Assemblyman
PETER
ABBATE
With News for Seniors



ASSEMBLY LEGISLATION WOULD INCREASE HMO ACCOUNTABILITY

Assemblyman Abbate speaks with seniors at senior citizen center
The Assembly recently passed legislation that I supported that holds health maintenance organizations (HMOs) and insurance companies accountable for denying or withholding necessary patient care.

This bill will ensure that important medical decisions will be made by people most qualified to make them, doctors, and not bureaucrats who lack expertise and patient knowledge. This legislation will help ensure HMOs put patient care above profits.

The legislation I supported holds insurance companies and HMOs liable for the consequences of denying or withholding treatment. The measure also prohibits insurers from retaliating against health care providers who criticize them for delays or refusals to cover treatment.

There’s more than just money at stake when insurance and HMO executives refuse to cover medical treatments. Their decisions sometimes mean the difference between life and death.

I urge patients who have been denied coverage for treatment recommended by their doctor to turn to New York’s managed care external review law (Ch. 586 of 1998). The law gives patients the option to seek an outside medical review if that situation occurs.

To receive an external appeal application, call the Department of Insurance at 1-800-342-3736 or the External Appeal Consumer Information Line at 1-800-400-8882.

I’ll continue my efforts to ensure that New York’s families are receiving quality, affordable health care by fighting against any proposed health care cuts and taxes that would have a devastating effect on our state’s job market and health care coverage.

I will continue to fight to ensure that our families get the care and respect they deserve, and support legislation that ensures health care providers make first-class patient care a priority.




ASSEMBLY PASSES COMPREHENSIVE ASSISTED LIVING LEGISLATION

Recognizing that there are significant problems within New York State’s growing unlicensed and unregulated assisted living senior housing community, the Assembly took action by passing legislation to protect seniors, both physically and financially that will ensure that these facilities provide residents safe and healthy surroundings.

As our senior population increasingly turns to assisted living residences, there is a need to provide oversight and important consumer protections to ensure the health and safety of some of our most vulnerable citizens. This legislation will help ensure that individuals looking for an assisted living residence have enough background to make an informed decision, while ensuring residences provide the best possible care for our loved ones.

The Assembly bill would, for the first time, clearly define "assisted living residences" and require the facilities to offer a range of services, including home-and-personal care services, twenty-four-hour supervision and the administration of medication. The measure would also require the state Department of Health (DOH) to conduct unannounced inspections of assisted living facilities every 18 months.




EPIC MEANS BIG SAVINGS FOR SENIORS

Thousands more senior citizens in New York State are eligible for big savings on their prescription drugs thanks to expansions in the Elderly Pharmaceutical Insurance Coverage Program (EPIC).

The Assembly succeeded in increasing income eligibility, decreasing co-pays and enrollment fees and simplifying the program to enhance EPIC.

EPIC takes some of the financial burdens of the high costs of prescription drugs off seniors with fixed incomes.

EPIC was enacted in 1986 to help seniors (age 65 and over) meet the soaring costs of prescription drugs. Thousands of elderly New Yorkers have enrolled in the program since then and realized substantial savings in their prescription drug costs.

The charts below explain how the enhanced EPIC plan works. If you have questions about eligibility requirements or would like to apply for EPIC, please contact one of my offices or call the EPIC hotline at 1-800-332-EPIC.


***Click here for printable copy.***
EPIC Has Two Plans:
1. Fee Plan

Below are listed the fees for a year of EPIC coverage. Locate your annual income and then find the fee. You may pay your yearly fee in convenient quarterly payments.

IF YOU ARE SINGLE:
Annual income
ranges
Annual fee
ranges
$6,000 or less $8
$6,001-$9,000 $16 - $28
$9,001-$11,000 $36 - $40
$11,000-$15,000 $46 - $80
$15,001-$17,000 $110 - $140
$17,001-$19,000 $170 - $200
$19,001-$20,000 $230

If you are married:
Annual joint income ranges Annual fee per person
$6,000 or less $8
$6,001-$10,000 $12 - $24
$10,001-$13,000 $28 - $36
$13,001-$15,000 $40
$15,001-$18,000 $84 - $126
$18,001-$21,000 $150 - $194
$21,001-$24,000 $216 - $260
$24,001-$26,000 $275 - $300

Who is eligible?
New York State residents 65 and older with an income of $35,000 or less if you are single, or $50,000 or less if you are married. Persons receiving Medicaid benefits are not eligible.

What drugs are covered?
Almost all prescription medicines, including insulin and insulin syringes.

How does epic work?
When you go to the pharmacy show your EPIC card and for each prescription costing:
Up to: you pay:
$15 $3
$15.01 to $35 $7
$35.01 to $55 $15
$55.01 and over $20
2. Deductible Plan

There is no fee to join the plan. Instead, you pay full price for prescriptions until you spend the deductible listed below. EPIC keeps track of how much you spend so you don’t have to save receipts. After the deductible is met, you save more than half for the rest of the year.

IF YOU ARE SINGLE:
Annual income
ranges
Annual fee
ranges
$20,001-$22,000 $530 - $550
$22,001-$24,000 $580 - $720
$24,001-$26,000 $750 - $780
$26,001-$28,000 $810 - $840
$28,001-$30,000 $870 - $900
$30,001-$33,000 $930 - $1,160
$33,001-$35,000 $1,190 - $1,230

If you are married:
Joint annual income ranges Deductible range for each person
$26,001-$29,000 $650 - $700
$29,001-$32,000 $725 - $930
$32,001-$35,000 $960 - $1,020
$35,001-$38,000 $1,050 - $1,100
$38,001-$41,000 $1,140 - $1,200
$41,001-$44,000 $1,230 - $1,290
$44,001-$47,000 $1,320 - $1,610
$47,001-$50,000 $1,645 - $1,715

Assemblyman Peter Abbate on a recent visit to a local senior citizen center discusses issues with members.



Assemblyman Peter Abbate’s District Offices
8500 18 Avenue
Brooklyn, NY 11214
(718) 236-1764
6419 11 Avenue
Brooklyn, NY 11219
(718) 232-9565


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