The Basics of Qualified Health Plan (QHP)

Qualified Health Plans (QHPs) are health insurance policies that meet protections and requirements set by the Affordable Care Act (ACA). They are typically not for people with Medicare. QHPs must:Follow federally established cost-sharing limitsProvide essential health...

Part B enrollment decisions with QHP coverage

If you have a Qualified Health Plan (QHP), deciding what to do as you approach Medicare eligibility depends on your circumstances. In most cases, you should enroll in Medicare and disenroll from your QHP, but there are two exceptions:You have End-Stage Renal Disease...

How EPIC Works With Medicare Low-Income Programs

EPIC (Elderly Pharmaceutical Insurance Coverage) is the New York State Pharmaceutical Assistance Program (SPAP). EPIC is available to New York State residents who are 65 or older and have annual incomes below $75,000 if single and $100,000 if married. EPIC provides...

Questions to Ask When Considering an SPAP

If you are thinking about joining a State Pharmaceutical Assistance Program (SPAP), here are some questions to ask to find out if you are eligible and how your state’s program works with other drug coverage you may have.SPAP eligibilityDoes my state have an SPAP?Who...

State Pharmaceutical Assistance Programs (SPAPs) Basics

Many states offer State Pharmaceutical Assistance Programs (SPAPs) to help residents pay for prescription drugs. Each program works differently.States may coordinate their drug assistance programs with Medicare’s prescription drug benefit (Part D). Some SPAPs require...

Part D When you Have Medicare and Extra Help

If you have Extra Help and do not choose a Part D plan, Medicare will automatically enroll you in a benchmark Part D plan. Benchmark Part D plans have a premium below the specified amount for your state, which means that Extra Help will pay the full cost of your Part...