Where to Mail Your Medicare Savings Program Application in NYC

If you live in one of the five boroughs and are mailing your Medicare Savings Program application in NYC, send it to HRA/Medical Assistance Program, Initial Eligibility Unit, 5th Floor, PO Box 24390, Brooklyn, NY 11202-9814. That address is for the MSP application by itself. If you are applying for the MSP and Medicaid at the same time, use a different PO Box: HRA/Medical Assistance Program, MSP-CREP, 5th Floor, PO Box 24330, Brooklyn, NY 11202-9801.1NYC.gov. Medicare Savings Program

The Two Addresses and When Each Applies

NYC’s Human Resources Administration processes MSP applications for everyone in the five boroughs, and it routes mail through two separate PO Boxes depending on what you are asking for.

  • MSP only — HRA/Medical Assistance Program, Initial Eligibility Unit, 5th Floor, PO Box 24390, Brooklyn, NY 11202-9814.1NYC.gov. Medicare Savings Program
  • MSP and Medicaid combined — HRA/Medical Assistance Program, MSP-CREP, 5th Floor, PO Box 24330, Brooklyn, NY 11202-9801.1NYC.gov. Medicare Savings Program

Using the wrong PO Box can delay your application, because the two units handle different intakes. The street name is identical and the zip codes look nearly the same, so check the zip+4 before you seal the envelope.

How to Mail It So It Arrives

Send the application by certified mail with a return receipt. That gives you a dated record of when HRA received your package, which matters if there is later a question about when the 45-day processing clock started.

If your submission runs to several pages of supporting documents, use a large envelope or a flat mailer instead of a standard letter envelope. Thick packets fare poorly in postal sorting. Keep a photocopy of everything you send, including the signed form.

What to Put in the Envelope

The application is Form DOH-4328, the official Medicare Savings Program Application. You can download it from the New York State Department of Health or call the HRA Medicaid Helpline at 888-692-6116 to request a paper copy by mail.2NYC Human Resources Administration. Public Health Insurance The form asks for your Social Security number, date of birth, and your Medicare Claim Number (the alphanumeric code on your red, white, and blue Medicare card). If you are married and live with your spouse, both the “Self” and “Spouse” sections need to be completed even if only one of you is applying. Sign and date the form.

Include photocopies of your supporting documents with the form:

  • Proof of Medicare coverage: the front and back of your Medicare card.
  • Proof of income: a recent Social Security award letter, pension statements, four weeks of pay stubs if you are working, or documentation of other income such as veterans’ benefits.
  • Proof of identity and date of birth: a state driver’s license, U.S. passport, birth certificate, permanent resident card, or NYS Benefit Identification Card.
  • Proof of New York residency: a utility bill, lease, rent receipt, property tax record, or mortgage statement dated within six months of when you sign the application.
  • Proof of other health insurance premiums you pay, if any.
  • Immigration documents, if you are not a U.S. citizen.

You do not need to send bank statements, investment records, or any information about your savings. New York eliminated the resource test for the MSP, so qualification depends on your monthly income alone.3New York State Department of Health. Medicare Savings Program

Other Ways to Submit if You’d Rather Not Mail

Mailing is one of four accepted submission methods. Any of the others gets your application to the same HRA unit.

Online

Apply through ACCESS HRA at nyc.gov/accesshra. You create an account, then complete and submit the MSP application electronically.4NYC.gov. ACCESS HRA Website and Mobile App This is often the fastest route because there is no postal delay and no risk of lost mail.

Fax

Fax your completed application and supporting documents to 917-639-0732. If an authorized representative is submitting on your behalf, the fax number is 917-639-0731.2NYC Human Resources Administration. Public Health Insurance Keep the fax confirmation page as your proof of submission.

In Person

You can drop off a completed application at any HRA Medicaid community office and get a dated receipt. Locations include:5NYC Human Resources Administration. Medicaid Locations

  • Bronx: 305 Rider Avenue; 2541 Bainbridge Avenue
  • Brooklyn: 1912 Mermaid Avenue; 2400 Fulton Street; 441 Clarkson Avenue; 495 Clermont Avenue
  • Manhattan: 115 Chrystie Street; 4055 10th Avenue
  • Queens: 32-20 Northern Boulevard; 165-08 88th Avenue
  • Staten Island: 215 Bay Street

Check the current hours of the office you plan to visit before you go, since some locations require appointments.

What Happens After HRA Receives Your Application

HRA generally issues a written decision within 45 days of receiving a complete application. You will get a letter telling you whether you were approved, denied, or whether HRA needs more documents to decide. If HRA requests additional documentation, the 45-day clock pauses until you send it in.

Once you are approved, HRA notifies the Social Security Administration through a process called “state buy-in,” and SSA stops deducting the Part B premium from your monthly check. The standard Part B premium in 2026 is $202.90, so your monthly Social Security deposit goes up by that amount once the change takes effect, which can take a pay cycle or two.6CMS. 2026 Medicare Parts A and B Premiums and Deductibles

MSP coverage can also be retroactive for up to three months before the month you applied, provided you would have been eligible during that period. If you paid Part B premiums during those months, you may be due a refund. For Qualifying Individual (QI) applicants, retroactive coverage cannot cross into a prior calendar year.7CMS. State Payment of Medicare Premiums

To check on your application status at any point, call the HRA Medicaid Helpline at 888-692-6116.8NYC Human Resources Administration. Health Assistance

Free Help Before You Mail

You do not need to pay anyone to help you apply. HRA keeps a list of community-based partner organizations that can walk you through the form, screen you for eligibility, and in some cases submit your documents electronically. LiveOn NY serves older adults in all five boroughs and offers MSP application assistance by phone, by appointment, or through home visits when needed; the number is 212-398-5045.9NYC Human Resources Administration. Find a Partner Organization A local State Health Insurance Assistance Program (SHIP) counselor is another free source of help with MSP and Medicare questions.