New York EPIC and Medicare Part D

New York EPIC

The Elderly Pharmaceutical Insurance Coverage (EPIC) program is a New York State Program that provides seniors with prescription drug assistance secondary to Medicare Part D.

• Members must be enrolled in a Medicare Part D drug plan. including any Medicare Advantage plan with Part D prescription drug coverage
• Provides secondary coverage for Medicare Part D and EPIC covered drugs purchased after the Part D deductible, if any, is met.

Who Is Eligible to Enroll?

• You must be a resident of New York State with annual income up to $75,000 if single or $100,000 if married.  (Based on most recent NY State tax filing Adjusted Gross Income, Plus Social Security Benefits Less Part B premiums)
• You must be age 65 or older and not receiving full Medicaid benefits.
• You must be enrolled in a Medicare Part D plan; either standalone or combined within a Medicare Advantage plan.

What Does EPIC Cost?
EPIC has two plans based on your income.

• The Fee Plan is for members with income up to $20,000 if single or $26,000 if married. Benefits begin immediately.
• The Deductible Plan is for members with incomes ranging from $20,001 to $75,000 if single or $26,001 to $100,000 if married. Benefits begin when the deductible (Part D co-payment) has been met.

What Are The Benefits?

• EPIC provides secondary coverage for Medicare Part D covered drugs purchased after the Part D deductible, if any, is met.
• EPIC co-payments are $3, $7, $15 or $20 based on the prescription cost after your Part D (see below)
• Up to $42.27 (2021) monthly Part D drug plan premium assistance is available for members with annual income below $23,000 if single or $29,000 if married. (This monthly amount is adjusted yearly)
• EPIC members enjoy a once annual special election period to change their Medicare Part D prescription drug plan, including any Medicare Advantage plan with Part D prescription drug coverage.

Next Step

• Confirm you meet the above residency, age and income eligibility requirements.
• Download, print, complete and mail in the EPIC application. (see below)
• You will receive a separate EPIC Member card.  Provide the EPIC Member ID number to your New York based retail and mail order pharmacy.
• New York based retail and mail order pharmacies are connected to EPIC and will report your out of pocket copay. Do this even if you’re income has you in the deductible plan in case your drug needs change later in the year.
• Once the EPIC fee based or deductible plan requirement is met, EPIC steps  in as secondary coverage which reduces your copay to  $3, $7, $15 or $20 (see below)

For Existing EPIC Members – Annual Renewal Process

• You do NOT have to reapply for EPIC each year.
• EPIC reviews your residency and income on an annual basis to confirm eligibility and updated Fee or Deductible levels.
• At Year One, EPIC will obtain updated residency and income information from government tax files and advise you in writing of any fee or deductible change.
• At Year Two and every two years, EPIC will send you a form to update your contact information, address and income and advise you in writing of any fee or deductible change.
• EPIC Member Service telephone number is 800-332-3742 (Monday through Friday until 5:00 pm / eastern)

And, of course, if you have any questions about your Part D prescription drug coverage please don’t hesitate to call us at (518) 346-2115 or send us a note below and request a no-obligation consultation with an agent advisor:

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