Over the past few years we have been seeing rising costs almost everywhere we go. One of the most concerning is the rising cost of life saving medications. To combat rising drug prices and ensure the wellbeing of our Older Americans New York State has a program called Elderly Pharmaceutical Insurance Coverage, generally referred to as EPIC.

EPIC helps more than 325,000 income-eligible participants aged 65 and older to supplement their out-of-pocket Medicare Part D drug plan costs. Older Americans can apply for EPIC at any time of the year and must be enrolled or eligible to be enrolled in a Medicare Part D drug plan to receive EPIC benefits and maintain coverage. This results in additional savings for members to purchase needed medications.

EPIC provides secondary coverage for Medicare Part D and EPIC-covered drugs purchased after any Medicare Part D deductible is met. It can help pay the Medicare Part D drug plan premiums for members with income up to $23,000 if single or $29,000 if married. Higher income members are required to pay their own Part D premiums but EPIC provides premium assistance by lowering their EPIC deductible.

EPIC has two plans based on income. The Fee Plan is for members with income up to $20,000 if single or $26,000 if married. The Deductible Plan is for members with incomes ranging from $20,001 to $75,000 if single or $26,001 to $100,000 if married. With these plans copayments can range from as low as $3, $7, $15 and $20 based on the out of pocket cost after the Medicare Part D plan has been billed. Remember that the Office for Aging Services can help to clarify any of the confusing parts and we are only a phone call away.

It is easy to join the program. To qualify you must be a NYS resident, 65 years of age or older, have annual income below $75,000 single or $100,000 married and not receiving full Medicaid benefits. You may apply for EPIC at any time during the year even if you do not have a Medicare Part D Plan. Once enrolled members will receive a Special Enrollment Period from Medicare allowing them to join a Medicare Part D drug plan. If you have union or retiree benefits, please contact your benefit office to see if you are eligible to join a Part D drug plan. Then you just complete the application which can be found at https://www.health.ny.gov/forms/doh-5080.pdf or email nysdohepic@magellanhealth.com. Next mail or fax the application to the EPIC address found on the application. No documentation is required. Your information will be verified with the Social Security Administration and the New York State Department of Taxation and Finance by the EPIC program.

For further information, please call the toll-free EPIC Helpline at 1-800-332-3742 Monday through Friday from 8 a.m. to 5 p.m. or visit the EPIC website at http://www.health.ny.gov/health–care/epic/

If you would like to obtain an EPIC application locally or would like assistance please contact NYConnects at (716) 753-4582.