Office for the Aging: A brief history of HIICAP Part II

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This is the second of two articles that provide readers, especially those new to Medicare, a brief history of the Health Insurance Information Counseling and Assistance Program or HIICAP.

Part I of this series consisted of an interview with Brenda LaMere, NYS HIICAP Directorwith the New York State Office for the Aging (NYSOFA). We will begin with the conclusion of last month’s interview of the Director. 

Director LaMere, let’s turn to the direct services that the HIICAP program offers. State-wide, what do you see as the two or three most critical services that HIICAP is providing?

“The answer to that question depends on the time of year. During the fall Open Enrollment the focus is on finding the right Part D plan. In the spring the focus turns to explaining co-pays and helping clients who can make changes during one of several special enrollment periods.

We always have ongoing Medicare and Medigap questions. For my office, the late summer is the time for us to train over 400 counselors on the regulations for fall Open Enrollment.”

Are there services that HIICAP provides that you feel are being underutilized?

“The numbers are always going to be lower for Extra Help (also called the Low-Income Subsidy).” This is a federal program that helps you pay for some or most of the costs of Medicare Part D prescription drug coverage. But, to qualify you must meet income and asset limits. “On the other hand, the Medicare Saving Program (MSP) has no asset test. It does, however, have an income test.”

Through March, 2019 if your monthly income is below $1,386 ($1,872 for couples) you will qualify. These numbers may be revised by the new Congressional budget deal.

“Many people who were denied Extra Help through Soc Security may be eligible for MSP.”

Finally, is there anything new in HIICAP for 2019?

“The main change will involve Medicare. New supplemental benefits are going to be offered this year and are scheduled to be implemented in 2020.

One thing I failed to mention earlier was that the low income saving to eligible beneficiaries has increased from 42.7 million dollars to 56.6 million over the past few years. That is a significant increase.” 

Again, I would like to think Director LaMere for helping with these two articles. She has helped to put the Oneida County HIICAP program into a larger, state-wide perspective.

Turning specifically to our Oneida County program, I want to briefly review a number of basic services that are offered through HIICAP. Here is a brief list of the core programs that HIICAP counselors work with on a daily basis:

Medicare Part A. This covers inpatient hospital care, skilled nursing facility care that is connected to a hospital discharge, hospice care and limited home care services.

Medicare Part B. Part B covers services and/or supplies that are needed to diagnose or treat a medical condition. The most common service for most beneficiaries is a visit to a doctor’s office. This part also covers preventive services, such as the annual wellness visit and flu shots. Taken together, Part A and B are known as Original Medicare. 

Medicare Part C. This Part is more commonly known as Medicare Advantage Plans. These plans vary widely in their coverage and premiums. They provide all the coverage you will find under Medicare Parts A and B as well, in many cases, a Part D drug plan. Many also provide additional services that are not covered under Original Medicare.

Medicare Part D. Part D covers prescription drugs. All Medicare beneficiaries are required to have adequate drug coverage, either through a separate Part D plan or an Advantage Plan which offers drug coverage. Coverage and cost vary between plans and HIICAP counselors can always walk you through the steps necessary to receive the coverage that best fits your needs. 

The Elderly Pharmaceutical Insurance Coverage (EPIC) program. EPIC is a New York State program, administered by the Department of Health, which helps more than 327,000 income-eligible adults aged 65 and older to supplement their out-of-pocket Part D drug plan costs. Older people can apply for EPIC at any time of the year and must be enrolled or eligible to be enrolled in a Medicare Part D drug plan to receive EPIC benefits and maintain coverage.  

Extra Help. These programs were discussed by Director LaMere earlier in this article. But it should be noted that many eligible Oneida County residents could, according to CMS estimates, save as much as $4,900 a year in drug costs if they apply for the program.

Uninsured resources. HIICAP counselors may be able to assist you in locating additional resources to help you cover the cost of your prescription drugs. These resources include such things as pharmacies that may waive or reduce cop-pays for low-income beneficiaries, hospital programs and services designed to assist low income adults and community health centers that may accept a sliding scale payment. These are only a few of the many examples of underutilized resources.

Who do I contact in Oneida County for help? The Oneida County Office for the Aging/Continuing Care/NY Connects Health Insurance Information, Counseling and Assistance program (HIICAP) offices provide their services at no cost to Medicare beneficiaries. HIICAP offices are found at the following locations:

Copper City Community Connection (formally the Ava Dorfman Senior Center), 305 E. Locust St., with hours of operation on Tuesday and Thursday from 10 a.m. to 2 p.m. Again, while consumers are seen on a “first come, first served” basis you may call the center at 315-337-1648 to see if there are long wait times.

North Utica Senior Citizens Community Center, 50 Riverside Drive, Utica with hours of operation on Monday, Wednesday and Friday from 10 a.m. to 2 p.m. Consumers are counseled on a “first come, first served” basis. However, if you want to call ahead to see how busy the office is you may call the Center’s HIICAP program at 315-724-8680.

HIICAP services are provided by Oneida County Office for Aging and Continuing Care/NY Connects. Anyone with questions about HIICAP, including issues with your Medicare Advantage Plan, should call the program directly at 315-798-5456 and press 4 in the choice list. It will direct you to someone who can assist you.

Dr. William Lane is the owner of William Lane Associates, a gerontological firm located in Homer, NY. 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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