Quick Links to Worksheets
Social Security: 1-800-772-1213
Phone Hours: 8:00 am -7:00 pm
Visit Website
Medicare: 1-800-633-4227
Phone Hours: 24 hours a day
7 days a week including some Federal Holiday’s
Visit Website
Click on Links below to open and download forms.
2025 Medicare Changes
Click on the button below to see all changes to Medicare for 2025.
Medicare SAVINGS Program
Click on the buttons below to download the Qualifications and / or Application form for the Medicare Savings Program.
Enrolling in Medicare Part A & B
Enrolling in Medicare Part B
Medicare Part B (medical insurance) is part of Original Medicare and covers medical services and supplies that are medically necessary to treat your health condition. This can include outpatient care, preventive services, ambulance services, and durable medical equipment. It also covers part-time or intermittent home health and rehabilitative services, such as physical therapy, if they are ordered by a doctor to treat your condition.
Some of the preventive services Medicare Part B covers include a one-time “Welcome to Medicare” preventive visit, flu and hepatitis B shots, cardiovascular screenings, cancer screenings, diabetes screenings, and more.
Request for Employment Information
In order to apply for Medicare in a Special Enrollment Period, you must have or had group health plan coverage within the last 8 months through your or your spouse’s current employment. People with disabilities must have large group health plan coverage based on your, your spouse’s or a family member’s current employment.
(EPIC) Elderly Pharmaceutical Insurance Coverage
The Elderly Pharmaceutical Insurance Coverage (EPIC) program is a New York State program administered by the Department of Health. It provides seniors with co-payment assistance for Medicare Part D covered prescription drugs after any Part D deductible is met. EPIC also covers many Medicare Part D excluded drugs.
Medicare Income-Related Monthly Adjustment Amount for Life Changing Event
If you had a major life-changing event and your income has gone down, you may use this form to request a reduction in your income-related monthly adjustment amount. See page 5 for detailed information and line-by-line instructions.
If you prefer to schedule an interview with your local Social Security office, call 1-800-772-1213
WORKSHEETS
Information provided in these worksheets is kept confidential and allows us to assist you select the best options as we help you navigate the complex world of Medicare & insurance.
Click on a link below to get started:
Medicare
Long Term Care
Life Insurance
ASSISTANCE PROGRAMS TO HELP WITH MEDICATION COSTS
Many programs are available from federal and state governments, non-profits, manufacturers, and other organizations to help you get the drugs you need at a reduced cost. Eligibility is often based on income, insurance or Medicare status, and other factors. You’ll need to apply through each program, either online, over the phone, or with your doctor’s help.
Advair Diskus
Fluticasone / Salmeterol, Wixela Inhub
Patient Assistance Program from PAN Foundation
Patient Assistance Programs (PAPs) are usually sponsored by pharmaceutical companies and provide free or discounted medicines to low income or uninsured and under-insured people who meet specific guidelines. Eligibility requirements vary for each program.
Provider: Patient Access Network Foundation (PAN)
Phone Number: 1-866-316-7263
Applicable Drugs: Advair Diskus (fluticasone propionate-salmeterol xinafoate) Powder, Inhalation
Eligibility Requirements: *Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance. Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly.
Note: All new enrollment is now done electronically or over the phone. Contact program for details.
Patient Assistance Program from GSK
This program helps patients and healthcare professionals in the U.S. with coverage, reimbursement, and coding issues for certain GSK products.
Provider: GSK Reimbursement Resource Center
Phone Number: 1-800-745-2967
Applicable Drugs: Advair Diskus (fluticasone propionate-salmeterol xinafoate) Powder, Inhalation
Bystolic
Nebivolol
Patient Assistance Program from Allergan
The following program is offered by the manufacturer of this drug.
Program Name: Allergan U.S. Patient Assistance Program
Provider: Allergan
Phone Number: 1-800-851-0758
Patient Assistance Program from PAN Foundation
The following program is offered by the manufacturer of this drug.
Program Name: PAN Foundation Patient Assistance
Provider: PAN Foundation
Phone Number: 1-866-316-7263
ELIQUIS
Apixaban
Patient Assistance Program for Eliquis
The following program is offered by the manufacturer of this drug. Co-payment assistance and patient assistance programs are available for eligible patients.
Provider: Bristol-Myers Squibb Patient Assistance Foundation (BMSPAF)
Phone Number: 1-800-736-0003
Applicable Drugs: Eliquis (Apixaban) Tablet
Breo Ellipta
Fluticasone / Vilanterol
Patient Assistance Program from GlaxoSmithKline
Breo Ellipta is used to treat COPD, including chronic bronchitis and emphysema. Breo Ellipta is slightly less popular than other beta agonist/corticosteroid combinations. There are currently no generic alternatives to Breo Ellipta.
The following program is offered by the manufacturer of this drug.
Program Name: GSK Access
Provider: GlaxoSmithKline
Phone Number: 1‑866‑728‑4368
Patient Assistance Program from PAN Foundation
The following program is offered by the manufacturer of this drug.
Program Name: PAN Foundation Patient Assistance
Provider: PAN Foundation
Phone Number: 1-866-316-7263
Trelegy Ellipta
Fluticasone / Umeclidinium / Vilanterol
Patient Assistance Program from GlaxoSmithKline
Trelegy Ellipta (fluticasone/umeclidinium/vilanterol) is used to treat chronic obstructive pulmonary disease (COPD). It is less popular than other comparable drugs. There are currently no generic alternatives to Trelegy Ellipta.
The following program is offered by the manufacturer of this drug.
Program Name: GSK Access
Provider: GlaxoSmithKline
Phone Number: 1‑866‑728‑4368
Incruse Ellipta
Umeclidinium
Patient Assistance Program from GlaxoSmithKline
The following program is offered by the manufacturer of this drug.
Program Name: GSK Access
Provider: GlaxoSmithKline
Phone Number: 1‑866‑728‑4368
JANUMET
Janumet (Metformin/sitagliptin)
Patient Assistance Program from Merck
The following program is offered by the manufacturer of this drug.
Program Name: Merck Helps
Provider: Merck
Phone Number: 1-800-727-5400
JANUVIA
Sitagliptin
Patient Assistance Program from Merck
The following program is offered by the manufacturer of this drug.
Program Name: Merck Helps
Provider: Merck
Phone Number: 1-800-727-5400
Ozempic
SEMAGLUTIDE
SEMAGLUTIDE is used to improve blood sugar control in adults with type 2 diabetes. This medicine may be used with other diabetes medicines. This drug may also reduce the risk of heart attack or stroke if you have type 2 diabetes and risk factors for heart disease.
Patient Assistance Program from Novo Nordisk
The following program is offered by the manufacturer of this drug.
Program Name: Novo Nordisk Patient Assistance Program
Provider: Novo Nordisk
Phone Number: 1-866-310-7549
Multaq
Dronedarone
Patient Assistance Program from Sanofi
The following program is offered by the manufacturer of this drug.
Program Name: Sanofi Patient Connection
Provider: Sanofi
Phone Number: 1-888-847-4877
Patient Assistance Program from PAN Foundation
The following program is offered by the manufacturer of this drug.
Program Name: PAN Foundation Patient Assistance
Provider: PAN Foundation
Phone Number: 1-866-316-7263
Repatha
Evolocumab
Patient Assistance Program from Amgen
The following program is offered by the manufacturer of this drug.
Program Name: The Safety Net Foundation
Provider: Amgen
Phone Number: 1-888-762-6436
Patient Assistance Program from PAN Foundation
The following program is offered by the manufacturer of this drug.
Program Name: PAN Foundation Patient Assistance
Provider: PAN Foundation
Phone Number: 1-866-316-7263
Restasis
Cyclosporine
Patient Assistance Program from HealthWell Foundation
The following program is offered by the manufacturer of this drug.
Program Name: AbbVie Patient Assistance Foundation
Provider: AbbVie
Phone Number: 1-800-222-6885
SPIRIVA Respimat
The following programs are offered by the manufacturer of this drug.
TIOTROPIUM (bronchodilator)
Patient Assistance Program from PAN Foundation
Program Name: PAN Foundation Patient Assistance
Provider: PAN Foundation
Phone Number: 1-866-316-7263
Applicable Drugs: Spiriva Respimat (tiotropium bromide) Spray, Inhalation
*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance. Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly.
Note: All new enrollment is now done electronically or over the phone. Contact program for details.
Patient Assistance Program from Boehringer Ingelheim
Program Name: BI Cares Patient Assistance Program
Provider: Boehringer Ingelheim
Phone Number: 1-800-556-8317
Applicable Drugs: Spiriva HandiHaler (tiotropium bromide) Powder; Inhalation, Spiriva Respimat (tiotropium bromide) Spray; Inhalation
Eligibility Requirements: Must be uninsured or under-insured
*Some Medicare eligible patients who have difficulty meeting their Part D drug costs and who do not qualify for other assistance may be eligible.
Entresto
The following programs are offered by the manufacturer of this drug.
Novartis Patient Assistance Foundation
Provider: Novartis
Phone Number: 1-800-277-2254
PAN Foundation Patient Assistance
Provider: PAN Foundation
Phone Number: 1-866-316-7263
Basaglar
Insulin Glargine
Patient Assistance Program from Lilly
The following program is offered by the manufacturer of this drug.
Program Name: Lilly Diabetes Solution Center
Provider: Eli Lily
Phone Number: 1-833-808-1234
Farxiga
Dapagliflozin
Patient Assistance Program from AstraZeneca
The following program is offered by the manufacturer of this drug.
Program Name: AZ&Me Prescription Savings Program
Provider: AstraZeneca
Phone Number: 1-800-292-6363
Fiasp
Insulin Aspart
Patient Assistance Program from Novo Nordisk
The following program is offered by the manufacturer of this drug.
Program Name: Novo Nordisk Patient Assistance Program
Provider: Novo Nordisk
Phone Number: 1-866-310-7549
Prolia
Denosumab
Patient Assistance Program from Amgem
The following program is offered by the manufacturer of this drug.
Program Name: The Safety Net Foundation
Provider: Amgen
Phone Number: 1-888-762-6436
Stelara
The following programs are offered by the manufacturer of this drug.
Ustekinumab
Patient Assistance Program from PAN Foundation
Program Name: PAN Foundation Patient Assistance
Provider: PAN Foundation
Phone Number: 1-866-316-7263
Johnson & Johnson Patient Assistance Foundation, Inc.
Provider: Johnson & Johnson Patient Assistance Foundation, Inc.
Phone Number: 1-800-652-6227
Synthroid
Levothyroxine
The following program is offered by the manufacturer of this drug.
AbbVie Patient Assistance Foundation
Provider: AbbVie
Phone Number: 1-800-222-6885
PAN Foundation Patient Assistance
Provider: PAN Foundation
Phone Number: 1-866-316-7263
Synthroid Delivers Program
Provider: Synthroid
Phone Number: 1-888-920-0527
Jardiance
Boehringer Ingelheim Cares Foundation Patient Assistance Program
Provider: Boehringer Ingelheim
Phone Number: 1-800-556-8317
Xarelto
Rivaroxaban
Patient Assistance Program from Johnson & Johnson
The following program is offered by the manufacturer of this drug.
Program Name: Johnson & Johnson Patient Assistance Foundation
Provider: Johnson & Johnson
Phone Number: 1-800-652-6227
