Medicare Issues Projected Drug Premiums for 2018

CMS reports the average 2018 monthly premium for a basic Part D prescription drug plan will be reduced by $1.20 to $33.50.

In addition to the monthly premium other Part D variables Medicare beneficiaries should compare are:

  • Plan Formulary – not all plans are alike. Check and confirm your medication is included in the list of covered drugs.
  • Tier Levels – competing plans may list the same covered drugs however may assign different tier levels with higher or lower copays.
  • Deductible – Like with your car insurance, this is the amount you pay before the Part D plan benefits begin. Some plans apply a deductible to all drugs, other plans apply only to certain tier levels.
  • Preferred pharmacy or Mail Order – some plans negotiate lower retail and copay costs with national retail or Mail Order pharmacies.

Extra Help for Part D plan premium, deductible and copay amounts is available to individuals meeting income and resource levels. 

https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2017-Press-releases-items/2017-08-02-3.html

When what we do helps someone… February 2017

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New York EPIC and Medicare Part D

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2016 EPIC CoPayment

 

The Elderly Pharmaceutical Insurance Coverage (EPIC) program is a New York State Program that provides seniors with co-payment assistance for Medicare Part D prescription drugs.

  • Members must be enrolled in a Medicare Part D drug plan. including any Medicare Advantage plan with Part D prescription drug coverage
  • Provides secondary coverage for Medicare Part D and EPIC covered drugs purchased after the Part D deductible, if any, is met.

Who Is Eligible to Enroll?

  • You must be a resident of New York State with annual income up to $75,000 if single or $100,000 if married.  (Based on most recent NY State tax filing Adjusted Gross Income, Plus Social Security Benefits Less Part B premiums)
  • You must be age 65 or older and not receiving full Medicaid benefits.
  • You must be enrolled in a Medicare Part D plan; either standalone or combined within a Medicare Advantage plan.

What Does EPIC Cost?
EPIC has two plans based on your income.

  • The Fee Plan is for members with income up to $20,000 if single or $26,000 if married. Benefits begin immediately.
  • The Deductible Plan is for members with incomes ranging from $20,001 to $75,000 if single or $26,001 to $100,000 if married. Benefits begin when the deductible (Part D co-payment) has been met.

What Are The Benefits?

  • EPIC provides secondary coverage for Medicare Part D covered drugs purchased after the Part D deductible, if any, is met.
  • EPIC co-payments are $3, $7, $15 or $20 based on the prescription cost after your Part D (see below)
  • Up to $41 monthly Part D drug plan premium assistance is available for members with annual income below $23,000 if single or $29,000 if married. (This monthly amount is adjusted yearly)
  • EPIC members enjoy a once annual special election period to enroll or change their Medicare Part D prescription drug plan, including any Medicare Advantage plan with Part D prescription drug coverage.

 

Next Step

  • Confirm you meet the above residency, age and income eligibility requirements.
  • Download, print, complete and mail in the EPIC application.  Download the PDF EPIC Application Here
  • You will receive a separate EPIC Member card.  Provide the EPIC Member ID number to your New York based retail and mail order pharmacy.
  • New York based retail and mail order pharmacies are connected to EPIC and will report your out of pocket copay. Do this even if you’re income has you in the deductible plan in case your drug needs change later in the year.
  • Once the EPIC fee based or deductible plan requirement is met, EPIC steps  in as secondary coverage which reduces your copay to  $3, $7, $15 or $20 (see below)

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For Existing EPIC Members – Annual Renewal Process

  • You do NOT have to reapply for EPIC each year.
  • EPIC reviews your residency and income on an annual basis to confirm eligibility and updated Fee or Deductible levels.
  • At Year One, EPIC will obtain updated residency and income information from government tax files and advise you in writing of any fee or deductible change.
  • At Year Two and every two years, EPIC will send you a form to update your contact information, address and income and advise you in writing of any fee or deductible change.
  • EPIC Member Service telephone number is 800-332-3742 (Monday through Friday until 5:00 pm / eastern)

And, of course, if you have any questions about your Part D prescription drug coverage please don’t hesitate to call me at (518) 346-2115.

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Informational Guides to Medicare

Download your own copy of these informational guides from Medicare Made Clear.

Do you have additional questions about Medicare?

There’s a guide for that!

The comprehensive Show Me Guide and the other resources listed below can help.
http://www.medicaremadeclear.com/information/medicare-guides

Contact me with any questions:
http://www.myuhcagent.com/daniel.alcorn