Health Insurance

• Medicare Part D Prescription Drug Plan
• EPIC
• Prescription Programs
• HIICAP
• Medicare
• Medicare Advantage Preferred Provider
• Supplemental(Medigap)Insurance
• Medicaid
• Long-Term Care Insurance

• NYS Partnership for Long-Term Care Insurance Policies
• Employer-Sponsored Retiree Health Plans
• Veterans' Health Benefits
• Programs for the Uninsured
• Fight Medicare Fraud and Abuse
• CMS Prevention immunizations_FINAL -- 083010_health professionals version (2)
• CMS Prevention immunizations_FINAL_ 083010_beneficary dropin version (2)

This program, administered by the New York State Department of Health, helps eligible older New Yorkers cope with the high cost of prescription drugs.

To obtain an application, call EPIC at (800) 332-3742 or visit their website for further information.

Benefit Checklist

Pharmaceutical Research and Manufacturers of America (PhRMA) Patient Assistance Programs

Eligibility depends on the criteria set by the individual companies; usually for low-income individuals with no other prescription coverage. An individual's physician needs to contact the company on his/her behalf. 

For further information, call PhRMA at (202) 835-3400 or visit their website.

National Organization for Rare Disorders (NORD) Patient Assistance Programs

Assists individuals in obtaining prescriptions they could not otherwise afford or that are not yet on the market. Through the NORD Patient Assistance Program eligible patients are provided cost-free medication, or in some cases, subsidy for high health insurance co-payments. 

For further information, call NORD at (203)744-0100 or visit their website.

New York State

New York State offers discounts on nearly all prescription drugs to low-income persons between the ages of 50 and 65. More than 2,500 pharmacies across the State are participating. To be eligible for the card, annual income must be at or below $35,000 for single persons and at or below $50,000 for married individuals. Individuals enrolled in Medicaid or in the State's Elderly Pharmaceutical Insurance Coverage (EPIC) program are not eligible for the Prescription Saver Card.

The program, administered through the State Department of Health, is expected to provide lower-income New Yorkers with average savings of 30 to 40 percent off the price of generic, and at least 25 percent off the full retail price of brand name prescriptions. Actual savings will vary depending on the quantity, type, and brand of drug purchased. Applications are accepted online at NY Prescription Saver or by phone at (800) 788-6917. Applications are also available at pharmacies and through community organizations. 

Approved participants receive a New York Prescription Saver Card usually within two weeks of filing their application.

HIICAP provides information and assistance regarding Medicare, Medicare Supplemental (Medigap), Long-Term Care, Managed Care (HMOs), EPIC, Medicaid, and other insurance options.

One-on-one counseling is available by appointment, along with confidential assistance with claims filing and referrals to appropriate agencies, including those offering legal assistance.

Medicare is a federal government health insurance program for people age 65 or older or for persons under 65 who have been disabled for 24 months.

To enroll, contact the Social Security Administration toll-free at (800) 772-1213 or, for further information, visit their website.

For further information on Medicare, visit: Medicare Part A information, Medicare Part B, and Durable Medical Equipment information

Extra Help paying for Medicare Part D Costs and Medicare Savings Programs

MEDICARE SAVINGS PROGRAM WORKSHEET- download the Medicare Savings Program PDF Worksheet and Guidelines

For general Medicare information:

• Medicare
• Medicare Rights
• AARP

Medicare Preventive Services 

• A "Welcome to Medicare" Physical Exam
• Ultrasound Screening for Abdominal Aortic Aneurysm
• Cardiovascular Screening Blood Tests
• Diabetes Screening Tests, Supplies, Self-Management Training, Medical Nutrition Therapy, and Other Medicare-Covered Services for People with Diabetes
• Screening Mammography
• Screening Pap Tests
• Screening Pelvic Examination
• Colorectal Cancer Screening
• Prostate Cancer Screening
• Influenza, Pneumococcal, and Hepatitis B Vaccinations
• Bone Mass Measurements
• Glaucoma Screening
• Smoking and Tobacco-Use Cessation Counseling Services

Mymedicare.gov is a secure online service for accessing your personal Medicare information. You can use this site to:

• View claim status (excluding Part D claims)
• Order a duplicate Medicare Summary Notice (MSN) or replacement Medicare card
• View eligibility, entitlement and preventive services information
• View enrollment information including prescription drug plans
• View or modify your drug list and pharmacy information
• View address of record with Medicare and Part B deductible status
• Access online forms, publications and messages sent to you by CMS
• Sign up

2025 Medicare HMO Plans

2026 HMO Plans

A Medicare-contracting HMO is an organized, community-based network of physicians, hospitals, and other health care providers that is approved by Medicare (choice of physicians and hospitals is limited to those affiliated with the HMO)

For further information on Medicare HMOs, visit the following websites:

• Medicare.gov
• New York State Office for the Aging
• Medicare Rights Center

• Privately purchased policies that cover some Medicare deductibles, co-payments, and non-covered services. Designed to supplement Medicare benefits by filling some of the gaps in Medicare
• Available only to Medicare beneficiaries enrolled in Medicare Parts A and B

• Any age Medicare enrollee is eligible
• 2025 Medigap Plans
• 2026 Medigap Plans

2025 PPO Plans

2026 PPO Plans

A Preferred Provider Organization (PPO) must have a network of providers so that enrollees can get all services within the plan, but enrollees are not required to use only network providers. Cost-sharing amounts will usually be lower when beneficiaries use network providers than when they use out-of-network providers. 

Premiums are usually more than HMO premiums, but less than premiums for Medicare Supplement Insurance (Medigaps). They do not have to get a referral to see a specialist and they must get Part D drug coverage through the same plan.

Under a Private Fee-for-Service (PFFS) plan, a person with Medicare may go to any Medicare participating medical provider or any hospital when that provider or hospital accepts the plan’s payment terms. PFFS plans also have networks of providers and are very similar to PPO plans so it may cost more for out-of-network providers and doctors. No referrals are necessary, and the plans may provide extra benefits Original Medicare doesn’t cover.

2026 PFFS Plan

PFFS plan members should check to make sure their doctors, hospitals, and other providers will agree to treat them under the plan and that they will accept the PFFS plan’s payment terms. Prescription drug coverage (Part D) may be included in the PFFS plan, but if it is not included, a person with Medicare can also enroll in a separate stand-along Medicare Prescription Drug Plan (PDP).

A Medicare Special Needs Plan (SNP) is a type of Medicare Advantage plan that is only available for certain Medicare beneficiaries, such as those with Medicare and Medicaid (or who are enrolled in a Medicare Savings Program), institutionalized beneficiaries, or those with certain chronic conditions. SNPs may offer more focused and specialized health care as well as better coordination of care for those beneficiaries than other types of Medicare Advantage plans. All SNPs include Part D drug coverage.

• Medicare Advantage Health Maintenance Organizations Plans in Erie County
• Medicare Advantage Private Fee For Service (PFFS) in Erie County
• Medicare Advantage Preferred Provider Organizations(PPO'S)
• Medicare Special Needs Plans (SNP) Plans in Erie County
• 2026 SNP Plans

For further information on Medicare supplemental insurance, visit the following websites:

• New York State Office for the Aging
• Medicare Rights Center
• Medicare.gov
• Benefits Checkup - Get all the benefits you deserve. Find and enroll in federal, state, local and private programs that help pay for prescription drugs, utility bills, meals, health care and other needs.

Medicaid is a joint federal and state government program that provides health assistance for persons who are blind, disabled, or 65 or older, who have low income and resources; or persons under 65 who meet social services' home relief rules.

Programs to assist individuals/couples in paying for Medicare premiums: QMB (Qualified Medicare Beneficiary) and QI-1 (Qualified Individual-1) 

To enroll, call the Erie County Department for the Aging at (716) 858-7883. 

A partner agency that assists with medicaid applications is WNY Independent Living - call 716-836-0822 extension 331 for more information.

For further information, visit the following websites:

• New York State Department of Health
• AARP
• Benefit Checklist

Employer-Sponsored Retiree Health Plans

• Not available to many retirees (only about one-third of the Medicare-eligible population has employer-paid coverage after retirement)
• Plan may cover some or many of the costs Medicare does not
• Constant changes make it necessary to re-evaluate your retiree plan's cost benefits annually
• For further information call or visit your company's Employee Benefit office

Veterans' Health Benefits

• For information on veterans' health benefits and services, call the VA Health Benefits Service Center toll free at (877) 222-VETS/(877) 222-8387 or visit their website.
• TRICARE for Life Program for military retirees who have served at least 20 years. Must be registered with Defense Enrollment Eligibility Reporting System (DEERS). For information on DEERS, call toll free at (800) 538-9552.
• TRICARE Senior Pharmacy Program extends the same prescription drug coverage for those active and retired military under 65 to those 65 and older and those with Medicare. For information on the TRICARE Senior Pharmacy Program, call toll free at (877) DOD-MEDS/(877) 363-6337.
• For general information on TRICARE for Life, call toll free at (888) DOD-LIFE/(888) 363-5433.

Programs for the Uninsured

Steps to Health Insurance for Persons Without Medicare

To obtain information and an application, call the Erie County Department for the Aging at (716) 858-7883 or call toll free at (877) 9FH-PLUS/(877) 934-7587. Information can also be obtained by visiting the New York State Department of Health website.

Volunteer with HIICAP The Health Insurance Information Counseling and Assistance Program needs volunteer counselors to help people understand health insurance options and long-term care insurance options. Training and certification is provided. Make your own hours at a senior center near you. Call RSVP at (716) 858-7548 for more information.