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.

For more information call the toll-free EPIC Helpline at 1-800-332-3742

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