Research Suggests New York’s Efforts to Expand Medicare Cost Assistance Eligibility Are Working

A new independent research brief from academic experts examines the impacts of New York’s recent efforts to improve access to Medicare Savings Programs (MSPs) and Medicaid for Medicare beneficiaries. The authors trace these policy changes, connecting them with better uptake and coverage.

Medicare Beneficiaries Face Affordability Challenges

Despite Medicare’s significant successes, health care cost problems are far too common for many enrollees. The program’s benefit design, including the lack of comprehensive financial protections like an out-of-pocket cap, exposes beneficiaries to the risk of frequent and high costs. Enrollees financially contribute to their coverage through payroll taxes, premiums, deductibles, and other cost-sharing amounts. Many also pay for drug coverage, supplemental insurance, and services that Medicare does not cover, such as comprehensive dental, vision, and hearing care.

The program’s benefit design exposes beneficiaries to the risk of frequent and high costs.

Many older adults and people with disabilities have few resources. In 2024, one in four Medicare beneficiaries (16.5 million people) had income below $24,600 and less than $18,950 in savings. Many rely heavily on Social Security to stay afloat. In 2025, for 55% of Medicare enrollees, Social Security (about $20,000 a year) represented at least 75% of their income. And Medicare Part B and D costs accounted for nearly one-fourth of those monthly benefits, on average.

Intense financial pressures create impossible choices. Beneficiaries who cannot afford care may be forced to go without it. In 2023, more than one-third (36%) of beneficiaries delayed or skipped care due to affordability concerns. In addition to leading to worse outcomes and lower well-being, the cost to Medicare is also extreme. Beneficiaries who forgo treatment and experience declining health as a result may require more expensive interventions later.

Medicare Savings Programs Can Be a Lifeline

Cost assistance programs—including MSPs and Medicaid when it pays after Medicare—can help.

Administered by state Medicaid offices, the MSPs provide a financial lifeline for low-income Medicare enrollees by paying their Medicare Part B premiums ($202.90 per month in 2026) and enrolling them in Extra Help, the federal prescription drug subsidy program that the Social Security Administration (SSA) estimates is worth about $5,700 per year. Combined, these programs save enrollees an estimated $8,000 annually, allowing them to maintain Medicare coverage, afford medications, and better meet daily living expenses like food and housing.

Due to administrative barriers that complicate enrollment, as well as overly strict eligibility limits, MSPs have consistently been underenrolled.

But due to administrative barriers that complicate enrollment, as well as overly strict eligibility limits, MSPs have consistently been underenrolled. Taken together, an estimated 40% of those who are eligible are missing out on important MSP benefits.

New York’s MSP and Medicaid Changes

Although states can address these barriers, including by expanding eligibility criteria beyond federal guidelines, few have. New York is a notable exception: In 2023, New York raised income limits for MSP enrollment—in response to a coalition of advocates including the Medicare Rights Center—to include nearly 300,000 more New Yorkers (the state eliminated the asset test in 2008). This shift was paired with an expansion of New York’s Medicaid program for the aged, blind, and disabled population, helping even more people access care and coverage. Beyond modernizing eligibility, these reforms improved alignment for individuals transitioning to Medicare from expansion Medicaid, who used to lose access to important benefits and face financial barriers to care.

In 2023, New York raised income limits for MSP enrollment to include nearly 300,000 more New Yorkers.

The paper highlights New York’s leadership on this issue: “Medicaid eligibility rules for Medicare enrollees are often more restrictive than criteria for other adults; therefore, the transition from Medicaid to Medicare can be unwanted, complicated, and financially burdensome. New York is the only state that has aligned QMB and Medicaid income limits for adults, and is one of few states without an MSP asset limit.”

Research Findings

To capture the impact of these important policies, the authors examine the outcomes of New York’s eligibility expansions, finding higher enrollment “in programs that provide the most comprehensive financial assistance.” This is critical, as dually enrolled individuals have access to coverage and cost protections that Medicare-only enrollees do not, which can improve access to care and “free up an individual’s limited income for other necessities.”

Dually enrolled individuals have access to coverage and cost protections that Medicare-only enrollees do not.

The authors observed enrollment increases in two groups: (1) those who moved from existing MSP or Medicaid coverage “into combined MSP and Medicaid enrollment,” and (2) those who were newly eligible for income-based assistance after the Medicaid and MSP expansions.

By December 2023, there were 52,640 more new dually enrolled individuals and 143,327 more individuals who transitioned from either Medicaid or the MSP to both, compared with 2022. All received more assistance affording care and coverage as a result.

The two groups differed on a number of characteristics, and relative to prior years. For example, new dual enrollees were older compared with those in 2022 (68 vs. 66), while Medicare beneficiaries who transitioned from one to both programs had a higher share of younger beneficiaries (67 vs. 64).

The Medicare Rights Center Supports MSP Improvements

These findings align with our experience on the importance of MSP and Medicaid for Medicare enrollees. We have long worked to boost MSP uptake, including by identifying state-level interventions to ease MSP access. In addition to advocating for the MSP eligibility expansion, we worked to advance legislation automating MSP enrollment for people with Extra Help, using information already on file with SSA. This approach makes the program easier to access and administer, improving efficiency and equity.

We have long worked to boost MSP uptake, including by identifying state-level interventions to ease MSP access.

In 2025, we compiled a set of case studies from our national helpline to highlight what a difference this assistance can have in the lives of older adults and people with disabilities, share their stories, and support advocacy efforts to expand MSP eligibility and enrollment. Those real-world experiences demonstrate the obstacles beneficiaries commonly face when trying to get and keep an MSP and underscore the importance of the program. We have also developed materials on lessons learned from our New York MSP advocacy, to support the efforts of other states and to guide future policy improvements.

At the federal level, we have also championed MSP simplification, including rulemaking to streamline MSP enrollment nationally. These changes were initially estimated to increase MSP uptake by at least 860,000, but were blocked by the 2025 reconciliation bill, H.R. 1, to reduce the bill’s price tag and pay for other priorities. Experts estimate this “could result in 18,200 additional deaths among Medicare enrollees every year.”

We continue to urge policymakers to ease state and federal barriers to MSP access.

Read the research brief: Expansion of Medicaid Benefits for Medicare Beneficiaries in New York State.

Learn more about the MSP expansion and our work in New York:

Medicare Savings Programs: A Lifeline for Millions

Increasing Access to Medicare Savings Programs: Lessons Learned and Policy Recommendations from New York