Business As Usual For Most In EPIC Program

Question: A number of weeks ago you answered a question about EPIC asking for verification of income. You told us to watch for that letter and be sure to send it back. I never got it, but I did get an EPIC letter saying my EPIC coverage was renewed. What happened? Why did I not have to send them anything?

Answer: This has been a common question in the last couple of weeks. (That should sound familiar, I said that last time!) First, I need to clarify what EPIC is for those that don’t know.

New York State’s EPIC program (Elderly Pharmaceutical Insurance Coverage) is available to any resident of New York state who qualifies. Those qualifiers are; you must live in New York state, be over age 65 and make less than $75,000 for an individual and $100,000 for a married couple. (This income standard is based on last year’s income.) Individuals and Couples can apply for EPIC anytime, any year they meet those criteria.

For those individuals who already have EPIC, we are usually told that EPIC will automatically recertify your eligibility using your New York State tax returns. This year EPIC changed their answering message to say that ‘everyone’ would be receiving a request to verify their income. I came across a number of people who got that letter. When EPIC changed their message on their answering service, I started hearing from individuals and wrote the earlier article.

In practice, it turns out something different happened. We did run across a number of people who received the letter to request current income information. Those individuals were NOT the majority. Most of EPIC enrollees received the annual coverage letter. This letter indicated which type of EPIC coverage they had, Fee or Deductible. It then defined what their fee or deductible was.

It sounds like you fell into the second group. Most individuals we have talked with did not receive the request for information, but instead received the annual coverage letter. That letter is good news. You have EPIC and you don’t have to do anything further to ensure your EPIC benefits continue.

In the future if EPIC requests information to continue your coverage, I highly recommend completing the form and sending it back. EPIC’s coverage is a useful safety net for those over 65 living in New York state. For those individuals who make less than $23,000 and those couples making less than $29,000 a year, EPIC will continue to pay the Part D Premiums as they have in the past. EPIC will pay up to $39.00 per month towards your Part D premium.

There are some basic rules about EPIC that are important to remember. EPIC will NOT help reduce the cost of your medications during your Part D deductible, if your Part D plan has a deductible. When your plan has a deductible, you will pay the full cost of the medication at the pharmacy. Most deductibles are $405. Some plans have different deductibles than that, but they are never more than $405.

After your deductible has been met, (if you have one), EPIC will reduce your prescription medication co-pays to $3, $7, $15 or $20 per refill. If your Part D plan allows 30, 60, or 90 supplies, EPIC will follow that and reduce your co-pays. So make sure your prescriptions are for as many days as are allowed by your plan to save you the most possible.

EPIC can help to cover those medications that Medicare Part D excludes.

If you don’t have EPIC and think you are eligible call 1-800-332-3742 to talk to an EPIC staff member and get a copy of the EPIC application. There is also a useful website where you can print off an application and learn more about the program,–care/epic/. To be eligible for EPIC, you must live in New York state, be over 65 and make less than $75,000 for a single person and $100,000 for a married couple.

PLEASE, remember to show your EPIC card to your pharmacy. Also when picking up prescriptions look at your receipt. Be sure that your Part D plan has been billed and EPIC has been billed. You will know this because it shows up as a line on your receipt. If you can’t find that, be sure to ask the pharmacy staff to clarify whether or not EPIC has been billed.

To contact Janell Sluga, GCMC with questions or concerns, please call 720-9797 or e-mail her at