New York
The purpose of this document is to provide resources for gathering more
information regarding Medicare Part D in your state. This listing supplies
contact information for state and federal agencies working on issues
relating to the Medicare prescription drug benefit. It also includes
information about groups with which MHAs may partner to conduct outreach
and education activities.
Centers for Medicare & Medicaid Services (CMS):
- The Medicare Part D prescription drug benefit is administered
by CMS within the Department of Health and Human Services. The CMS
Region II Office
serving New York is located in New York and can be reached at 212-264-3657.
For inquiries regarding the CMS Medicare Prescription Drug Education
Campaign, contact:
- • Medicare beneficiaries can also visit the official government website,
www.medicare.gov, for additional information, including billing,
appeals and enrollment. For general Medicare information, as well as information
about health plans, contact the 24-hour toll-free hotline at 1-800-MEDICARE
(1-800-633-4227).
Social Security Administration (SSA):
- The Social Security Administration helps individuals determine whether
or not they qualify and how to apply for benefits, including additional
help for the prescription drug benefit. SSA maintains a toll-free number,
1-800-772-1213, twenty-four hours a day.
- The Western Program Service Center is located in San Francisco.
Its website is http://www.ssa.gov/sf/index.html.
- Further contact information, including addresses, for SSA’s
local Nevada offices can be found at http://www.ssa.gov/sf/offices/sf-nevada-offices.htm.
- Individuals are also able to search for local Social Security Administration
offices through a zip code locator at: http://s00dace.ssa.gov/pro/fol/fol-home.html
State Medicaid Agency:
- To obtain information regarding Medicaid enrollment, eligibility
and coverage information for those residing in New York State, contact
the Department
of Health at:
518-486-9057 (Medicaid Helpline)
1-800-505-5678 (New York City Medicaid Managed Care Information)
1-888-562-9092 (Nassau County Medicaid Managed Care Information)
1-888-566-9799 (Suffolk County Medicaid Managed Care Information)
http://www.health.state.ny.us/health_care/medicaid/index.htm
State Pharmacy Assistance Programs (SPAPs):
- Additional prescription drug benefits may be offered through
a State Pharmacy Assistance Program.
Access, Eligibility and Contact Information:
- EPIC (Elderly Pharmaceutical Insurance Coverage) provides prescription
benefits to those who are 65 and older and have an annual income of $35,000 or
less
(for single individuals) or $50,000 or less (if married). Those who receive
full Medicaid benefits or have other prescription coverage that is superior
to EPIC are ineligible.
Single seniors with income up to $20,000 and married seniors with income
up to $26,000 are eligible for the Fee Plan. The cost of joining is based
upon
annual income and is paid in quarterly installments. Those with income
between $20,001 and $35,000 for single seniors and $26,001 and $50,000
for married
seniors, are enrolled in the Deductible plan. Once enrolled, seniors
pay full price for their prescriptions until they meet an annual deductible
based
upon
income. Co-payments for both programs range from $3 to $20 depending
upon the cost of the medication.
Qualified individuals can receive assistance from EPIC even if they receive
drug benefits under Medicare Part D. EPIC will pay a portion of the costs
of qualified prescription drugs for which no payment or reimbursement
is made
by Medicare Part D. This portion of the program was enacted in 2004.
1-800-332-3742
http://www.health.state.ny.us/nysdoh/epic/faq.htm
Legislative Issues:
• Bill S03081 was sent to aging committee on March 7, 2005. If passed,
disabled individuals who are eligible for SSDI would also be eligible for EPIC.
• If passed, Bill A05955 would provide for assistance to potential EPIC
enrollees for prescreening, scope of coverage counseling and application assistance.
It was sent to the aging committee on March 3, 2005.
Access to Benefits Coalition (ABC):
- ABC coalitions work to help Medicare beneficiaries locate and
apply for additional assistance in paying for prescription drugs. They
also aid individuals
in enrolling in both public and private prescription savings programs.
www.accesstobenefits.org
- There are two coalitions in New York: the
State Health Insurance Assistance Program (SHIP):
- SHIPs offer free counseling and assistance to Medicare beneficiaries
and their families. In addition, SHIPs will be planning Medicare
Part D enrollment and education events throughout each state. The National
Network
website is https://www.shiptalk.org. You may find information about
New York ’s
SHIP below or at the national website.
- The Health Insurance Information, Counseling and Advocacy Program
(HIICAP) is administered by the New York State Office for the Aging. HIICAP
counselors operate through Area Agencies on Aging to aid seniors and caregivers
to better understand Medicare and other insurance programs. 1-800-333-4114
www.hiicap.state.ny.us
- National Conference of State Legislatures (June 14, 2005). 2005 Prescription
Drug State Legislation, Mid-year Edition: updated June 14, 2005.
NCSL Health Program. Available at http://www.ncsl.org/programs/health/drugdisc05.htm.
- Ibid.
www.nmha.org/medicare
For more information or questions, please email schrinfo@nmha.org or
call 1-800-969-6642
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