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What is EPIC?

EPIC is the Elderly Pharmaceutical Insurance Coverage program. It is a New York State program administered by the Department of Health. It offers financial assistance to Seniors age 65 and older to help cover out-of-pocket Medicare Part D drug costs. Seniors can apply any time of the year once they have Medicare Part D coverage or are eligible.

To enroll in EPIC, you must be a resident in New York State. This means that your permanent address is in NY on official and legal documents and you reside here on a regular, ongoing basis. You can qualify if you have an annual income less than $75,000 (2024) if single or $100,000 (2024) if married. If you are receiving Full Medicaid Benefits, this is not for you.

EPIC works together with your Medicare Part D Drug plan, which may be a stand alone plan or a plan included in your Medicare Advantage Plan. Depending on your income level, you may qualify for two different EPIC plans. The Fee Plan is for members with income up to $20,000 if single and $26,000 if married (2024) and the Deductible Plan is for members with income $20,001-$75,000 if single and $26,001 - $100,000 if married (2024).

EPIC may help pay towards Medicare Part D premiums up to $48.72 per month (2024) and may help reduce your drug copays, depending on your income level. EPIC may also cover approved Part D-excluded drugs such as prescription vitamins as well as cough and cold medicines. However, if your Part D plan has a deductible, you must pay that first. EPIC will not pay that for you. In addition, you may also have to pay an EPIC deductible, which is separate from your Part D Plan deductible.

Once approved, you show both your Part D Plan ID card and your EPIC ID card to a pharmacy that participates with both plans. It's easy to join with a simple application that can be mailed in or faxed. No documentation is required. EPIC verifies the information with the Social Security Administration and the New York State Department of Taxation and Finance.

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