Elderly Pharmaceutical Insurance Coverage (EPIC)

April 15, 2014
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The Elderly Pharmaceutical Insurance Coverage Program expands coverage by increasing the income limits for single and married couples.

The Elderly Pharmaceutical Insurance Coverage (EPIC) program has been an important benefit available to seniors in New York. It has helped more than 270,000 income-eligible seniors aged 65 and older supplement their out-of-pocket Medicare Part D drug plan costs. This is of particular importance since prescription drug rates have increased significantly over the years. In fact, a recent study done by the Bureau of Economic Analysis reports that prescription drugs have increased twice the rate of inflation. Thankfully with the recent passage of the State Budget, effective April 1st EPIC will be expanded by increasing income eligibility thresholds thus making it more accessible to New York Seniors.

How EPIC Works

Seniors can apply for EPIC at any time of the year and must be enrolled or eligible to be enrolled in a Medicare Part D drug plan to receive EPIC benefits. EPIC provides secondary coverage for Medicare Part D and EPIC-covered drugs purchased after any Medicare Part D deductible is met. Essentially EPIC helps seniors by cost sharing the Part D co-pay. With EPIC’s help, a member’s Part D co-pay will be no higher than $20 per drug and can range anywhere $0 to $20 depending on the medication. EPIC also covers many Part D excluded drugs. This is of particular importance as not all Part D prescription plans will have a seniors medications listed in their formulary.

EPIC also helps pay the Medicare Part D drug plan premiums for members with income up to $23,000 if single or $29,000 if married (the EPIC premium contribution was limited to $43.22 in 2013). Higher income members are required to pay their own Part D premiums but EPIC provides premium assistance by lowering their EPIC deductible. As stated above, effective April 1st, the eligibility income threshold for a single person and couple has been increased (single $75,000 and $100,000 for a couple). Assets are not counted toward eligibility. Individuals already on Medicaid are not allowed to participate in EPIC.

It is easy to join the EPIC program and because the benefits are significant we encourage all seniors who are in this income threshold to do so. Just complete the application and mail or fax it to EPIC. No documentation is required. EPIC verifies information with the Social Security Administration and the New York State Department of Taxation and Finance.

To download an application please click http://www.health.ny.gov/forms/doh-5080.pdf

EPIC also operates a toll-free Helpline which is available from 8:30AM to 5:00PM, Monday through Friday. Call 1-800-332-3742.

To learn more about how EPIC and Medicare D work together please click on the following link http://www.health.ny.gov/health_care/epic/medicare.htm

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