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Community Corner

EPIC Program Helps Seniors Save

Library seminar presented by NYS Department of Health answers questions.

The Sayville Library held a seminar on the Elderly Pharmaceutical Insurance Coverage (EPIC) program and Medicare Part D recently. The lecture, presented by Reba Wilkins of the New York State Department of Health, was designed to give attendees more information on the senior prescription plan offered by New York State.

In order to be eligible, a person must be 65 or older and have an annual income of less than $35,000 if single, or $50,000 if married. According to Wilkins, more than 300,000 seniors in New York State are currently enrolled in the not-for-profit program. In order to take part in the program, seniors need to be enrolled in Medicare. If the applicant is not enrolled in a Medicare Part D drug plan, EPIC will help select and enroll them in one to use with EPIC at no added cost.

EPIC is a New York State  program and it is accepted at almost all pharmacies. In most cases, 80 to 90 percent of prescriptions are covered, including generic and name brand, as well as insulin and insulin syringes. EPIC is accepted as supplemental or secondary coverage to Medicare or other insurance programs. EPIC helps enrollees pay for their Medicare Part D premiums and cover the Medicare Part D deductible, co-payments and coverage gap. Those seniors on Medicaid are not eligible for the program. In limited situations, seniors without Medicare Part D or other coverage may be eligible for EPIC.

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EPIC has two different types of plans for payment. The Fee Plan is for seniors with income no higher than $20,000 if they are single and $26,000 if married. With the Fee Plan, seniors pay an annual fee (ranging from $8 to $300, depending on income and marital status) as well as the EPIC co-payment for each prescription (ranging from $3 to $20 depending on the cost of the medicine). EPIC pays any deductible or co-payment required by the Part D drug plan.

The Deductible Plan is for seniors with slightly higher incomes (from $20,001 to $35,000 if single, or $26,001 to $50,000 if married). Instead of an annual fee, seniors pay the full price for their prescriptions until their annual deductible is met (varies from $530 to $1,715 depending on income and marital status).

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EPIC automatically keeps track of how much is spent and notifies the enrollee when the deductible has been met. If the senior has Medicare Part D coverage, the EPIC deductible will be lowered by the average annual cost of a basic Part D plan.

"Some are here for a refresher course, while others are here just to see if anything is new," Wilkins said. "Either way, it helps you to get the right information."

EPIC also covers any gaps within coverage and offers an emergency three-day supply of medication if necessary.

For more information on the EPIC program, call (800) 332-3742 or download an application on their website

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