The following is based on information from the New York State Department of Health and is being provided as a courtesy. We are not affilliated or directly endorsed by the NY State EPIC program Elderly Pharmaceutical Insurance Coverage (EPIC) Program EPIC is a New York State sponsored prescription plan for senior citizens who need help paying for their prescriptions. Over 350,000 seniors already belong to and are saving, on average, over 80% of the cost of their medicine.
ELIGIBILITY REQUIREMENTS New York State residents can join EPIC if they are 65 or older, and have an annual income of $35,000 or less if single, or $50,000 or less if married. Seniors who receive full Medicaid benefits are not eligible for EPIC Seniors with other prescription coverage through Medicare or most other plans can join EPIC to cover drug costs not covered by the other coverage.
HOW EPIC WORKS EPIC is a cost sharing program. Seniors with moderate incomes pay a low quarterly fee, and participate in the Fee Plan. Seniors with higher incomes meet an annual deductible, and participate in the Deductible Plan. Those who pay a fee or meet their deductible make a copayment at the pharmacy when purchasing prescriptions. For more detailed information on how EPIC works visit the New York State Department Of Health website.
FREE PLAN Single seniors with income up to $20,000 and married seniors with income up to $26,000 are eligible for the Fee Plan; the cost to join this plan is based on annual income. Seniors may pay their annual fee in quarterly installments. DUDUCTABLE PLAN The Deductible plan is available to single seniors with income between $20,001 and $35,000, and married seniors with income between $26,001 and $50,000. This plan is designed to help seniors with high drug costs. There is no fee to join the Deductible Plan. Those enrolled pay full price for their prescriptions until they meet an annual deductible which is also based on income. There is no need to send in receipts; EPIC automatically keeps track of how much deductible enrollees have spent at the pharmacy. After the deductible is met, these enrollees save more than half of their prescription costs for the rest of the year.
COPAYMENTS (approximate) At the pharmacy, those enrolled in the Fee Plan and those enrolled in the Deductible Plan who have met their annual deductible show their EPIC cards, and...
For Each Prescription Costing Enrollees Pay Up to $15............$3 $15.01 to $35....$7 $35.01 to $55....$15 Over $55.............$20
WHICH DRUGS ARE COVERED? Almost all prescription medicines are covered, as well as insulin, and insulin syringes and needles. Both brand name and less expensive generic drugs are included. Enrollees can buy up to 100 tablets, or a 30-day supply at a time.
PHARMACIES Most pharmacies in New York State are enrolled as EPIC providers, allowing seniors full access to EPIC benefits. However, EPIC cannot be used at pharmacies located outside of New York State. When traveling outside New York State, enrollees should ensure they have an adequate supply of their medications with them. They can also make arrangements with their pharmacy in New York to have their prescriptions mailed or delivered to them on a short-term basis or in emergency situations.
HOW CAN EPIC BE USED WITH OTHER PRESCRIPTION DRUG COVERAGE? EPIC can be used with other prescription coverage for greater benefits and savings. When purchasing prescription drugs, the enrollee should show both of their cards at the pharmacy. EPIC covers any drug costs that are not covered by the other prescription coverage, except the EPIC co-payment on that amount. This results in the lowest possible co-payment, and is often lower than using only EPIC or the other coverage alone.
For example, if an EPIC enrollee also has other prescription drug coverage that requires a $25 co-payment on a brand-name drug that costs $100, the $25 co-payment will be covered by EPIC and the enrollee would pay only a $7 EPIC co-payment. In this example, if the senior did not use EPIC, they would have paid $25. If they used EPIC alone, they would have paid a $20 EPIC co-payment. By using both plans together, they paid a much lower co-payment! For more detailed information you can visit our links page and go to the official NY State EPIC website. Or you can fill out the form on this page, click submit and we will help you.
This is a proprietary website. and is not, associated, endorsed or authorized by the Social Security Administration, the Department of Health and Human Services or the Center for Medicare and Medicaid Services. This site contains decision-support content and information about Medicare, services related to Medicare and services for people with Medicare. If you would like to find more information about the Medicare program please visit the Official U.S. Government Site for People with Medicare located at medicare.gov
We are in no way affilliated or compensated by New York State or the EPIC program. If you need further help or have health insurance questions call and If we can answer any questions we will, or we will direct you to the proper agency. You can be sure to get a response in a timely manner. There are other programs also available to those who qualify.