The Elderly Pharmaceutical Insurance Coverage (EPIC) program is a New York State program for seniors administered by the Department of Health. It helps more than 330,000 income-eligible seniors aged 65 and older to supplement their out-of-pocket Medicare Part D drug plan costs. Seniors can apply for EPIC at any time of the year and must be enrolled or eligible to be enrolled in a Medicare Part D drug plan to receive EPIC benefits and maintain coverage.
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.
EPIC helps pay the Medicare Part D drug plan premiums for members with income up to $23,000 if single or $29,000 if married. Higher income members are required to pay their own Part D premiums but EPIC provides premium assistance by lowering their EPIC deductible.
EPIC has two plans based on income. The Fee Plan is for members with income up to $20,000 if single or $26,000 if married. The Deductible Plan is for members with incomes ranging from $20,001 to $75,000 if single or $26,001 to $100,000 if married.
It is easy to join the program. Just complete the application and mail or fax it to EPIC. No documentation is required. EPIC verifies information with the Social Security Administration and the New York State Department of Taxation and Finance.
- What are the EPIC eligibility requirements?
- How does the EPIC Fee Plan work?
- How does the EPIC Deductible Plan work?
- How does EPIC and Medicare Part D work together?
- How does EPIC provide Medicare Part D Premium Assistance?
- What does EPIC cover?
- What are the EPIC co-payments for covered drugs?
- How do I apply for EPIC?
- Where do I find Frequently Asked Questions (FAQ) for Billing Topics or General Topics
- Medicare Plan Finder
- Medicare (Home Page)
- Health Insurance Information, Counseling & Assistance Program (HIICAP)
- New York State Office for the Aging
- Social Security Administration – Extra Help With Medicare Prescription Drug Plan Costs
- BenefitsCheckUpRx – A Decision-Support and Enrollment Service
- New York Statewide Senior Action Council, Inc.
- Medicare Rights Center
- NY State of Health
- New York State Elder Law, as it pertains to the EPIC program, can be found at the web site for the Laws of New York State.
Navigate the list at the web site to: ELD, then select it. Select: Title 3 from the next web page.