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It Is OK To Have A Part D Plan And EPIC

Question: Can I have EPIC and a Part D Plan?

Answer: New York state provides extra Prescription Drug Coverage for those who qualify. New York state’s program is called EPIC (Elderly Pharmaceutical Insurance Coverage). EPIC is available to any resident of New York State who is over age 65 and make less than $75,000 for an individual and $100,000 for a married couple. EPIC always has open enrollment. If you were denied EPIC in the past, but your situation has changed, you can apply now. If you just turned 65 or are turning 65 soon you may apply after you are 65. Fill out the application, but mail it on your birthday. If EPIC receives your application prior to your actual 65th birthday, your application will be denied because you are not yet 65. For more information visit health.ny.gov/health–care/epic. An application from the website can be printed, but it must be completed on paper and mailed in.

Once approved, you are sent information explaining your coverage and an EPIC card. You must bring your EPIC card to show pharmacy staff. EPIC can’t help pay for medications if the card isn’t on file. EPIC is always secondary coverage for prescription drugs. EPIC is in addition to Part D, not a replacement, so all medications must first be processed (billed) through your Part D plan, then co-pays are processed through your EPIC coverage.

EPIC has two levels of coverage. Most individuals/couples fall into the deductible plan. which keeps track of medication expenses at the pharmacy, and uses those expenses toward your deductible. If you reach a deductible, your cost is reduced because EPIC pays part of the co-pays.

For those individuals/couples with the EPIC fee plan you pay a quarterly or annual fee for enrollment. EPIC helps to pay for your medications immediately. The level of coverage you have with EPIC is a sliding scale depending on your income. If your personal annual income is less than $21,000, EPIC will pay up to $36 of your premium. If a couple makes less than $29,000, EPIC will pay both of your premiums up to $36.

Fill out the one page application for EPIC, and EPIC makes a determination, and informs you of your coverage.

Part D and EPIC are NOT competing insurances. Your Part D plan will always be primary and EPIC always will be secondary. This combination of benefits saves the most money on medications.

You do need to inform your Part D that you have EPIC. If you already have EPIC, as you look at your monthly statements sent to you from your Part D Provider, you notice they have a column illustrating what (others) have paid on your prescription drugs. That ‘Others’ column may be your EPIC coverage. If you have met your EPIC deductible or if you are in the EPIC fee plan, your medications cost $3, $7, $15, or $20 per fill. You may have been paying more and suddenly your costs decrease meaning your EPIC benefit has begun, and you are saving money.

If you are not sure how the EPIC benefit works, call EPIC (800) 332-3742 to ask some questions or get an application. If you want to apply for EPIC, visit the website anytime. You can also get EPIC applications at most pharmacies in New York state.

Remember when you call for your Part D plan, it is available to people with Medicare in the US. Your Part D plan may not know what EPIC is, so call EPIC directly with questions. Those prescription drug plans available nationally sometimes don’t understand or explain benefits to residents in New York State. Each state is a little bit different, but Part D is required coverage for those with Medicare in every state.

You should enroll in Medicare Part D and EPIC. You have wrap-around benefits for prescriptions which saves the most money. Be sure to show both insurance cards to your pharmacist. Neither insurance products save you money if a pharmacy doesn’t know you have them.

To contact Janell Sluga, GCMC with questions or concerns, please call 720-9797 or e-mail her at janells@lutheran-jamestown.org.

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