If you need a prescription drug but can’t afford it because of the cost, there are several ways you can get help.
• Enroll in a Part D plan that offers additional coverage in the donut hole.
• Consider switching to generics or other lower-cost drugs.
• Apply for Extra Help, also known as a low-income subsidy (LIS), which helps those with low income get help with prescription costs. (More details on LIS below)
• Many states have State Pharmaceutical Assistance Programs that help pay for prescriptions, Part D premiums, and/or other drug costs.
• Pharmaceutical Assistance Programs. Some drug companies offer programs to help pay for medications for those enrolled in Part D plans. Ask your doctor or insurance company if there are plans available for the drugs you need help with.
• There are also other national and community-based charitable programs to help with drug costs, including:
o National Patient Advocate Foundation
o National Organization for Rare Disorders
o Benefits checkup
• In New York, The Elderly Pharmaceutical Insurance Coverage (EPIC) program administered by the Department of
Health is available to help with drug costs. EPIC helps seniors that meet certain income criteria with their out-of-pocket Medicare Part D drug costs. Seniors may apply for EPIC at any time of the year but must be enrolled in or eligible for a Part D drug plan.
In the list of help available above, we mentioned Extra Help or Low-Income Subsidy and want to provide some additional information on this program as it is an important one to take advantage of if you qualify. To apply for Extra Help, you need to meet the following criteria:
• You have Medicare Part A and/or Medicare Part B and;
• You live in one of the 50 States or the District of Columbia; and
• Your combined savings, investments, and real estate are not worth more than $29,520 if you are married and living with your spouse, or $14,790 if you are not currently married or not living with your spouse. (Do NOT count your home, vehicles, personal possessions, life insurance, burial plots, irrevocable burial contracts, or back payments from Social Security or SSI.)
If you meet these conditions and have Medicare and Supplemental Security Income (SSI) or Medicare and Medicaid, you don’t need to enroll because you will automatically get extra Help.
Anyone who has Medicare and meets the income and asset criteria can apply to get Extra Help with their Part D prescription drug costs. If you qualify for Extra Help, you will get assistance with monthly premiums, annual deductibles, copays, and coinsurance that apply to prescription drugs. Once you have been approved to get Extra Help, the Social Security Administration will notify Medicare and your insurance company. The insurance company will make the appropriate changes to your Part D drug plan, so you don’t have to worry about figuring it out yourself. The Extra Help is estimated to be worth about $5,000 per year. Many people qualify for Extra Help and don’t even realize it. You can apply for Extra Help on the Social Security Administrations’ website, or reach out to your local Medicare Advisor, Maura O’Toole from the FitzGibbons Agency, who can help with any questions you may have; just give her a call at 315-312-0803.
Have further Questions? Just Ask Fitz!
Maura O’Toole
FitzGibbons Agency
44 E Bridge St, Suite 1
Oswego, NY 13126
(315) 312-0803
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