New York State EPIC Program: Help with Medicare Part D in NY

New York EPIC

The New York State pharmaceutical assistance program (SPAP) is called Elderly Pharmaceutical Insurance Coverage or EPIC for short. The New York State EPIC program provides financial assistance to seniors to help with the costs of prescription medications (both generic and brand names).

The program has two tiers; the Fee Plan and the Deductible Plan. Placement into one of these tiers is based on income. Both of these plans are Medicare wraparound programs, which means the benefits wrap around those benefits provided by a Medicare Part D plan, which is Medicare’s prescription drug plan. When making a prescription purchase, Medicare Part D is the first payer, and then the EPIC program contributes towards those costs the Part D plan does not cover.

The New York State EPIC program will pay for Medicare Part D premiums, co-payments, coverage gap, and some drugs not covered by Part D.This program is overseen by the New York Department of Health.

Common Eligibility Guidelines

To be eligible for this program, seniors must meet the following criteria:

  • Be a New York resident
  • Be 65+ years old
  • Not enrolled in Medicaid (also called NY Managed Long Term Care)
  • Enrolled in or be eligible for a Medicare Part D plan

New York State EPIC program – Fee Plan

Eligibility

Annual income for single applicants should be less than $20,000 or $26,000 for married couples

Annual Fee

An annual fee is from $8 to $300 and is based on the prior year’s income

Medicare Part D premium

EPIC pays the Medicare Part D plan premiums up to $39.33 per month in 2019

EPIC Copayments

Copayments for prescriptions are between $3 and $20 and are based on the cost of the medication. For instance, if a drug costs $15, the co-payment is $3, and if a drug is over $55, the co-payment is $20.

How does plan work?

  • Your Medicare Part D is your primary coverage, EPIC provides secondary coverage
  • First, you must meet your Medicare Part D deductible (if you have one)
  • After Medicare Part D Deductible paid, you are only responsible for EPIC copayments (see above)
  • EPIC also covers Medicare Part D-excluded drugs, such as prescription vitamins and prescription cough and cold preparation.
  • If you have Medicare Extra Help (LIS), you will not be required to pay any EPIC fees and your copayments will be lower.

 

New York State EPIC program – Deductible Plan

Eligibility

Annual income for single seniors should be between $20,001 and $75,000 or between $26,001 and $100,000 for married couples.

Annual Fee

None

EPIC Deductible

Deductible Plan members are eligible for benefits after they’ve met a sliding scale EPIC deductible based on their prior year’s income. Deductibles may be as low as $530 per year and as high as $3,215 per year.

Medicare Part D premium

EPIC pays the Medicare Part D plan premiums up to $39.33 per month in 2019 for seniors with incomes ranging from $20,001 to $23,000 for singles or $26,001 to $29,000 for married.

EPIC Copayments

Copayments for prescriptions are between $3 and $20 and are based on the cost of the medication. For instance, if a drug costs $15, the co-payment is $3, and if a drug is over $55, the co-payment is $20.

How does plan work?

  • Your Medicare Part D is your primary coverage, EPIC provides secondary coverage
  • First, you must meet your Medicare Part D deductible (if you have one)
  • After Medicare Part D Deductible paid, your out-of-pocket drug costs will be applied to your EPIC deductible
  • After you met EPIC Deductible, you are only responsible for EPIC copayments (see above)
  • EPIC also covers Medicare Part D-excluded drugs, such as prescription vitamins and prescription cough and cold preparation.

How to Apply / Learn More

To learn more about this program, visit the New York State EPIC program webpage or call their toll free number at (800) 332-3742.  This program is available statewide.  To apply one can download an application here.

How Can Liberty Medicare Help with Drug Costs?

Liberty Medicare is a leading insurance agency that specializes in Medicare insurance in New York. All our services are entirely free to you. An essential part of our job is working with low-income senior citizens and providing suggestions on available Medicare Extra Help Programs and State Pharmaceutical Assistance Programs (such as EPIC) that will help with your Prescription Drug Costs.

You should be aware that Medicare Extra Help Programs and State Pharmaceutical Assistance Programs (SPAPs) qualify for the Special Enrollment Period (SEP). It allows you to change your Medicare Advantage or Prescription Drug Plan once per calendar quarter during the first nine months of the year.

Learn more about all the benefits of working with Liberty Medicare.

Receive our Medicare Quotes, or give us a call at 877-657-7477, and you will be connected to a licensed agent/broker.