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...

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...

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...

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...

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...

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...

To keep your Extra Help benefits from year to year, you must continue to meet the eligibility requirements. Depending on your state and how you initially qualified for Extra Help, this process may be automatic or require that you submit information to...

If the Social Security Administration (SSA) denies your Extra Help application and you disagree, you have two opportunities to request that your case be reexamined.1. Before the final decisionIf your application is going to be denied, you will receive a...

If you do not have Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program (MSP), you can apply for the Extra Help program through the Social Security Administration (SSA) using either the agency’s print or online application. (If you...

Managed long-term care (MLTC) health plans provide services for some chronically ill New Yorkers and/or those with disabilities. MLTC plans are available on a regional basis to those who have Medicare and Medicaid (dually eligible individuals) and require...

If you have Medicare and Medicaid (dually eligible), your drugs are usually covered by the Medicare Part D prescription drug benefit and Extra Help (see How Do I Use Extra Help to Eliminate my Part D LEP?). In cases like those described below, Medicaid may cover drugs...

This is a general guide to the Medicaid application process. Be sure to contact your local Medicaid office for state-specific rules. Note: Your Medicaid office may be called the Department of Health, the Department of Social Services, the Department of Insurance, or...

All states have at least one Medicaid home- and community-based service (HCBS) waiver program that provides general health coverage and coverage for certain services to help you stay at home or in a community-based setting (for example, in an assisted living...

Aged, blind, and disabled (ABD) Medicaid provides coverage for a broad range of health services, including doctors’ visits, hospital care, and medical equipment if: You are 65+, blind, or have a disability And, you meet the financial eligibility requirements In many...

If you are eligible for Medicare and have a sufficiently low income, you may qualify for help from certain Medicaid programs in your state. Whether you qualify will depend on: Your earned and unearned income, including wages and Social Security payments Your assets,...