What services are provided by HIICAP

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If you have not yet gotten your free COVID-19 vaccine Medicare has made it easy for you to find a vaccination location. Just go the Vaccines.gov website, enter your zip and select the distance you want to travel. A map will come up indicating the locations along with a listing of the providers and their contact information.

I entered a Utica zip code, selected 5 miles and got a list of approximately 20 providers. Everyone needs to be vaccinated so we can all return to some version of a normal life. As the Medicare.gov website states, “Getting vaccinated is a great way to show your family, friends and community that you care about them.”

Getting the COVID-19 Vaccine in Your Home. According to a notice in the June 11 issue of the NY State Wide Senior Action Weekly Round-Up, if you are on Medicare and have a disability or other problems that prevent you from getting to a vaccination location Medicare will pay a doctor or other health provider to administer the COVID-19 vaccine in your home.

To access this service, you need to first contact your regular physician or other health care provider who accepts Medicare to see if they can come to your home to administer the vaccine. If they can not do so call 1-800-MEDICARE (1-800-833-4227) for the contact information of providers in your area who will provide this service. You can also find out more details by going to www.Vaccines.gov.

Medicare Savings Plans. In one of their recent e-mails, Medicare reminded beneficiaries that states, including New York, can provide help in paying for Medicare premiums through Medicare Savings Plans. In addition to paying for Medicare Parts A and B premiums, these plans may also help with coinsurance and copayments if you meet certain conditions. HIICAP counselors report that many people who are eligible are not taking advantage of these plans. If you would like more information about Medicare Savings Plans a HIICAP counselor can see if you qualify for one of these options.

Services Provided by HIICAP Continued. Last month’s column featured an interview with Joan Hyde, the Aging Services supervisor with the Oneida County Office for the Aging/Continuing Care/NY Connects. Among her duties, Hyde oversees the HIICAP program. In this month’s column we will conclude that interview, covering the remainder of topics with the exception of long-term care insurance and Medigap insurance plans. Full columns discussing these topics will appear in the coming months.

Medicare Part D and Coordination of Benefits. According to Hyde, formularies (a list of the drugs a plan covers) “are a major area of concern in selecting the right Part D plan for you.” Medicaid tends to enroll people in the basic or “benchmark” plans. Part D benchmark drug plans have a premium below an amount specified by the state.

This means that you should be able to qualify for Extra Help that will pay for your coverage in full. But, according to Hyde, many of the plans will not cover all of your prescriptions. In other words, they tend to be selected on the basis of cost and not the formulary that best fits the client’s needs. HIICAP counselors can assist in you in finding a more appropriate plan that will still allow you to qualify for Extra Help assistance.

The Elderly Pharmaceutical Insurance Coverage (EPIC) program. The EPIC program remains an extremely important resource for many New Yorkers. To qualify you must be age 65 or older, a resident of New York, enrolled in a Medicare Part D program and not be receiving Medicaid benefits. The income limits for EPIC are $75,000 for a single person and $100,000 for a couple. EPIC looks only at your income; they do not look at assets.

I asked Hyde how do you use EPIC now? She stated, “If you hit the donut hole in your Part D coverage EPIC can help. There are fee plans and deductible plans. Once a year you can make a change. If you are on EPIC and you qualify for extra help, EPIC will send out the enrollment forms for you. EPIC does so much for you, it is a ‘win-win’ situation.”

Medicaid questions? HIICAP does not qualify people for Medicaid but they do help with questions. “We will help those who have been deemed eligible with their Medicaid applications”, Hyde said. “In some cases, we direct clients to a health insurance navigator who can help them work through the marketplace. Two of the navigators that we use most often are ACR Health and Mohawk Valley Perinatal Network.”

Dual Eligibles. According to Hyde, HIICAP does enroll dual eligibles (those who are eligible for both Medicare and Medicaid). “There are 3 or 4 dual eligible plans in Oneida County and we direct clients to an agent. But, if you have questions, we try to answer them,” she said.

Other resources. Unfortunately, beneficiaries do experience situations in which they are denied coverage or are receiving lower payments than expected from Medicare. Hyde stated, “During the pandemic, we have been referring clients to the Medicare Rights Center to help with appeals and enrollment issues. Their number is 1-800-333-4114.

Contacting your Oneida County HIICAP program for assistance. As with almost every agency, program and business across the country the COVID-19 pandemic has brought about changes in the way services are provided. HIICAP is no exception. Now, as a result of retirements and other personnel changes, when you call the Oneida County Office for Aging and Continuing Care/NY Connects at 315-798-5456 and select option 2 you may receive a new message.

This message will state that it may be up to 72 hours before a trained HIICAP counselor will be able to return your call. If you have an urgent question you may want to call 1-800-MEDICARE (1-800-633-4227) for immediate assistance.

Dr. William Lane is the owner of William Lane Associates, a gerontological firm located in Homer, N.Y. He writes a monthly column on HIICAP related issues for the OFA.Dr. Lane does not sell insurance, work for any insurance company or recommend any insurance products.

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