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Medicare Advantage Plan (previously known as Part C) includes all benefits and services covered under Part A and Part B — prescription drugs and additional benefits such as vision, hearing, and dental — bundled together in one plan. Medicare Part D (Medicare prescription drug coverage) helps cover the cost of prescription drugs. Visit CDPHP to learn about all of the provider programs helping you offer more quality service to your patients.
How does the Medicare Part D drug plan requirement work?
EPIC members are required to be enrolled in a Medicare Part D drug plan or a Medicare Advantage (HMO) health plan with Part D (with no exceptions). Enrolling in EPIC will give a member a Special Enrollment Period (SEP) to join a Medicare Part D drug plan. Medicare Part D provides primary drug coverage for EPIC members. After a Part D deductible is met, if a member has one, EPIC provides secondary coverage for approved Part D and EPIC covered drugs. EPIC also covers approved Part D-excluded drugs such as prescription vitamins as well as cough and cold preparations after enrolling in a Part D drug plan.
The New York State EPIC program is not Creditable Coverage (primary coverage) for members. This means that EPIC benefits are not as generous as Medicare Part D. If a member is not enrolled in a Medicare Part D drug plan, the member will not have any prescription coverage from EPIC or receive any EPIC benefits.
Source: Medicare Australia, Medicare Statistics database. The number of dental services provided under the EPC program up to August 2008 has totalled 818 749, with total benefits paid reaching $133.8 million for the period. This expenditure represents nearly one-third of the original allocation for the entire four-year program.
Because EPIC is a State Pharmaceutical Assistance Program, EPIC can provide:
- a Medicare Special Enrollment Period (SEP) so that a new member may enroll in a Part D drug plan at any time during the year;
- a Medicare one-time plan change per calendar year for existing members;
- co-payment assistance after the Medicare Part D deductible is met, if the member has one. EPIC also covers approved Part D-excluded drugs once a member is enrolled in a Part D drug plan.
How is EPIC used with Medicare Part D?
EPIC supplements Medicare Part D drug coverage for greater annual benefits and savings. When purchasing prescription drugs, the member shows both their EPIC and Medicare Part D drug plan cards at the pharmacy. After any Medicare Part D deductible is met, if the member has one, drug costs not covered by Part D (including co-payments/co-insurance) can be submitted to EPIC for payment. The member will pay an EPIC co-payment ranging from $3 to $20 based on the cost of the drug. For example, if the EPIC member's out-of-pocket drug cost is $100, the member will pay $20.
Please note that EPIC deductible members must first meet their EPIC deductible before they pay EPIC co-payments. This is in addition to meeting their Medicare Part D drug plan deductible should their Part D plan have one.
How does Extra Help work?
Extra Help from Medicare comes in two levels – full and partial. All levels of Extra Help provide a Low Income Subsidy (LIS) with reduced co-payments for approved drugs. Drug co-payments are as low as $8.95 for brand or $3.60 for generic drugs in 2020 when enrolled in a Part D drug plan.
How does EPIC help members apply for Extra Help ?
Income-eligible EPIC seniors are required to apply for Extra Help. This may be done at the time of completing the EPIC application to enable EPIC to apply for this federal benefit on their behalf. This can also be done after becoming an EPIC member by using the application but checking off the box 'Extra Help only'. The application for Extra Help will also be submitted to the New York State Medicaid program for eligibility in a Medicare Savings Program that provides additional benefits as well as LIS for approved members.
Eligibility for Extra Help :
Individuals with limited income and resources who are receiving Medicare may qualify for Extra Help to lower drug costs. In 2020, those with an annual income level of up to $19,140 (single) or $25,860 (married) may qualify for full or partial Extra Help. Resources (such as savings, CDs, IRAs, stocks, bonds – not ones's home or car) can be no more than $14,610 (single) and $29,160 (married). If assets are higher, those individuals may qualify for a Medicare Savings Program.
What are the benefits of Extra Help and EPIC?
Those approved for full Extra Help, a Medicare Savings Program or a Medicaid Spenddown do not have to pay any EPIC fees. EPIC will continue to pay Medicare Part D plan premiums for LIS members, and those with Full LIS in enhanced plans or Medicare Advantage plans up to the basic amount ($36.55 per month in 2020) after Medicare premium subsidization.
At a glance
- $0 premium plans available in some areas
- Many plans offer prescription drug coverage and vision and dental benefits
- 4.9 million people are enrolled in a UnitedHealthcare Medicare Advantage Plan1
Certain UnitedHealthcare Medicare Advantage plans may offer dental coverage, which can include coverage for routine dental care and some basic dental services such as dental exams, cleanings, X-rays and other services.
The dental coverage available to you will depend on which UnitedHealthcare Medicare plan you choose.
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What Dental Services May Be Covered by a UnitedHealthcare Medicare Plan?
While Medicare Part A and Part B (also called Original Medicare) do not cover most routine dental care, procedures or supplies, some UnitedHealthcare Medicare Advantage plans can cover certain dental care services, which may include:
- Routine cleanings
- Exams
- Fillings
- Tooth extractions
- Dentures
- X-rays
- Periodontics
- Prosthodontics and oral surgery
The specific plan benefits, coverage and costs included in your plan will vary depending on which plan you have. Not all plans are available in all areas.
Will My Dentist Accept My UnitedHealthcare Medicare Advantage Plan?
If your dentist is part of your UnitedHealthcare Medicare plan’s network or has agreed to the terms and conditions of payment, you may use your UnitedHealthcare Medicare plan for dental care at that location.
UnitedHealthcare networks include 1.3 million physicians and other health care professionals across the U.S.2
When using your plan to receive covered dental care, you may be subject to a deductible and cost-sharing measures such as copayments or coinsurance. Some services, such as a routine exam, may be covered in full.
Dental coverage is an additional benefit that some, but not all, UnitedHealthcare Medicare Advantage plans offer. If you are enrolled in a Medicare Advantage plan with dental coverage, your insurance provider will detail what dental services are included and what each service costs.
Find a UnitedHealthcare Medicare Plan With Dental Coverage
Because Original Medicare does not provide dental coverage, Medicare beneficiaries may want to consider joining a UnitedHealthcare Medicare Advantage plan that offers dental coverage.
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To learn about the dental coverage included in any UnitedHealthcare Medicare plans that are available in your area, speak with a licensed insurance agent by calling 1-855-580-18541-855-580-1854TTY Users: 711 24 hours a day, 7 days a week.
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