What Is EPIC New York?

EPIC stands for Elderly Pharmaceutical Insurance Coverage. It is a New York State program administered by the Department of Health that helps income-eligible residents age 65 and older supplement their out-of-pocket Medicare Part D prescription drug costs.  You can apply for EPIC at any time during the year as long as you have Medicare Part D coverage — either through a standalone drug plan or a Medicare Advantage plan that includes prescription coverage.

Who Is Eligible?

To qualify for EPIC, you must be age 65 or older and:

• Be a permanent resident of New York State

• Have Medicare Part D coverage or be eligible for it

• Meet income guidelines:

Up to $75,000 annually for single individuals

Up to $100,000 annually for married couples

If you receive Full Medicaid benefits, EPIC would not apply because Medicaid already provides prescription drug coverage.

How EPIC Works With Medicare Part D

EPIC does not replace your Medicare drug plan. Instead, it works together with your existing Part D coverage to help lower costs.  Depending on income, members enroll in one of two EPIC options:

EPIC Fee Plan – Income up to $20,000 (single) or $26,000 (married)

EPIC Deductible Plan – Income $20,001–$75,000 (single) or $26,001–$100,000 (married)

What Help Does EPIC Provide?

EPIC may help by:

• Assisting with some Medicare Part D premiums

• Reducing prescription drug copays

• Helping during higher drug-cost periods

• Covering certain medications not normally included under Part D, such as some prescription vitamins and cough or cold medicines

If your Medicare Part D plan includes a deductible, that deductible must be satisfied first. EPIC does not pay the Part D deductible, and some members may also have a separate EPIC deductible depending on income level.

Using EPIC at the Pharmacy

Once enrolled, using EPIC is simple.

Just present:

• Your Medicare Part D plan ID card, and

• Your EPIC ID card

at a pharmacy that participates with both programs. The pharmacy coordinates the benefits automatically.

How to Apply

Enrollment is straightforward. Applications can be mailed, faxed or online, and no documentation is required when applying. Eligibility information is verified directly through the Social Security Administration and the New York State Department of Taxation and Finance.  You can apply at any time of the year — there is no limited enrollment period.

A Helpful Program Many People Overlook

Prescription costs are often viewed as an unavoidable expense in retirement, yet programs like EPIC exist specifically to provide additional support. Because it works quietly alongside Medicare Part D, many eligible seniors simply don’t realize it is available to them.

Taking a few minutes to learn about EPIC could lead to meaningful savings and greater peace of mind when it comes to medication costs.

Diane Andree - ABC Medicare Plans Broker

Helping you understand Medicare — one step at a time.

EPIC New York