When what we do helps someone…

…. it’s great to hear results.

Just before Thanksgiving I met with a recently widowed woman.  Still in mourning, she was reeling from her loss and struggling to make sense of her health plan costs and her dramatically reduced monthly income.

When she disclosed her assets and monthly income, I explained to her some programs she was likely eligible for and provided assistance with the enrollment process.

For starters, the easy one. I enrolled this client in the New York State Elderly Pharmaceutical Insurance Coverage (EPIC) program. EPIC helps with Medicare Part D premiums, prescriptions co-pays and the Part D “donut hole.”

Then, we confirmed she was eligible for Social Security Extra Help – available to Medicare participants with limited resources.

Third, New York State offers Part B premium assistance to Medicare participants with limited income and resources.

I love what I do.

When I received this note with the closing “Thank you again for giving me my life back” it reminds me of why we serve – to add some value to another’s life.  This is fulfilling and rewarding in its own way.

2016 0215 Thank you note

http://www.myuhcagent.com/daniel.alcorn
(518) 346-2115

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)
  • Part D drug plan premium assistance is available for members with annual income below $23,000 if single or $29,000 if married.
  • 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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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.