In Praise of New York HIICAP Medicare Counseling

I will be covered by Medicare starting on December 1, 2016 because I will have been collecting Social Security Disability for 2 years as of that date, and all recipients of Social Security Disability are automatically enrolled in the Medicare program two years following their SSD starting date.  Daunted and confused by the seemingly endless array of options, I went to see a Medicare counselor in New York city at the NYC Department for the Aging.  I have nothing but the highest praise.  You may have heard the term “SHIP (for State Health Insurance Assistance Program) counselor”, which is the term for these counselors in most other states, but here in New York they’re called HIICAP counselors, for “Health Insurance Information Counseling and Assistance Program”.  It was an excellent experience. I received easy to understand, valuable information that made my choices crystal clear, all within about 30 minutes without charge.  Most of all, I think my 30 minute time investment will result in substantial financial savings to me.  Pretty impressive.

I think the thing I learned from the counselor that surprised me most was that he sees mostly low income Medicare recipients.  Not that I doubt for a second that low income recipients need counseling.  Just that there are so many options for middle income folk who can afford to pay a bit more, that I don’t see how anyone makes these decisions without some expert help.  The counselor even gave me tips for using the Medicare website to be sure to obtain the results that would be most accurate.  And the tips were not inherently logical – they just related to the way the website happens to work.

Perhaps most impressive was the information I received about the EPIC program here in New York that appears to be nothing short of a windfall for those of us NET patients who use expensive drugs.  (Unfortunately for me, you have to be age 65 or older to qualify, which means that those of us who qualify for Medicare on the basis of being disabled are generally excluded.  This is an important exclusion for those of us who are affected by it, however, for purposes of describing the program, I will not mention that exclusion again here.)  Because EPIC assistance is based upon income, my husband and I assumed I wouldn’t qualify, but we were wrong.  This New York program has its own unique definition of “income” that excludes all interest and dividends from investments and still assists individuals with “income” up to $75,000 and married couples with “income” up to $100,000 per year.  Based upon these parameters, it would seem to me that many fully retired (as in non-working for pay) New Yorkers probably qualify.  So, for those of us New Yorkers using Sandostatin LAR or Somatuline Depot, among other very expensive drugs, even if your drug plan is pretty good, if you qualify for the EPIC “Deductible Plan”, you’ll probably pay less.  Under the EPIC Deductible Plan, you pay for your prescriptions until you meet your EPIC deductible, which is based on the previous year’s income. I don’t know how it’s calculated, but as an example, the counselor said my deductible would be $1200. After meeting the deductible, I would pay only the EPIC co-pay.  The co-pay is based upon the prescription cost and ranges between $3 and a current maximum of $20.  This means that after meeting the deductible, I would be guaranteed to never pay more than $20 for a prescription for the rest of the year.  All I can say is I hope this plan is still in effect when I reach age 65!

Like other SHIP counselors, HIICAP counselors offer Medicare beneficiaries free advice on how to choose from an array of drug and health insurance plans that can be truly mind-boggling. Furthermore, their counseling includes how to challenge coverage denials and how to obtain financial subsidies for premiums, co-payments and deductibles. Topics covered include Medicare Parts A and B, “Medigap” insurance, Medicare Advantage health plans, Medicare Part D and Medcare Savings Programs.  The counseling is free and is available both over the telephone and in person by calling 311 and asking for HIICAP.

For those who are considering reaching out to a HIICAP counselor, unfortunately it appears that this should be done sooner rather than later. While researching a few facts for this post, I was disheartened to learn that in June of this year the Senate Appropriations Committee approved the FY17 Labor, HHS, Education Appropriations bill with a nearly unanimous vote of 29-1. That bill would eliminate the entire $52.1 million in federal funding for the Medicare State Health Insurance Assistance Program (SHIP), effectively eliminating the program. The House Appropriations Committee has not yet taken action on its version of the FY17 Labor, HHS, Education Appropriations bill, but is expected to do so in the next few weeks. If you have been helped by this program as I have, or if you wish to take advantage of the program in the future, this is an excellent time to write to your representatives in Congress, as well as to our New York senators, Chuck Schumer and Kirstin Gillibrand.

Nancy Stone




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