EPIC Program Saves People Cash

Question: My husband recently passed away and I called EPIC to report the change and now I have to start my deductible all over? WHY??

Answer: Let’s review what EPIC is and how it works first. New York State’s EPIC program (Elderly Pharmaceutical Insurance Coverage) saves eligible individuals money on their prescriptions by supplementing their Medicare Part D plan. In order to qualify for EPIC, you must live in New York State, be over the age of 65 with an annual income up to $75,000 if single or $100,000 if married. Current EPIC eligibility is based on your 2017 income. You must also be enrolled in a Part D prescription drug plan. EPIC will act as a supplement. EPIC is never considered to be someone’s primary drug coverage.

There are two kinds of EPIC coverage; Fee Plan and Deductible Plan. The EPIC Fee Plan charges members annually based on their income. For single individuals who make up to $20,000 a year, and couples who make up to $26,000 a year, they would have EPIC co-payments ranging from $3-$20 based on the cost of the drug. EPIC deductible plan members must meet an annual out-of-pocket deductible based on their income before paying the reduced EPIC co-pays. EPIC also pays Medicare Part D plan premiums, up to $39 a month in 2018, for members with an annual income below $23,000 if single or $29,000 if married.

Back to the question. When your marital status changes, usually your income changes as well. In order to update EPIC you would call the toll-free hotline at 1-800-332-3742. EPIC would then send out a marital status change form for you to complete and send back. There are three boxes to choose from; the first choice is Widowed, Single, or Divorced, Married is the second choice, and Married, Living Separately is the third choice. By reporting a marital status change form, EPIC will then create you a new EPIC account and issue you a new EPIC card which will have a new ID number. It is like you are brand new to EPIC. In some cases this can bump a surviving spouse into a different EPIC plan, perhaps from the deductible to fee plan. Great! Now EPIC will provide you reduced EPIC co-pays without having to meet an EPIC deductible and pay up to $39 a month towards your Part D plan. Sometimes reporting our marital status change can bring changes that are not as desirable, like mentioned in your question. You are now considered Widowed and EPIC will follow the “single” income guidelines. For those with higher incomes on the deductible plan, this may assign you a NEW DEDUCTIBLE that you will have to start over with. Being conscious of where you are at on the overall spectrum of EPIC benefits is important. The day someone goes to the pharmacy and figures out they have met their EPIC deductible is a CELEBRATION! For the remainder of the year that individual will only pay the reduced co-pays of $3, $7, $15, or $20 based on the cost of drug.

If you are unsure about how your change in marital status will affect your EPIC benefits you can always reach out to EPIC at 1-800-332-3742 or view the income guidelines at http://www.health.ny.gov.health_care/epic. Janell and I can also offer assistance in determining how your EPIC coverage may change.

To contact Erin Green, Community Service Coordinator with questions or concerns, please call 716-720-9795 or email her at egreen@lutheran-jamestown.org.