 2026, but some Medicare Advantage enrollees face forced plan terminations, and roughly 100,000 lawfully present immigrants are projected to lose Medicare later due to recent federal legislation.

Medicare Advantage Changes

• Forced Disenrollment: According to Johns Hopkins Bloomberg School of Public Health, about 1 in 10 Medicare Advantage enrollees face forced plan disenrollment in 2026 as insurers scale back offerings.
• Network Drops: Major health systems nationwide have dropped specific Medicare Advantage plans due to disputes over prior authorization and reimbursements.

Immigrant Eligibility and Future Cuts

• Medicaid vs. Medicare: Recent changes from the federal spending law (such as the One Big Beautiful Bill Act) primarily target Medicaid eligibility for certain lawfully present immigrants starting October 1, 2026.
• Medicare Impact: While Medicaid changes took effect in late 2026, the Congressional Budget Office estimates that roughly 100,000 lawfully present immigrants could eventually lose Medicare coverage, with formal terminations anticipated around February 1, 2027.

The single biggest and most costly mistake people make with Medicare is missing enrollment deadlines, leading to permanent late-enrollment penalties and gaps in coverage.

Missing Enrollment Deadlines

• Initial Enrollment Period (IEP): This window lasts for seven months. It starts three months before the month you turn 65, includes your birthday month, and ends three months after.
• Late Penalties: Failing to sign up for Part B or Part D on time can trigger permanent monthly or yearly financial penalties added to your premiums.
• Delayed Enrollment Confusion: Many people wrongly assume they can delay Medicare past age 65 just because they have health coverage like COBRA, a marketplace plan, or small-employer insurance.

Other Costly Medicare Mistakes

• Ignoring Annual Changes: Sticking with automatic renewal without reading the Annual Notice of Change (ANOC) can result in unexpected costs, as drug lists and doctor networks shift every year.
• Choosing Solely by Low Premiums: Picking a plan based only on a low monthly cost while ignoring total out-of-pocket expenses like deductibles, copays, and coinsurance.
• Missing the Medigap Window: Forgetting to apply for a Medigap (Medicare Supplement) policy during your open enrollment window. After this six-month period, insurers can use medical underwriting to charge more or deny coverage.
• Skipping Financial Assistance: Overlooking programs like Medicare Savings Programs or Part D Extra Help that assist with out-of-pocket medical and prescription expenses.

Medicare does not cover blood tests that lack medical necessity, meaning routine wellness panels, self-ordered kits, or employment screenings are excluded.

Uncovered Blood Tests and Lab Work

• Routine Wellness Panels: General comprehensive metabolic or blood panels done just for a routine checkup or "peace of mind" during an annual physical are not covered unless tied to a specific symptom or diagnosis.
• Self-Requested Tests: Walk-in lab tests or direct-to-consumer mail-order kits ordered without a formal physician's prescription or authorization are completely excluded.
• Employment, Insurance, or Licensing Tests: Blood work required by an employer, for a life insurance application, or for legal/driving certifications is considered administrative rather than medical.
• Excessive Frequency: Tests repeated more often than Medicare's established guidelines allow (such as routine monitoring without a change in condition) will be denied.
• Experimental or Unproven Markers: Novel, alternative, or functional medicine blood tests that are not yet officially recognized by Medicare as standard, effective diagnostic tools.

You can review official guidelines for approved services through the Medicare Diagnostic Laboratory Tests Coverage Guide.