The Port Washington Senior Citizens Center recently sponsored a representative from the New York State EPIC (Elderly Pharmaceutical Insurance Coverage Program) to inform interested seniors about available pharmaceutical coverage. Jill Mullen, Outreach Representative from EPIC, spoke about the recently enacted Medicare Part D, and how it can work with EPIC.
Mullen began with a quick overview of New York State's EPIC program to assist residents of the state who are 65 or older and whose annual income is under $35,000 (single) or $50,000 (married), and who do not have full Medicaid benefits. There are two EPIC plans available: the fee plan and the deductible plan. Under the former, annual fees are on a sliding scale ranging from $8 per person up to $300. Under the latter, there is no annual fee; participants pay the full price of prescription drugs up to the annual deductible, which ranges from $530 to $1,715. Mullen told that seniors need to be aware that they will need to send proof of age, and, preferable, proof of income with the EPIC application.
Mullen explained that Medicare Prescription Drug Payment Plan known as Part D is for Medicare recipients, regardless of income, who do not have any coverage for prescription drugs, or who do not have what is deemed "creditable coverage." "Creditable coverage" means that one has private insurance or HMO coverage from an employer or elsewhere that is at least as good as Medicare's coverage. Mullen said that coverage under EPIC is considered "creditable coverage." She cautioned that individuals without coverage must sign up for Part D by May 15, or pay a severe penalty if they decide to sign up later. Those who have coverage now, but lose it for whatever reason, can sign up for Part D later, but they will have to have proof of coverage from the insurance company called a "letter of coverage." Mullen advised those who are now covered for prescription drugs and who choose not to sign up for Part D now procure and keep such a letter in the event they need or want to sign up for Part D in the future. (Applicants have 63 days after their other coverage ceases to apply for Medicare Part D.) Individuals should check with their current provider before enrolling in Part D. Mullen further advised that even seniors who are not currently taking prescription drugs consider signing up for the Medicare coverage before May 15 if they do not have other coverage. "You can join a plan that has a low premium," she said.
The Medicare drug plan began on Jan. 1, and enrollment is open until May 15. Mullen said that the Part D coverage is provided by private companies approved by Medicare. She said, "There are over 40 companies in New York providing coverage. The choice can be overwhelming." Mullen advised, "Look at the premiums, the deductibles and the copayment."
Mullen discussed the big gap in the Medicare drug coverage, sometimes referred to as the "doughnut hole," which has come under a great deal of criticism by health care experts and senior advocates. Columnist Saul Friedman in a Jan. 14, 2006 Newsday column wrote, "Welcome to 2006, when millions of older Americans will be falling down the doughnut hole, searching for new adventures in Medicareland, where things are 'curiouser and curiouser'" Mullen explained the hole as follows. "The Medicare drug plan covers 75 percent of your expenditures until you reach $2,250. Then, at the next level from $2,250 up to $5,100 there is no coverage. [Emphasis added.] She continued, "Above $5,100 Medicare comes back in and will cover 95 percent." She explained that, in total, one would have to lay out about $3,600 for the Medicare drug plan. Mullen added lower-income persons could qualify for a plan with little or no premiums, deductibles, and copayments.
Mullen advised that those who are currently covered by EPIC explore whether it is advantageous to switch to Part D or to use Part D as primary and EPIC as secondary to pick up the deductibles, copayments, the "doughnut hole," and/or what Medicare denies after an appeal process. For more information on EPIC, call 1-800-332-3742 , visit the New York State website http://www.state.ny.us (click on the EPIC link), or write P.O. Box 15018, Albany, NY 12212-5018.
Where do you go to find out about the Medicare drug plans? You can call 1-800-MEDICAR or 800-772-1213 or go on the website www.medicare.gov. Mullen said that the website has a "plan finder" where one can enter the medications one is currently taking and get back a plan that will cover all or most of those medications. It also will give a side-by-side comparison of three different plans. One can enroll by telephone or through the website.
This program was only one of many informational programs sponsored by the Port Washington Senior Citizens Center. The center also provides a place for seniors to find fun, companionship, recreation, and opportunities to be of service to others. Courses are offered in sewing, art, sculpture, ceramics, and other subjects. The center also sponsors a number of day trips and extended tours. Hot lunch is served daily. For more information, telephone 883-6656 or drop by 80 Manorhaven Boulevard.
Residents who want more information on Part D can attend a presentation sponsored by Legislator Craig Johnson, Commissioner Sharon Mullon, and the Nassau County Department of Senior Citizen Affairs on March 17 at 1 p.m. at the Roslyn library, 2 Peppermill Road. They promise to "help clear up the confusion."