Qualifying Individual (QI)

This program pays for the Medicare Part B premium only. Individuals cannot be eligible for QI and Medicaid. The applicant must have Medicare Part A. States are allotted money for this program on a yearly basis. The 2026 income requirements for this program are:

Income Below 186% FPL +$20 Single: $2,474 per month $2,494 Couple: $3,355 per month $3,375

Applications for these programs may be obtained from the Medicaid office at the local (county) Department of Social Services. You may print the application from the link below or apply online with the NY State of Health. All paper applications for the Medicare Savings Program must be mailed to the local Department of Social Services where you live.

If you have questions, the phone number to call for the Medicaid Helpline is 1-800-541-2831.

DOH-4328 - Medicare Savings Program Application (PDF) Also available in: Arabic , Bengali , Chinese , Hatian Creole , Italian , Korean , Polish , Russian , Spanish

DOH-4328 Instructions (PDF) Also available in: Arabic , Bengali , Chinese , Haitian Creole , Italian , Korean , Polish , Russian , Spanish

Rev. 3/26

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