New York Elderly Pharmaceutical Insurance Coverage (EPIC)
The New York State pharmaceutical assistance program is called Elderly Pharmaceutical Insurance Coverage or EPIC for short. This program provides financial assistance to seniors to help with the costs of medications.
The program has two tiers; the Fee Plan and the Deductible Plan. Placement into one of these tiers is based on income. For 2012, the Fee Plan requires an annual income of less than $20,000 (or $26,000 for couples). The Deductible Plan is for seniors with incomes between $20,000 - $35,000 (or $26,000 - $50,000 for couples).
Both of these plans are Medicare wraparound programs which means the benefits wrap around those benefits provided by a Medicare Part D plan. When making a prescription purchase, Medicare Part D is the first payer and then this program contributes towards those costs the Part D plan does not cover.
There is an annual fee of between $8 - $300 based on income for the Fee Plan. There is no charge to participate in the Deductible Plan.
To be eligible for this program, seniors must meet the following criteria:
-Be a New York resident
-Be 65+ years old
-Cannot be on Medicaid
-Enrolled in Medicare Part D plan (if eligible)
-Be under the annual income limit of $35,000 for an individual or $50,000 for a couple.
The EPIC program will pay for Medicare Part D premiums, co-payments, coverage gap, and some drugs not covered by Part D. Fee Plan members are immediately eligible for assistance and Deductible Plan members are eligible after they’ve met a sliding scale deductible.
Program Availability / How to Apply
New York residents might also reduce their prescription out-of-pocket costs by using a discount drug card
Page Reviewed / Updated - Apr. 2013