HIICAP (Health Insurance Information, Counseling and Assistance Program)

HIICAP (Health Insurance Information, 

Counseling and Assistance Program)

The Health Insurance Information, Counseling and Assistance Program (HIICAP) is a special grant program to help you learn how to file Medicare forms and how to choose an insurance carrier.  We can also show you how to appeal denials of your claims and assist you with referrals.  

During the open enrollment period, October 15th-December 7th, we can provide you with current information to help you make informed decisions regarding your health insurance options.

There are programs to help pay some of the costs of Medicare for people who qualify. Medicare Savings Program (MSP) assists with paying the Medicare Part A and B premiums. It can also help pay deductibles, co-pays and coinsurance depending on the level you qualify based on your income. Extra Help is a federal program that helps pay Part D prescription coverage and sometimes the premium depending on income for those with limited resources and income. EPIC is a NYS program administered by the Department of Health that provides secondary drug coverage and premium assistance to supplement out-of-pocket Medicare Part D drug plan costs. Seniors can apply for EPIC at any time of the year. 

Medicare Open Enrollment is October 15 to December 7 each year. This is the time of year to re-evaluate your health insurance and prescription drug insurance plans. It is a very important time of year and you have the opportunity to join or change plans during this time frame. Changes and enrollments made during this period become effective January 1st of the following year. If you did not have creditable coverage and did not enroll in a plan when you first became Medicare eligible you may have to pay a penalty. 

Gather up a list of your prescriptions and your Medicare card and make an appointment to meet with a HIICAP counselor to review your current plan and maybe make a change. Plans change their formulary list and participating pharmacies each year so it is always important to review them each year to make sure that you are enrolled in the best plan for you. 

There is a program available to assist you with your Medicare Part B premium called the Medicare Savings Program, also known as the Medicare Buy-In Program. Based on your current income, the Medicare Buy-In Program could help pay your Medicare premiums as well as your deductibles. An individual cannot make more than $2,280 a month and a couple no more than $3,077 a month. It does not look at assets in NYS. If you enroll in the Medicare Savings Program, you will automatically get Extra Help, the federal program that helps pay most of your Medicare Part D drug costs. 

Extra Help is a program to help you with your prescription drug costs and sometimes the premium, depending on your income. Your income must be below $1,843 a month for an individual or $2,485 a month for couples. Resources cannot be more than $16,660 for an individual or $33,240 for couples. Resources include such things as bank accounts, stocks, and bonds. They do not count your home, car, or any life insurance policy as resources. 

You can apply for Extra Help at: www.SocialSecurity.gov/extra help or call Social Security at 1 (800) 772-1213 to apply over the phone.

EPIC

(Elderly Pharmaceutical Insurance Coverage Program) 

The NYS Elderly Pharmaceutical Insurance Coverage program increased its income levels! You must be a NYS resident, 65 or older with an annual income of less than $75,000 for individual and $100,000 for married. Members must be enrolled in or join a Medicare Part D drug plan to receive EPIC benefits. If you were denied in the past reapply today! EPIC provides seniors with co-payment assistance for Medicare Part D covered prescription drugs after any Part D deductibles are met. EPIC also covers many Medicare Part D excluded drugs. It pays the Medicare Part D plan premiums, up to $38.90 per month in 2023 for members with annual income below $23,000 if single or $29,000 if married. Those with higher incomes must pay their Part D premiums but their EPIC deductible will be lowered by the annual cost of a Medicare Part D drug plan. 

Call the Columbia County Office for the Aging now, at (518) 828-4258 to make an appointment to review your coverage either in person or over the telephone. 

Related Links:
Medicare
Social Security Administration - Local phone number 1 (877) 828-1691