What you need to know about changes in your EPIC coverage

How will these changes affect me?

New EPIC rules are effective July 1, 2007, so it’s important to know now how these changes might affect you or your loved ones.

  • All EPIC enrollees must join a Medicare Part D drug plan. For seniors who do not contact EPIC to choose a plan, EPIC will enroll them in the plan best suited to their coverage needs.

  • EPIC will cover drugs excluded by the Medicare Part D drug plan and all expenses that fall within the Medicare Part D coverage gap.

  • For seniors enrolled in the EPIC fee plan and Medicare Part D, EPIC will pay up to $24.45 for Part D premiums and reduce drug co-pays. Enrollees pay the EPIC fee (waived if they have full Extra Help) and a portion of every prescription filled.

  • Seniors enrolled in the EPIC deductible plan and Medicare Part D will pay reduced deductibles and drug co-pays. Enrollees pay the plan’s premium, the reduced deductible and a portion of every prescription filled.

Whether you’re enrolled in the fee or deductible plan, show your EPIC card at the pharmacy and the prescription prices will be adjusted to the following EPIC rates:

For each prescription costing You will pay
Up to $15.00 $3.00
$15.01–$35.00 $7.00
$35.01–$55.00 $15.00
Over $55.00 $20.00

EPIC exceptions might affect you

Some exceptions to the new EPIC rules include seniors who:

  • did not meet their EPIC deductible in previous years

  • would lose retiree health care coverage if enrolled in a Part D plan

  • have Medicare Advantage plans that do not offer a cost-effective Part D option without reducing other medical benefits

Important EPIC dates

Watch for these important dates, so you know when you’ll be affected by the new EPIC rules.

  • June 15–July 31: EPIC and Medicare Part D cards arrive in the mail.

  • June 20–July 31: Medicare Part D bills arrive in the mail, and you can choose from three different payment options, including automatic deduction from Social Security benefits, automatic checking account deduction, or direct billing.

  • July 1: You may start using both EPIC and Medicare prescription cards for all prescription drugs.

Watch for mailings from the New York State Department of Health that will further explain the changes you can expect.

To apply for EPIC or enroll in a Part D drug plan, please call the EPIC Hotline at 1-800-332-EPIC (3742) or the Office for the Aging in Oneida County at (315) 798-5456.

What is EPIC?

Elderly Pharmaceutical Insurance Coverage (EPIC) is a New York State-sponsored prescription plan for senior citizens that will help reduce the costs of their prescriptions.

  • Over 360,000 seniors already belong and are saving, on average, over 80% of the cost of their medications.

  • 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.

Assemblywoman Donna Lupardo

State Office Building • 17th Floor
44 Hawley Street • Binghamton, NY 13901
(607) 723-9047 • lupardod@assembly.state.ny.us