Extra Help and MSP in New York: how they work together

Extra Help, also called the Part D Low-Income Subsidy or LIS, pays most of the cost of a Medicare drug plan for people with limited income and resources. With Extra Help you pay a $0 plan premium and a $0 deductible in a plan at or below the program's premium benchmark, plus small copays at the plan's network pharmacy. For most people with Extra Help, CMS caps those copays at $5.10 for each covered generic and $12.65 for each covered brand-name drug in 2026, rising to $5.80 and $14.40 in 2027, the amounts Medicare.gov now shows. People who also have full Medicaid can pay less; the table in the next section shows each group. If a person picks a plan whose premium is above the benchmark, they pay the difference, which is one reason a HIICAP counselor's plan comparison is worth the call.

Medicare.gov lists the 2026 limits Extra Help is built around: yearly income of $23,940 for an individual or $32,460 for a married couple living together, and resources of $18,090 for an individual or $36,100 for a couple. Resources mean things like bank accounts, stocks, bonds, and retirement accounts; the home you live in does not count.

What you pay at the pharmacy with Extra Help depends on which group Medicare puts you in. These are the most a drug plan can charge for a covered drug before you reach the yearly out-of-pocket limit. A plan can charge less, never more. The deductible is $0 in every row.

Sources: CMS's 2026 Extra Help cost-sharing memo (Table 2) and the CY 2027 Rate Announcement of April 6, 2026 (Table V-2). The yearly out-of-pocket limit is $2,100 in 2026 and $2,400 in 2027. Medicare.gov explains that once your covered drug costs reach that limit, counting what Extra Help pays for you, you pay $0 for covered drugs for the rest of the year.

What is planned for 2028. Congress passed the change in the Consolidated Appropriations Act, 2026, signed on February 3, 2026. It sets the generic-drug copay at $0, starting with plan years that begin on or after January 1, 2028, for people with Medicare and full Medicaid whose income is at or below 100% of the federal poverty level. On October 20, 2026, CMS published a proposed rule, CMS-4214-P, in the Federal Register to write that change into Medicare's drug plan rules. Under the proposed wording, generic drugs and biosimilars would cost $0. Other covered drugs would keep a small copay that is adjusted for inflation each year. CMS says the proposal does not change who qualifies or any other Extra Help amount, and it estimates about 6 million people would be affected nationwide.

It is still a proposal. CMS is taking public comments until 5 p.m. Eastern on December 15, 2026, and will publish a final rule after that, so the details can still change. Nothing changes for 2026 or 2027. In 2027, people in this group pay up to $1.65 for a generic and $5.00 for other drugs. We will update this page when the final rule is published.

Who this reaches in New York. In 2026 the federal poverty level is $15,960 a year for one person, about $1,330 a month, and $21,640 for a couple, about $1,804 a month, according to New York's own 2026 income chart. New York's Medicaid income level for people who are 65 or older, blind, or disabled is higher: $1,836 a month for one person and $2,489 for a couple. So many New Yorkers with full Medicaid have income above the poverty level. They are in the third row, and the 2028 generic change would not apply to them. It reaches people with full Medicaid whose income is at or below about $1,330 a month for one person.

How to see which row you are in. Medicare sets your Extra Help level from information New York sends. Your drug plan's Extra Help notice, often called the LIS Rider, lists your copays, and the plan or 1-800-MEDICARE (1-800-633-4227) can tell you your level. If you get Medicaid home care and are still charged copays, ask whether your record shows home and community-based services. If a pharmacy charges more than the amount in your row, call your plan first. Medicare.gov says the plan can ask for proof of your Extra Help and fix the cost.

Choosing a plan for 2027. Open Enrollment runs October 15 to December 7, 2026. Medicare.gov notes that people with Medicaid or Extra Help may be able to change drug coverage once a month. Before you switch, compare the premium against the benchmark and check that your drugs are on the plan's list. A free HIICAP counselor can run that comparison with you.

An MSP pays Medicare's own costs, starting with the Part B premium. New York's 2026 page lists two levels: Qualified Medicare Beneficiary (QMB) with monthly income at or below $1,836 for a single person and $2,489 for a couple, and Qualifying Individual (QI) with monthly income of $2,474 for a single person and $3,355 for a couple. QMB also covers Medicare deductibles and coinsurance; QI pays the Part B premium only. New York's overview states there is no resource test for its MSP programs. Our QMB vs QI post goes through those figures line by line.

This is the connection most people miss. New York's MSP page says that when you enroll in an MSP, you will also automatically get Extra Help. Medicare.gov says the same from the federal side: people in a Medicare Savings Program automatically get Extra Help without a separate application. The federal term for this is "deemed" status. The state tells Medicare that you are in an MSP, and Medicare marks your record as having Extra Help.

Two practical consequences follow. First, a person in QI, whose MSP on paper pays only the Part B premium, ends up with the full Extra Help drug benefit as a side effect. Second, the resource test disappears from the picture. Extra Help on its own has a resource limit; New York's MSP does not. A person whose savings put them over the Extra Help resource line might still be inside the MSP income band, and if the MSP is approved, Extra Help follows through deeming with no resource question asked.

Deemed Extra Help follows the MSP. If the MSP lapses, for example because a renewal form was not returned, the Extra Help can end with it. Treat the MSP renewal letter as important mail. Our post on Medicaid renewal and Extra Help letters explains the grey and orange notices that follow a lapsed MSP.

The connection runs the other way as well. When a person applies for Extra Help through Social Security, whether online at ssa.gov or by calling 1-800-772-1213, federal law requires Social Security to pass that application along. In plain terms: Social Security sends your information to the state Medicaid agency, which treats it as an MSP application. In New York City that agency is HRA; elsewhere in the state it is the county Department of Social Services.

This is described on Social Security's and Medicare's Extra Help pages, and it means an Extra Help applicant may get a letter from HRA or the county asking for a few more documents to finish an MSP application they did not know they had started. Answer that letter. The MSP is usually the bigger dollar benefit of the two, because the Part B premium alone is $202.90 a month in 2026.

The transfer is not instant, and the state may need income proof that Social Security did not collect. If you have not heard from HRA or your county within a couple of months of an Extra Help approval, call and ask whether an MSP application is open in your name.

The same person can be inside one program's limit and outside the other's.

• Who runs it. Extra Help is federal, through Social Security. MSP is state, through Medicaid (HRA in New York City, the county DSS elsewhere).
• Income measure. Extra Help is described on medicare.gov as a yearly income limit. New York's MSP is a monthly limit, with a $20 disregard applied first. The program handling the application does the math.
• Resources. Extra Help has a resource test ($18,090 for an individual and $36,100 for a couple in 2026, per medicare.gov). New York's MSP has none.
• What it pays. Extra Help pays drug plan costs. MSP pays Medicare premiums and, for QMB, deductibles and coinsurance.
• Renewal. Extra Help is redetermined by Social Security; deemed Extra Help follows the MSP. MSP is renewed by HRA or the county on its own schedule.

EPIC, the Elderly Pharmaceutical Insurance Coverage program, is a New York State program that helps with drug costs for older New Yorkers. The state's eligibility page lists four requirements: be a New York State resident age 65 or older, have an annual income below $75,000 if single or $100,000 if married, be enrolled or eligible to enroll in a Medicare Part D plan, and not be receiving full Medicaid benefits.

Those income limits are far above the Extra Help and MSP limits, which is the point. EPIC is designed for people who are past the low-income programs but still struggling with drug costs, and it can also coordinate with Extra Help on the same prescription. Which one to check first depends on age, income, and whether you already have Extra Help, and that ordering is exactly the kind of question a HIICAP counselor answers for free.

The EPIC Helpline is 1-800-332-3742 (TTY 1-800-290-9138), open Monday through Friday from 8 a.m. to 5 p.m., according to the state's application and contact page.

None of this is a determination; it is a way to ask the right offices the right questions.

1. Ask HIICAP to compare your monthly income with the current New York MSP figures. If it is in range, the application goes to HRA or your county DSS, and Extra Help follows.
2. If you are above the MSP range but near the Extra Help limits, apply through Social Security and expect the state to follow up on an MSP anyway.
3. If you are 65 or older and above both, ask about EPIC.