Dear Neighbor,

As your Assemblyman in the 149th District, covering Chautauqua, Cattaraugus & Allegany counties, my top priority is to represent you in the State Capitol. I am committed to ensuring that all seniors have the best health care opportunities and protections available.

This helpful guide is meant to acquaint you with some of the special programs and services available to senior citizens in New York. You may have more specific questions than the general answers listed in the guide. In that case, please contact my district office at (716) 373-7103 and we will help to find the information you need.

Also, if you’re not sure which agency to turn to for your needs, encounter problems in your search, or would like to request additional copies of this guide, please feel free to call me. Don’t forget to save the important phone numbers below!

Elderly Pharmaceutical Insurance Coverage (EPIC)

Benefits: New York’s Elderly Pharmaceutical Insurance Coverage (EPIC) program currently provides eligible seniors with an average savings of $1,999 per year in prescription drug relief. EPIC co-payments do not exceed $20, and EPIC does not have a restricted drug formulary. Seniors can combine EPIC benefits with Medicare drug coverage for even greater savings.

Eligibility: NYS residents 65 or older; must meet income guidelines. Seniors enrolled in the EPIC program are also enrolled in Medicare Part D. (Not eligible if receiving full Medicaid benefits.)

Income Limits: Fee Plan: Single: $20,000 or less Married: joint income $26,000 or less

Deductible Plan: Single: $20,001 to $35,000 Married: joint income $26,001 to $50,000

Resource Limits: None

EPIC Helpline: 1(800) 332-3742

EPIC Website: www.health.state.ny.us/health_care/epic

700 West State St., Westgate Plaza • Olean, NY 14760
(716) 373-7103 ph • (716) 373-7105 fax • giglioj@assembly.state.ny.us

Extra Help
The Social Security Administration offers eligible seniors with limited income and resources Extra Help, which pays for premiums and deductibles for Medicare prescription drug coverage and limits co-payments to $2.50 and $6.30. To encourage EPIC enrollees to apply for Extra Help, those enrolled in a Medicare prescription drug plan with full Extra Help will have their EPIC enrollment fees waived.

To apply, call the Social Security Administration at 1 (800) 772-1213 or complete an online application at www.socialsecurity.gov. If an individual qualifies, he or she would then enroll in Part D to defray high prescription drug costs.

Home Energy Assistance Program (HEAP)

Benefits: Renters/homeowners $400-$600. If heat included in rent: $40 or $50. Grant or energy credit depending on income, household size and type of fuel used.

Eligibility: Low-income homeowners and renters, food-stamp recipients, temporary assistance recipients, or supplemental security income recipients.

Maximum Gross Monthly Income:
1 person in household = $2,030
2 people in household = $2,654

NYS HEAP Hotline 1 (800) 342-3009
or
www.otda.state.ny.us/ main/heap/program.asp

Social Security Retirement Benefits

Benefits: Monthly cash benefits based on years of employment and amount withheld from earnings.

Eligibility: Full Retirement Age (FRA): 65 if born before 1938; if born 1938 and later, gradually rises from 65 to 67.

Income Limits:
Under full retirement age, persons may not receive more than $14,160 from employment sources without penalty.
No limit for individuals at full retirement age or older.
For persons under full retirement age, for every $2 earned over the limit, $1 withheld from benefits.
In the year you reach full retirement age, $1 will be withheld from benefits for every $3 earned over the limit, excluding the month full retirement age is reached.

Resource Limits: None

Social Security Administration
1(800) 772-1213 • www.socialsecurity.gov

Medicare Advantage
Plan includes Medicare Health Maintenance Organization (HMOs), Preferred Provider Organizations (PPO), Private Fee-for-Service Plans, and Medicare Special-Needs Plans.

Enrollees in Medicare Advantage Plans receive health insurance care and, in most plans, usually receive extra benefits and lower co-payments than in the original Medicare plan. However, seniors may have to see doctors who belong to the plan or go to certain hospitals to get services. To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you might have to pay a monthly premium to your Medicare Advantage Plan for extra benefits that they offer. The open enrollment period to switch Medicare Advantage Plans will be limited to just the first three months of the year. Seniors may call 1 (800) 633-4227 (Medicare) for more information.

Medicaid

Benefits: Comprehensive health care benefits, including coverage for hospitals, physicians, skilled nursing facilities, health-related facilities, and home care.

Eligibility: Persons 65+, blind, disabled children under 21 or the caretaker relative of a dependent child who is experiencing deprivation of parental support.

Accountable Income Limits: Individuals: $706/month or Couples: $881/month. When one spouse is institutionalized and receiving Medicaid, the other spouse, while not receiving Medicaid, may retain $2,739 in monthly income and $109,560 maximum in assets.

Resource Limits: Individuals: $13,800. Couples: $20,100.

Exempt: primary residence, car and certain additions for burial.

New York State Department of Health
Medicaid Helpline (518) 486-9057