New York Elderly Pharmaceutical Insurance Coverage (EPIC)

Page Reviewed / Updated - May 2014

Program Description

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 2014, 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.

 

Eligibility Guidelines

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.

Benefits and Services

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.

 

How to Apply / Learn More

To learn more about this program, visit the EPIC program webpage or call their toll free number at (800) 332-3742.  This program is available statewide.  To apply one can download an application here.

 New York seniors financially eligible for the EPIC Program might also be eligible for in home care assistance through the EISEP Program.

 

The state of Illinois has two programs designed to provide financial assistance to the elderly to help them purchase their prescription drugs.  Rx Basic is for individuals without Medicare insurance and the Rx Plus is designed for those on Medicare.

Rx Plus is known as a Medicare wraparound program 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.