EPIC Benefits for Your Medicare Clients
EPIC (Elderly Pharmaceutical Insurance Coverage) is a New York State pharmaceutical assistance program that helps older adults with Medicare pay for prescription drug costs.
EPIC is available for all NY State residents 65 or over that meet the income requirements. Currently, to qualify for EPIC, single NY State residents must have an income below $75,000 annually, and married couples less than $100,000. EPIC works to limit the costs of prescription medications paid for through the Medicare Part D benefit, so members must be enrolled in a Medicare Part D plan.
Under the EPIC program, there are two ways seniors benefit:
- For those in the middle to higher income tiers, the EPIC deductible program caps prescription costs between $3 and $20 per month, regardless of the cost of that medication, after the EPIC deductible has been met. The deductible amount is on a sliding scale based on income.
- The EPIC fee plan is available to those at the lower end of the income spectrum. Members pay an annual fee and EPIC pays the portion of their Medicare Advantage plan premium that accounts for the prescription benefit, capped based on the average cost of a part D plan. Rx costs for fee plan members are capped at between $3 and $20 for all medications right away.
The NY State EPIC program also provides an additional benefit for members. As an EPIC member, a Medicare beneficiary has a Special Enrollment Period that they can use one time per calendar year to change their Medicare plan selection if they so choose. This is a great benefit if your client’s health changes throughout the course of the year or if the plan they enrolled in is no longer a fit and they don’t want to wait until the next Annual Election Period to change plans.
Helping your clients with EPIC is a great way to provide value.
For more information about the program and how to enroll, visit the NYS Department of Health website.