When you are eligible for Medicare, you might qualify for a couple of different Programs administered by State or Federal Government. Sadly, when you go to your local Social Security workplace or contact Medicare, no one tells you about it. Nobody advises you that such programs exist, and no one assists you to send an application. Generally, there are qualifications for any of these programs. Numerous people certify for these substantial cost savings and do not even know it.

What is EPIC?

The Elderly Pharmaceutical Insurance Coverage (EPIC) Program is a New York State Program administered by the Department of Health. It provides elders with co-payment help for Medicare Part D covered prescription drugs after any Part D deductible is satisfied.

What is LIS or Extra Help with your Part D?

Part D Extra Help is a program to assist people with limited earnings and resources to pay Medicare prescription drug program expenses, like premiums, deductibles, and coinsurance.

We help countless senior citizens a year with their Medicare Planning, and each time we check if they certify. Often we hear from our customers, “I understand I don’t certify.” However, did you know to have EPIC, you can make up to $75,000 single and $100,000 couple?

Every Medicare beneficiary must have Medicare creditable Prescription drug protection. Under § 423.56(a) of the final regulation, coverage is countable if the actuarial value of the coverage equals or surpasses the actuarial amount of standard prescription drug coverage under Medicare Part D. If you do not get Part D when you very first time qualified, you might have LEP, Late Enrollment Penalty, starting building up. For each month you postpone registration in Medicare Part D, you will have to pay a 1% Part D late enrollment penalty (LEP) unless you: Have excellent drug coverage.

If you have Extra Help, you do not need to pay Part D Late Enrollment Penalty.

Who receives Extra Help (LIS)?

To receive Extra Help, your resources must not exceed $14,610 for an individual or $29,160 for a couple living together. Resources include the value of the things you own. Some examples are:

  • Real estate (aside from your first house).
  • Bank accounts consisting of monitoring cost savings and certificates of deposit. 
  • Stocks. 
  • Bonds, including U.S. Savings Bonds. 
  • Mutual funds. 
  • Individual Retirement Accounts (IRAs). 
  • Cash in the house or anywhere else.

What is the earnings limit?

To get approved for Extra Help, your annual income needs to be limited to $19,140 for an individual or $25,860 for a married couple living together. Even if your annual earnings are greater, you may still be able to get some assistance. Some examples where your profits may be greater, and you can still get Extra Help to include if you or your partner: 

  • Support other members of the family who live with you. 
  • Have revenues from work. 
  • Live in Alaska or Hawaii.

Making An Application For Extra Help 

How do I apply?

Making An Application For Extra Help is simple. Complete Social Security’s Application for Extra Help with Medicare Prescription Drug Plan Costs (Form SSA-1020).

Use one of these options:

  • Apply online at www.socialsecurity.gov/extrahelp.
  • Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) to use over the phone or to ask for an application.
  • Apply at your regional Social Security workplace.

After you submit an application, Social Security will examine and send it to you to let you know if you get approved for Extra Help. After you certify, you can select a Medicare prescription drug plan. If you do not choose a plan, the Centers for Medicare & Medicaid Services will do it for you. The earlier you sign up with a plan, the quicker you begin receiving benefits.

Do you have any questions?

We will be glad to assist you

Call us at 1-800-252-7047

Send Request

What should I understand?

Most of the questions on the application are about resources and earnings. We need to understand this information about both of you if you are married and coping with your spouse. Household members, caretakers, and other third persons can help you complete the application. The details below can help you decide if you are eligible and can help you achieve the actual form for Extra Help. The worksheet is not an application.

Who can get EPIC?

The Elderly Pharmaceutical Insurance Coverage (EPIC) Program is a New York State program administered by the Department of Health. It offers seniors with co-payment support for Medicare Part D covered prescription drugs after any Part D deductible is met.

EPIC also covers numerous Medicare Part D omitted drugs.

  • Fee Plan members pay a yearly fee to EPIC based upon their income. The EPIC co-payments vary from $3 – $20 based on the expense of the medication. Those with Full Extra Help from Medicare have their EPIC charge waived.
  • Deductible Plan members need to satisfy a yearly out-of-pocket deductible based on their earnings before paying EPIC co-payments for drugs.
  • Who can sign up with?
  • A resident of New York State 65 or older with yearly income up to $75,000 if single or $100,000 if married.
  • A qualified senior with a Medicaid invest down not receiving complete Medicaid advantages.

How to Apply?

  1. Complete the application, sign it and mail or fax it in.
  2. Report overall earnings for you and your partner if you live together (even if just one of you is applying), and both should sign the type.
  3. Apply separately, or spouses living together can both use the same kind.

When you request EPIC, no documents are required. EPIC verifies details with the Social Security Administration and the New York State Department of Taxation and Finance.

Keep in mind, and EPIC deals with your Part D plan to help you spend your prescription drugs. You must have a Part D plan to have EPIC. EPIC will serve as secondary (extra) coverage for EPIC- and Part D-covered drugs, after your Part D and/or EPIC deductible is satisfied. Your Part D plan must pay first on your medicines, and EPIC will pay the 2nd. EPIC might also cover medications that Medicare Part D doesn’t cover (excluded drugs), such as prescription vitamins and minerals.

If you have N.Y. State Medicaid, you generally instantly get approved for Extra Help with Part D. If you have Full Extra Help, there is no need to get EPIC. If you do not receive Extra Help, you should think about requesting an EPIC.

If you have Epic or LIS, you receive Special Enrollment Period SEP to enlist in Medicare Advantage Prescription Drug Plan MAPD or Medicare Part D Plan.

Call us on 1-800-252-7047 to see if you qualify!

The First Manhattan Financial group is always here to assist!