Everything You Need to Know About The EPIC Program




The Elderly Pharmaceutical Insurance Coverage (EPIC) program is a New York State based program designed for income-eligible seniors aged 65 and older. The program is administered by the Department of Health, and currently helps more than a quarter of a million people cover the cost of their out-of-pocket Medicare Part D drug plan costs.

Who is eligible for EPIC? 

To join the EPIC program, a senior must meet the following criteria:

  • Aged 65 years or older
  • A New York State resident
  • Enrolled or eligible to be enrolled in a Medicare Part D drug plan
  • Annual income below $75,000 if single or $100,000 if married
  • Not be receiving full Medicaid benefits.

When can you apply for EPIC?

Eligible seniors are able to enroll in EPIC any time of the year so long as they are enrolled in or eligible to be enrolled in a Medicare Part D drug plan. If you are not yet enrolled in a Medicare Part D plan, you can enroll in EPIC, and you will receive a “Special Enrollment Period” in which you can enroll in a Medicare Part D plan.

How does EPIC help?

EPIC provides secondary coverage for Medicare Part D and EPIC-covered drugs purchased after any Medicare Part D deductible is met. EPIC also covers approved Part D-excluded drugs once a member is enrolled in Part D.
There are two types of EPIC plans based on income.
The Fee Plan is for EPIC members who have an annual household income of $20,000 if single or $26,000 if married.
For those who are on the Fee Plan, EPIC will pay the Medicare Part D plan premiums up to $39.73 per month (this is the benchmark amount equivalent to the average cost of a Part D Drug plan).
The Deductible Plan is for EPIC members who have an annual income range from $20,001 to $75,000 if single or $26,001 to $100,000 if married. There is no fee to join the EPIC Deductible Plan. You pay the full price that Part D charges for your drugs until the Annual Deductible is met. This Annual Deductible is based on your previous year’s income.

How do you use your EPIC card?

  • Show both your Medicare Part D drug plan and EPIC ID cards when you go to the pharmacy to purchase your drugs.
  • Your Medicare Part D drug plan is your primary drug coverage and you must maintain enrollment in a Part D drug plan to receive EPIC benefits.

For EPIC Fee Plan Members:

  • EPIC provides secondary coverage for Medicare Part D- and EPIC-covered drugs after you meet your Medicare Part D-deductible if you have one.
  • Once enrolled in a Medicare Part D drug plan, EPIC also covers approved Medicare Part D-excluded drugs such as prescription vitamins and prescription cough and cold preparations.
  • You will only pay the EPIC co-payments ranging from $3 to $20 based on the cost of your drug.

For EPIC Deductible Plan Members:

  • Once enrolled in a Part D drug plan, EPIC also covers approved Part D-excluded drugs such as prescription vitamins and prescription cough and cold preparations.
  • After you meet any Part D deductible if you have one, out-of-pocket drug costs for covered Part D and EPIC medications will be applied to your EPIC deductible.
  • Once you are enrolled in a Part D drug plan, drug costs for approved Part D-excluded drugs will be applied to your EPIC deductible.
  • After you meet your EPIC deductible, you will only pay the EPIC co-payments ranging from $3 to $20 based on the cost of your drug.

EPIC is a great program to help cover the cost of Part D plans for those who need assistance. Do not hesitate to reach out to an experienced agent at Plan Medicare 516-900-7877, to learn more about EPIC and the benefits of enrolling.