Questions to ask your doctor.

My thoughts on some of the six excellent questions Elizabeth Rosenthal, author of “An American Sickness,” suggests you should ask at every doctor’s appointment to make sure your medical bills are what you expect.

Question #1. How much will this cost?  Your provider’s office staff will know the fee a procedure, or series of procedures are billed at. And they will be able to tell you if your health plan has negotiated a different fee schedule including your flat copay or co-insurance percentage. To be forewarned is forearmed.

Question #4: Are there cheaper alternatives that are equally good, or nearly so? One example I see is a medication that is a combination of two, or more, off-patent generics. Check your health plan’s drug formulary and compare the co-pays. If the new combination pill is high priced ask your prescribing doctor why the one pill is recommended over taking two; sometimes the only benefit is convenience.

Question #5. Where will this procedure take place and how does that selection affect my cost?  Your health plan may have a preferred pricing arrangement (called “in network”, “participating” or “contracted”) with other facilities. Ask your doctor about performing the procedure at one of those.

One more suggestion. Contact your health plan agent or member services representative when planning an appointment with a new provider or facility.  Your plan may have preferred providers, usage limitations and pre authorization requirements. 

http://www.pbs.org/newshour/making-sense/column-6-questions-to-ask-at-every-doctors-appointment/?utm_source=facebook&utm_medium=pbsofficial&utm_campaign=newshour

NY State EPIC Drug Plan for Seniors

drug-costsEPIC, (Elderly Pharmaceutical Insurance Coverage) is a New York State program for seniors administered by the Department of Health. It helps eligible seniors supplement their out-of-pocket Medicare Part D drug plan costs.  Eligibility requirements are:

  • Resident of New York State
  • Age 65 or older
  • Income up to $75,000 (single) or $100,000 if married.

EPIC offers two plans, based on your income:

  • Fee Plan for members with income up to $20,000 if single or $26,000 if married.
  • Deductible Plan members with incomes ranging from $20,001 to $75,000 (single) or $26,001 to 100,000 (married.)   Download EPIC Application Here

EPIC members are required to be enrolled in a Medicare Part D drug plan or a Medicare Advantage health plan which includes Part D. Enrolling in EPIC will give a member a Special Enrollment Period (SEP) to join a Medicare Part D drug plan. Medicare Part D provides primary drug coverage for EPIC members. After a Part D deductible is met, if applicable, EPIC provides secondary coverage for approved Part D and EPIC covered drugs. EPIC also covers approved Part D-excluded drugs such as prescription vitamins as well as cough and cold preparations after enrolling in a Part D drug plan.

help

You or someone you know may now be eligible for EPIC help.  Download the EPIC Application and call me at (518) 346-2115 for assistance with submitting your request.

 

NY State Budget and Senior Drug Plan expansion

The Elderly Pharmaceutical Insurance Coverage (EPIC) program is a New York State program for seniors administered by the Department of Health. It helps income-eligible seniors aged 65 and older to supplement their out-of-pocket Medicare Part D drug plan costs.

The New York State 2014-15 budget included the expansion of the program to cover the prescription needs of more seniors.  Currently, the eligibility requirements for EPIC are capped at $35,000 for an individual and $50,000 for a married couple. These threshold will rise to $75,00 for an individual and $100,000 for married enrollees.

help

With these new thresholds you or someone you know may now be eligible for EPIC help.  Until the Department of Health prints new forms,  Download the EPIC Application and call me at (518) 346-2115 for assistance with submitting your request.