Elderly Pharmaceutical Insurance Coverage Program (EPIC) Expansion

Effective January 1, 2001

Within the 2000-01 State budget, the EPIC program is expanded by increasing the income eligibility limits to $35,000 for single individuals and $50,000 for married couples. The added income levels are covered by a deductible plan, while a fee plan is maintained for the current income levels. In addition, enrollment fees, co-payments and co-payment maximums are lowered, and the co-payment schedule is reduced from five tiers to four. Participation in the program will increase to an estimated 215,000 seniors by fiscal year 2002-03, costing an additional $180 million when fully implemented. While these new benefits are not available until January 1, 2001, seniors may apply for the expanded EPIC program starting October 1, 2000.

Program Characteristics
Program Changes
Income Eligibility Limits Increase income eligibility limits from $18,500 to $35,000 for singles, and from $24,400 to $50,000 for married couples
Co-Pays Reduces co-pays by an average of 20 percent and simplifies the co-pay schedule from 5 tiers to 4.

Old co-pay Schedule
 
Cost of Drug Co-Pay
up to $8.00 3
$8.01 to $13.00 5
$13.01 to $23.00 7
$23.01 to $33.00 10
$33.01 and over 23
New Co-Pay Schedule
 
Cost of Drug Co-Pay
up to $15.00 3
$15.01 to $35.00 7
$35.01 to $55.00 15
$55.01 and over 20
Fees Reduces annual fees for current enrollees by an average of 20%
Co-pay Maximums Reduces co-pay maximums for current enrollees by an average of 5%
Deductibles New deductible schedule for expanded income levels ranges from 2.5% to 3.5% of participant income
Simplification of Program Structure Fee plan only for incomes of $0 to $20,000 for singles and $0 to $26,000 for married couples. Eliminates deductible option for low- income seniors. New deductible plan for incomes of $20,001 to $35,000 for singles and $26,001 to $50,000 for married couples.
Enrollment Enrollment will double to an estimated 215,000 participants by fiscal year 2002-03, when fully implemented.