As individuals retire or age into Medicare, their insurance situation can change dramatically. There are a multitude of options open to those with Medicare. The terms are different, the prices are different, the products offered are dramatically different each year.
The purpose of this column is to give those who are eligible for Medicare, or soon to be eligible for Medicare, some understanding of their insurance options and how it could impact their health and finances.
These questions and answers are meant as a guide to help you understand the complex questions you are now thinking about. Each individual's specific situation may create a different solution. You shouldn't necessarily do what your friends, family and neighbors do.
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Janell Sluga
Q: I have EPIC and recently got a letter in the mail about sending them more information. I don't think I want to send them anything. EPIC hasn't helped me at all this year with paying for my medications. What do you think I should do?
A: One thing I have talked a lot about this year is EPIC and the changes to the program. The good news is EPIC will be back to more comprehensive coverage in 2013.
In August, all EPIC enrollees will be getting a letter asking for verification of their income. This will be a one-page form with your name and address on the top. The letter will ask you to report your income to determine your EPIC coverage. Remember that EPIC always wants last year's income figures. So when you get your form in August, use the income figures from 2011.
The form, once completed, must be returned to EPIC in the postage paid envelope they include in this mailing. Also included in the mailing is an explanation of the 2013 coverage.
In 2013 Epic will return to two types of coverage, fee or deductible. The different coverage models are explained in the letter. EPIC will continue to pay the Part D premiums for those individuals who make less than $23,000 and those couples making less than $29,000 a year.
Some new changes for 2013 is first; that EPIC will not help reduce the cost of your medications if your Part D plan has a deductible. If your plan has a deductible, you will pay the full cost of the medication at the pharmacy. Most deductibles are $320. Some plans have different deductibles than that, but they are never more than $320.
This means that when looking at your coverage choice for 2013, you may want to switch to an insurance product that does not have a deductible. There will be a number of choices for insurance that do not have a deductible for their medication coverage.
For those individuals with EPIC, this should be a factor in your decision making process.
Also in 2013, those individuals with a retiree plan that is offering prescription drug coverage should not join EPIC. EPIC will not work as secondary coverage for retiree products.
EPIC will again be covering those medications that Medicare Part D excludes, such as prescription vitamins, cold and cough medications, etc. There are also other categories of medications that Part D excludes, so EPIC will help reduce more of your medication costs again.
After your deductible has been met, if you have one, EPIC will reduce your prescription medication co-pays to $3, $7, $15 or $20 per refill. If your Part D plan allows 30, 60 or 90 supplies, EPIC will follow that and reduce your co-pays. So make sure your prescriptions are for as many days as are allowed by your plan to save you the most possible.
We are looking forward to EPIC being back to help our seniors. A big thank you to all those seniors who voiced their frustration and disappointment with the plan in 2012. Your elected officials in New York state heard you clearly.
Please, remember to fill out that form you receive and send it back promptly. This will help the EPIC staff complete this change quickly and efficiently. If you have questions when you get the form, call EPIC for help. You should be hearing from EPIC in the month of August.
If you don't have EPIC and think you are eligible, call 1-800-332-3742 to talk to an EPIC staff member. To be eligible for EPIC, you must live in New York state, be over 65 and make less than $35,000 for a single person and $50,000 for a married couple.
Janell Sluga is a geriatric care manager certified and works for Senior Life Matters, a program of Lutheran Senior Housing, and has worked in Chautauqua County with seniors for more than 18 years. She is HIICAP (Health Insurance Information, Counseling & Assistance Program) counselor-trained by Office for the Aging. She does not sell insurance or represent any insurance company. She is an unbiased source of insurance and education to help seniors choose the best option for them.
You may submit questions to be answered in later columns to Janell Sluga at Senior Life Matters, 737 Falconer St., Jamestown, NY 14701, or call 716-720-9797, or by email at janells@lutheran-jamestown.org. Please remember that not all questions can be answered in this format, but as many as can be, will be.