EPIC – Elderly Pharmaceutical Insurance Coverage

The New York State EPIC program can help you with your Medicare Prescription Drug Coverage costs in two ways:

1. EPIC Fee Plan: If your income is less than $20,000 (single) or $26,000 (married), you will have to pay an annual EPIC fee ranging from $8 to $300, based on your income. Additionally, you must pay your Medicare Part D plan’s deductible (if you have one). Then, you will only pay EPIC copays ranging from $3 to $20 for drugs covered by the plan. EPIC will also pay the Part D drug plan premium up to $42.27 in 2021. If you choose a Part D plan with premiums higher than $42.27, you will have to pay the additional amount of the monthly premium.If you have the full or partial Extra Help available through Medicare, Medicare Savings Program (MSP), or Medicaid Spenddown, EPIC will also help with your premiums (up to $42.27 in 2021). If you have full Extra Help, you will not have to pay any EPIC fees. If you have Partial Extra Help, you will pay the quarterly EPIC fee.
2. EPIC Deductible Plan: The EPIC Deductible Plan is for people who have income too high for the EPIC Fee Plan. It is available if you are single and have income between $20,001 and $75,000 or if you are married and have income between $26,001 and $100,000.When you enroll in the EPIC Deductible Plan, you get an EPIC identification card. After you meet your Medicare Part D deductible (if you have one), the money you spend on prescription drugs covered by the plan will be applied to your EPIC deductible. After you meet your EPIC deductible for the year, you are eligible to pay the EPIC copays (ranging from $3 to $20 for drugs covered by the plan). The annual EPIC deductibles range from $530 to $2,430. EPIC may also cover drugs that are not included in a Part D plan, like prescription vitamins.Within the Deductible Plan, benefits vary depending on whether you have income over or under $23,000 ($29,000 if you are married).If your income is under $23,000 (single) and $29,000 (married), EPIC will pay your Part D drug plan premium (up to $42.27 in 2021).

   If your income is over $23,001 (single) or $29,001 (up to the maximum program limit of $75,000 / $100,000), you will have to pay your Medicare Part D drug plan premium. However, the monthly premium you pay will be used to meet your EPIC deductible.

How do I apply?

To apply, print and fill out an application and send it to EPIC.