Assembly Member


Simplifying Medicare’s new prescription drug coverage

What you
need to know

You may have started receiving letters and notices regarding Medicare’s prescription drug coverage, which will help you pay for brand name and generic drugs. The voluntary program takes effect January 1, 2006. It’s important to open, read and save all coverage notices to ensure you understand the benefits you are entitled to.

Unfortunately, the program created by the federal government is tremendously bureaucratic and confusing. To help you find your way through the maze of regulations, here is some basic information:

  • The new Medicare prescription drug program is voluntary. However, if you have both Medicaid and Medicare you must enroll in a Medicare prescription drug plan. If you do not pick a plan and enroll before December 31, 2005, you will be enrolled in one of the new drug plans automatically because your Medicaid drug benefit will end on that date.

  • If you have drug coverage (other than Medicaid) now, your current insurance company has to provide you with a notice indicating if your current prescription coverage is "as good or better than" the standard Medicare plan. If it is, you do not have to consider joining a Medicare plan at this time. Otherwise, you should consider signing up for a Medicare drug plan between November 15, 2005 and May 15, 2006 to avoid paying a late enrollment penalty.

  • Seniors with EPIC can keep their EPIC coverage. For some, particularly those eligible for"extra help" for low income beneficiaries, enrolling in the Medicare drug program will mean more savings. EPIC will waive fees for low-income enrollees eligible for full "extra help" who join a Medicare plan.

  • The new Medicare drug program provides"extra help" to pay for drug costs for beneficiaries with lower incomes; contact your local social security office or area agency on aging. Those already in Medicaid or in one of the Medicare savings programs (QMB, SMB and QI-1) will be eligible automatically for "extra help."

  • This new Medicare drug benefit will only be available through private plans. This means that in order to get prescription drugs covered through Medicare, New Yorkers must enroll in one of the plans offering the benefit in New York State. HMOs and other Medicare Advantage plans will also be offering the new prescription drug benefit.

Make an
informed decision

Assembly Member O’Donnell urges you to talk with a trained individual who can help you get the answers and information you need. Organizations who can assist you include the Health Insurance Information, Counseling and Assistance Program (HIICAP), the EPIC program, the StateWide Senior Action Council’s Medicare-EPIC Project, and the Medicare Rights Center.

Important phone numbers and Web sites
*** Click here for printable view. ***

NYC Department For The Aging 1-212-442-1322

HIICAP Hotline 1-800-333-4114

EPIC Helpline 1-800-332-3742

StateWide Helpline 1-800-333-4374

Medicare Rights Center Helpline 1-800-333-4114

Local Social Security Office 1-212-860-6161


Social Security

NYS Health Information


"The new Medicare prescription drug plan can be confusing, but it may save you money. Take the time to learn about your options so that you don’t pay too much for your prescription drugs."
Assembly Member O’Donnell Assembly Member
Daniel O’Donnell
245 W. 104th Street
New York, New York 10025
(212) 866-3970