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Submitted URL: http://www.health.state.ny.us//nysdoh//epic//faq.htm
Effective URL: https://www.health.ny.gov/health_care/epic/
Submission: On June 21 via api from US — Scanned from US
Effective URL: https://www.health.ny.gov/health_care/epic/
Submission: On June 21 via api from US — Scanned from US
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SECTION MENU
EPIC PROGRAM
* What is EPIC?
* EPIC and Medicare
* Apply for EPIC
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* Member Info
* Pharmacy/Prescriber Info
* Other Info
* Privacy Notice
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WHAT'S NEW?
2024 PROGRAM HIGHLIGHTS
The 2024 EPIC program highlights are now available. The document includes the
2024 EPIC Fee Plan Schedule and the Deductible Plan Schedule.
EPIC OUTREACH
The EPIC Outreach team provides educational services to the community and
professional organizations. The web page EPIC Outreach outlines the mission and
services provided by the team along with contact information.
FAQ
* Medicare Savings Program
* Common billing questions are answered in this document.
* General questions are answered in this document.
PRESENTATIONS
2024 EPIC Professional Presentation is available to be downloaded to assist
professionals in serving the elderly in New York State.
The presentation used for the July 30, 2019 webinar regarding Late Enrollment
Penalty (LEP) assistance is available.
You are Here: Home Page > Elderly Pharmaceutical Insurance Coverage (EPIC)
Program
ELDERLY PHARMACEUTICAL INSURANCE COVERAGE (EPIC) PROGRAM
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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
325,000 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
RELATED LINKS
* 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.
Questions or comments: nysdohepic@primetherapeutics.com
Revised: April 2024
DEPARTMENT OF HEALTH
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