The Elderly Pharmaceutical Insurance Coverage (EPIC) is the New York State Pharmaceutical Assistance Program which covers for more than half the cost of prescription drugs for New York residents who are 65 or older. The eligibility requirements for EPIC are:
- You must be 65 or older.
- You must be a New York resident, meaning that your home address in all legal and official documents but be a New York address.
- Your annual income must be below $100,000 as a married couple or $75,000 if you are single.
- You must not be receiving full Medicaid benefits.
- You must be enrolled or eligible to be enrolled to a Medicaid Part D plan without exceptions.
If you meet all the requirements mentioned above, you can apply for EPIC at any time of the year. With EPIC, there are two plans which are based on income. The Fee Plan is for members with a gross annual income of up to $20,000 if they are single or $26,000 if they are married; and the Deductible Plan is for who have a gross annual income of between $20,001 to $75,000 if they are single or $26,000 to $100,000 if they are married.
Fee Plan members pay an annual fee from $8 to $300 based on their previous year’s gross income. This fee can be paid all at once or in quarterly installments. If you have the full Extra Help Low-Income Subsidy (LIS) from Medicare, you will not be required to pay any EPIC fees and your co-payments will be lower.
Members must meet an annual EPIC deductible which is determined by their previous year’s gross income. After meeting your EPIC deductible by paying your Medicare Part D premium every month, you will only pay the EPIC co-payments ranging from $3 to $20 based on the cost of your drug.
For both plans, your Part D drug plan is your primary drug coverage and you must maintain enrollment in a Part D drug plan in order to receive EPIC benefits. With both plans, EPIC covers approved Part D-excluded drugs like prescription vitamins and prescription cough and cold preparations. Once you have successfully enrolled to EPIC, an EPIC identification card is mailed to you. It is issued only once and it should be kept safely. In 2019, Medicare Part D plan premiums which can be up to $39.33 are also covered by EPIC. All members pay the EPIC co-payments for drugs which range from $3 to $20 depending on the drug cost not covered by Medicare Part D.
For Part D- and EPIC-covered drugs after any Medicare Part D deductible is met or approved Part D-excluded drugs, EPIC will cover:
- New prescriptions and refills;
- Insulin, insulin syringes and needles;
- Brand name and generic prescription drugs;
- Quantities up to your Part D plan’s limits.
To enjoy EPIC benefits, you need to show your Medicare Part D drug plan and EPIC cards to your pharmacist. Your pharmacist needs to know that your Medicare Part D drug plan is your primary prescription coverage and all claims for prescription medications should be submitted to Medicare Part D first and then to EPIC.