Category: Case Studies

New York State EPIC and Mary – a case study

Post author By Dan Alcorn
Post date May 11, 2020
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“… a huge thanks for cluing us in to the EPIC ..program.”

“…we now estimate yearly savings to be $7,000+/-”

“…we’d never heard of this program until one of your newsletter emails..”

When Mary became eligible for Medicare I helped her enroll in the Medicare Supplement Plan G she selected as secondary to Original Medicare.

Then we searched and found a Part D prescription drug plan that included her specialty medication in its covered drugs, known as the “formulary.” Although the specialty drug was categorized at the highest cost sharing, tier 5, its being included saved the added step and hassle of requesting a “formulary exception.”

John and Mary’s joint income is below $100,000 so she became eligible for the New York State EPIC program.

As John’s note to me states, once Mary’s pharmacy cumulative copayments reached her EPIC 2020 deductible level, that tier 5 specialty drug copay was reduced to $20. John estimates this saves the household about $7,000 annually.

Of course I was thrilled to hear my mention of EPIC helped John and Mary like this. I encourage every client to confirm your New York EPIC eligibility and enroll. I have included the EPIC enrollment form below and am available to assist with any eligibility or enrollment process questions.

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Download NY EPIC application [715.73 KB]

Tags Albany NY, EPIC, Medicare Part D, Medicare PDP, New York State, NY State EPIC, Prescription Drug Plan, Special Enrollment Period

Case Studies Part C Medicare Advantage Part D Prescription Drug

“Thank you for helping me change my insurance!”

Post author By Dan Alcorn
Post date February 29, 2020
No Comments on “Thank you for helping me change my insurance!”

This month I received this wonderful thank you note from Nancy. She had recently relocated and needed to find new doctors along with a Medicare Advantage plan covering those doctors and her medications.

Nancy was concerned that she would have to remain on her current plan and wait until the Annual Open Enrollment Period in order to find a new plan effective January 1 of next year!

Nancy was relieved when I let her know she was eligible for a plan change due to a Special Enrollment Period.

A Special Enrollment Period allows eligible individuals like Nancy who are enrolled in Medicare Parts A and B to make a Medicare Advantage or Prescription Drug Plan selection or change outside of the normal October 15 – December 7 time frame.

When are you eligible for the Special Enrollment Period? The 5 most frequent examples I see:

Leaving your employer’s group coverage. I see this most often with individuals working past age 65.
Like with Nancy, when you relocate outside of the service area of your current plan.
When there is a change in the level of Social Security Extra Help.
Belong to a state pharmacy assistance program such as New York State EPIC.
The January 1 through March 31 Medicare Advantage Open Enrollment Period. (Limited to those already enrolled in a Medicare Advantage plan.)

Summary:

The initial, annual and special enrollment periods are when individuals enrolled in Medicare Parts A and B can make Medicare Advantage, Medicare Supplement or Medicare Part D prescription drug plan. Please feel free to call Dan at (518) 346-2115 for a no-cost no-obligation consultation.

Tags Albany NY, Buffalo NY, EPIC, Medicare Advantage, Medicare Part D, Medicare supplement, NY State EPIC, Social Security Extra Help, Special Enrollment Period

Case Studies Part D Prescription Drug

“Having this EPIC plan was a miracle; an absolute miracle.”

Post author By Dan
Post date October 23, 2017
2 Comments on “Having this EPIC plan was a miracle; an absolute miracle.”

Only a fraction of the nearly 3 million New York State residents aged 65 and older are enrolled in the state’s pharmaceutical assistance program known as New York EPIC.

When I meet with New York Medicare Part D clients, I ask if their individual income is below the $75,000 threshold, $100,000 if married. If so, I advise enrolling in EPIC even if they don’t take any or have only inexpensive medication. Because, as Schenectady County, New York resident Beth says, “You never know.”

Beth shares her story. The $20,000 per dose medication.

In this 16 minute interview Beth shares her story of how she originally enrolled in EPIC and didn’t use it. She explains how her doctor prescribed a specialty medication. And how that medication was not included on her Medicare Part D plan formulary, its list of covered medications. And when she learned the drug would require a special exception approval from her Medicare Part D plan and costs $20,000 per dose, she was relieved to hear that EPIC would help. Listen in as Beth explains how affordable this $20,000 medication became after EPIC’s help.

Beth: “To me, having this EPIC plan was miracle, an absolute miracle. Because I wouldn’t have been able to get that drug and I would still remain very ill.”

If you reside in New York State, are age 65 or above, and have questions about how EPIC and your Medicare Part D plan can work together, please call (518) 346-2115.

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Case Studies Medicare supplement

A conversation: Focus the fight against cancer instead of the HMO

Post author By Dan
Post date October 2, 2017
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In this nearly 16 minute conversation Greensboro North Carolina residents, Bob and Signe Foxworth, talk about their frustration and anxiety of trying, unsuccesfully, to obtain HMO approval for Bob’s preferred out of network prostate cancer treatment. Listen as Bob and Signe explain how peace of mind came when Dan counseled them to revert to Original Medicare and enroll in Medicare Supplement Plan N.
Signe: “As I recall, it was tremendous anxiety at the time. Because not being able to get the treatment sooner rather than later could have had fatal consequences … We had more anxiety fighting the (HMO) insurance company than we did about his illness… We were kind of at our wits end.”
Bob: “I got $20,000 worth of treatment for $20 … Everything was covered.”
Signe: “In this whole thing, the most precious thing is that peace of mind knowing that you are covered. Yes, you strain a little on your monthly budget But things happen unexpectedly and you are covered. It’s really beautiful.”

For a personal consultation regarding your Medicare choices, call Dan at (518) 346-2115

Case Studies Part D Prescription Drug

Medicare Extra Help: “The savings are a godsend…”

Post author By Dan
Post date September 27, 2017
2 Comments on Medicare Extra Help: “The savings are a godsend…”

Medicare Extra Help

I was delighted to assist this New York based beneficiary who is on a limited income and was not aware of the Medicare Savings Program available through a New York State program for Medicare Part B premium or that Social Security offers “Extra Help” with Part D premium and prescription drug co-pay.

Call 518-346-2115 for a confidential review of your Medicare Part B or Part D costs.