The New York State Elderly Pharmaceutical Insurance Coverage (EPIC) program, managed by the Department of Health, assists over 325,000 eligible seniors aged 65 and above in supplementing their Medicare Part D drug plan expenses. Eligible seniors can submit applications for EPIC throughout the year, provided they are enrolled or eligible for enrollment in a Medicare Part D drug plan to access EPIC benefits and continue their coverage.
EPIC serves as supplementary coverage for both Medicare Part D and EPIC-covered medications, stepping in after any Medicare Part D deductible has been met. Additionally, EPIC extends coverage to approved Part D-excluded medications once a member is enrolled in Part D.
Eligibility for EPIC requirements:
- Being 65 years or older
- Having an annual income below $75,000 if single or $100,000 if married
- Not receiving full Medicaid benefits
- Being enrolled or eligible for enrollment in a Medicare Part D drug plan or Medicare Advantage Plan that includes drug coverage
EPIC offers two benefit plans: the Fee plan and the Deductible plan, each with its own criteria and coverage structure.
Fee Plan
Under the EPIC Fee plan, individuals with incomes below $20,000/year if single or below $26,000/year if married qualify. You pay an annual fee based on last year’s income, ranging from $8 to $300. EPIC covers Part D premiums up to the state benchmark, and members are responsible for any excess premium. EPIC also assists with Part D deductibles, but members must pay for drugs excluded from Part D coverage.
Deductible Plan
The EPIC Deductible plan is for those with incomes ranging from $20,001 to $75,000/year if single, or $26,001 to $100,000/year if married. Annual fees are waived for those earning between $20,001 and $23,000 (single) or $26,001 and $29,000 (married). Like the Fee plan, EPIC covers Part D premiums up to the state benchmark, but members must pay their Part D deductibles and an EPIC deductible. Once deductibles are met, EPIC covers copays for drugs.
It’s important to note that EPIC works alongside Part D plans, acting as secondary coverage. EPIC may cover drugs not included in Part D coverage, and members have a once-per-year Special Enrollment Period to adjust their Part D or Medicare Advantage coverage. For further inquiries, individuals can contact the toll-free EPIC helpline at 800-332-3742.
