New York State Programs for Medicare Beneficiaries
New York State has a variety of programs that help Medicare beneficiaries get extra benefits. This article will explain the most useful programs, their qualifications, and how to apply.
The first program that I’d like to talk about is the Medicare Savings Program (MSP). Known also as “extra help” or “low-income-subsidy” (LIS) or “qualified individual” (QI), the MSP helps qualifying beneficiaries pay their insurance premium, and get extra help on prescription drugs. First and foremost, remember that Medicare Part B has a monthly premium of $174.90. For most people, that is deducted automatically from their social security check. However, if you qualify for MSP, New York State will pay the premium instead. In addition, MSP significantly lowers drug copays usually to a nominal amount, like one dollar and change, three dollars and change, or at the most, for specialty tier drugs, $15. Additionally MSP will pay for monthly premiums associated with Medicare Advantage plans. In 2024, MSP will pay for up to $42 per month for advantage plan premiums. So, if you qualify, your broker will make sure that you are on a premium advantage plan, as they usually have more benefits. In 2024 the MSP income limit for individuals is $2,280 and for couples is $3,077. At AJ Medicare Benefits, we help members complete and send in this application, as it is an important program to have if you qualify, and you only need to apply once, and you have it for the rest of your life. For more information on the Medicare savings program, see NYS Department of Health's page on MSP.
The next program, which is somewhat related to MSP, is Medicaid. Similar to MSP, Medicaid is a New York State funded program. If you have Medicaid, you automatically qualify for MSP and all of its benefits. Once qualified, beneficiaries can either have Medicare as a primary insurance Medicaid as a secondary insurance, paired with a Part D drug plan (paid for by the State), or (and usually more beneficial) enroll in a Dual Eligible Medicare Advantage Plan. To qualify, beneficiaries must have a monthly income of less than $1,697 (single), or $2,288 (married), and no more than $15,000 in assets. Beneficiaries must re-certify every year to remain enrolled in Medicaid. For more information on Medicaid, see NYS Department of Health's Page on Medicaid.
Last and certainly not least is The Elderly Pharmaceutical Insurance Coverage (EPIC) Program. Over 325,000 NY residents are members of EPIC, and it helps subsidize drug costs. For each income bracket, there is an associated deductible, and after the deductible is met in out of pocket drug costs, EPIC pays the vast majority of copays for the rest of the year. For example, if you are single, and make $45,000 per year, your deductible is $1,570. So, if you paid $1,570 in a given year in drug copays, after that, EPIC picks up the rest. Additionally, EPIC gives members an additional special enrollment period for Medicare plans any time of year. The extra SEP allows members to change their plan at any time of year, and for the change to take effect on the first day of the next month. To qualify, you must be at least 65 years of age and have an annual income of less than $75,000 (single) or $100,000 (married). To learn more, or to see an application, visit NYS DOH's page on EPIC. AJ Medicare Benefits also has applications that we can send out upon request to NYS residents.
Qualifications for these three programs change every year, which is why it is important to stay updated on these. At AJ Medicare Benefits, our software is able to flag any members that may be qualifying for MSP as a result of annual changes in income thresholds.
