By Christina Finkle
You may have heard the word “EPIC” in your circle of friends or vaguely remember something about it from your parents having had it, but are unsure what it is all about.
The Elderly Pharmaceutical Insurance Coverage Program (EPIC) is offered through NYS to help you save money on your prescription costs by supplementing your Medicare Part D plan.
You must reside in NYS, be 65 or older, on a Medicare plan that includes Part D and your annual income below $75,000.00 if you are single, $100,000.00 if married. You also qualify if you are an eligible senior with a Medicaid spend down, but not receiving full Medicaid benefits.
There are two sides to EPIC. A fee side which includes incomes up to $20,000.00 annual for a single person and $26,000.00 for a married couple. The fee side of EPIC includes an annual fee determined by your income, which EPIC will break down into quarterly payments. The fee side gives those of lower incomes immediate assistance to afford their medications, limiting their co-pay for prescriptions to between $3.00 – $20.00. This is very beneficial if your meds are falling on a tier 3, 4, or 5 on your current plan. Being on the fee side also means EPIC will pay up to $39.75 per month towards the Part D premium of whatever plan you are on.
The deductible side of EPIC works a little differently. Based on your income, there will be a deductible you must meet before EPIC assistance kicks in. This is not additional money out of your pocket.
How it works is…
Whatever co-pay you pay for your prescriptions currently, your pharmacy will report it to EPIC. For example, you have a deductible on EPIC of $150.00. In February, you were prescribed 4 medications and the co-pays you had to pay according to your plan totaled $120.00. Your pharmacy reported what you spent out of pocket and now your deductible is $30.00. In March, you are still taking 2 of those medications. One has a copay of $42.00. OK, you have now finished meeting your deductible and EPIC is going to start assisting with your costs, lowering your co-pays significantly for the rest of the year.
I definitely suggest that if you fall onto the deductible side of EPIC, regardless of if you take any medications or not, please sign up. It will cost you nothing but it will give you an additional benefit of 1 special election period per year to change your plan outside of annual enrollment in case the need arises. If you are on the annual fee side of EPIC, please take time to consider if it will benefit you based on your current prescription costs.
You can enroll in EPIC at any time during the year, just know that if you have a deductible to meet, it runs on a calendar year. For more information you can call the EPIC helpline at 1-800-332-3742.