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Expanding Eligibility for Medicare Savings Programs: The Case for New York State

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Abstract:

New York State can save up to $180 million a year for its EPIC (Elderly Pharmaceutical Insurance Coverage) prescription drug assistance program by increasing the number of EPIC members who qualify for Medicare's Extra Help program (also called the Low-Income Subsidy). Extra Help, the fully federally funded assistance program for people with low incomes, would pay the premiums and cost-sharing under the Medicare Part D prescription drug benefit that are now largely paid by EPIC, a program exclusively funded with state monies.

The best way to increase enrollment in Extra Help is to expand eligibility for Medicare Savings Programs (MSPs), which pay premiums and cost-sharing for low-income people with Medicare and automatically qualify MSP enrollees for Extra Help. The savings generated for EPIC offset all or most of the additional state cost from increased enrollment in MSPs, while giving a substantial benefit to older New Yorkers with limited incomes. In addition, this reform could help fund an expansion of EPIC to include people under the age of 65 who have Medicare because of a disability.