Changes to EPIC Program Take Effect July 1

I know that many senior citizens are faced with tough choices as they try to cope with high cost-of-living expenses, property taxes, expensive prescription drugs and skyrocketing health care costs. Many New York seniors live on a fixed income. To help seniors keep money in their pockets the 2007 state budget made changes to New York's Elderly Pharmaceutical Insurance Coverage (EPIC) program so that it will continue to provide New York seniors access to affordable prescriptions.

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

  • All EPIC enrollees must join a Medicare Part D drug plan. If seniors do not contact EPIC to choose a Medicare drug plan, EPIC will enroll them in a plan that works best for them, based on the drugs and pharmacy they use.

  • EPIC will provide coverage for drugs not covered by the new drug plan and for expenses that fall within the Medicare Part D coverage gap.

  • For seniors enrolled in the EPIC fee plan and Part D, EPIC will pay up to $24.45 for your Part D premium in any plan and will also reduce your drug co-pays. You will pay the EPIC fee (waived if you have full Extra Help) and a portion of the cost of every prescription you fill at the pharmacy.

  • For seniors enrolled in the EPIC deductible plan and Part D, the changes initiated in the enacted budget will reduce your EPIC deductible and drug co-pays. You will pay the plan's premium, a reduced EPIC deductible and a portion of the cost of every prescription you fill at the pharmacy.

Whether you are 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
$35.00-$55.00 $15.00
Over $55.00 $20.00

It is important to note that seniors who did not meet their EPIC deductible in previous years will not be required to join a Part D plan, nor will EPIC enrollees who would lose retiree health care coverage if enrolled in a Part D plan. Seniors in Medicare Advantage plans that do not offer a cost-effective Part D option without reducing other medical benefits are also not required to join a Part D plan.

EPIC will be notifying you about the changes that are going to affect your health care regimen; watch for mailings that will explain the changes you can expect. In the meantime, if you want more information or you would like to apply for EPIC, please call the EPIC Hotline at 1-800-332-EPIC (3742). You may also contact the Office for the Aging in Onondaga County at (315) 435-2362 or the Medicare Rights Center at (800) 333-4114.