State Could Save Millions On Prescription Drugs By Making It Possible For More Low-Income, Elderly New Yorkers To Get Medicare Drug Subsidy

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Seniors / Aging
Article Date: 14 Dec 2007 - 5:00 PDT

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New York State could save nearly $184 million a year on spending for prescription drugs for EPIC, the state's pharmaceutical assistance program for residents 65+, by making it possible for more low-income people with EPIC to qualify for Extra Help, the federal subsidy that helps low-income people pay for the Medicare drug benefit (Part D).

"Medicare Part D has given New York State a golden opportunity to save millions on prescription drugs and help low-income New Yorkers with EPIC get richer drug and health care benefits through Medicare," said Robert M. Hayes, president of the Medicare Rights Center, a national consumer service organization. "This is a win-win proposal for all."

If New York State were to expand the eligibility criteria for Medicare Savings Programs more low-income people with EPIC could automatically get Extra Help, explains the Medicare Rights Center and New York StateWide Senior Action Council, Inc., a New York senior advocacy organization, in a joint report released today.

Enrollment in the Medicare Savings Programs, federal, low-income programs administered by the state that pay the monthly Medicare premiums, deductibles and cost sharing for medical services, automatically triggers enrollment in Extra Help. Medicaid statute gives the state broad flexibility to set income and asset criteria for Medicare Savings Programs.

The report details the savings that New York State could achieve through different levels of expanding the eligibility criteria for the Medicare Savings Programs-from simply eliminating the asset test for all of the programs to increasing the income limits to match those of the EPIC Fee Program.

Should New York State both align the Medicare Savings Programs income criteria with that of the EPIC Fee Program ($20,000/individual; $26,000/couple) and also eliminate the Medicare Savings Programs asset test ($4,000/individual and $6,000/couple) at least 157,000 more low-income New Yorkers enrolled in EPIC would qualify for Full Extra Help, the Medicare Rights Center and New York StateWide Senior Action Council, Inc. report in " Expanding Eligibility for Medicare Savings Programs: The Case for New York State. "

For New York State to realize the savings that would be generated by expanding the eligibility criteria for Medicare Savings Programs, EPIC would have to automatically enroll qualified members into the Medicare Savings Programs.

Should New York State expand eligibility for Medicare Savings Programs to the full extent recommended in the report, the state would incur some costs but they would be offset by the savings reaped from EPIC, explains the Medicare Rights Center and StateWide Senior Action Council, Inc. Two of the three Medicare Savings Programs, QMB and SLMB, are funded by both the state and federal government, and QI-1 is fully federally funded. There is no asset test for QI-1.

EPIC "wraps around" Part D, by reducing consumers' drug copays; covering drugs not on Medicare private drug plans' formularies; covering restricted drugs; and filling in the major coverage gap known as the "doughnut hole." For people with both EPIC and Extra Help, the federal government pays most of those costs.

EPIC estimates that it will save $1,430 for every member who receives Full Extra Help in the next fiscal year.

"Older New Yorkers with low incomes will have better health security if New York does what Maine already did - simply expand eligibility for the Medicare Savings Program," said John Eadie, executive director of New York StateWide Senior Action Council. "Expanding Eligibility for Medicare Savings Programs: The Case for New York State" is available online here.

Medicare Rights Center (MRC) is the largest independent source of health care information and assistance in the United States for people with Medicare. Founded in 1989, MRC helps older adults and people with disabilities get good, affordable health care. Founded in 1989, MRC helps older adults and people with disabilities get high-quality, affordable health care.

Medicare Rights Center