EPIC (Elderly Pharmaceutical Insurance Coverage) is aNew York State-sponsored prescription plan for people over 65 who need help paying for their prescriptions. EPIC covers almost all prescription medicines, as well as insulin, and insulin syringes and needles. Both brand name and less expensive generic drugs are included.
- New prescriptions and refills;
- Insulin, insulin syringes and needles;
- Brand name and generic prescription drugs;
- Quantities up to your Part D plan's limits.
What is covered by Epic?
What Is Covered By EPIC. For Part D- and EPIC-covered drugs after any Medicare Part D deductible is met or approved Part D-excluded drugs, EPIC will cover: New prescriptions and refills; Insulin, insulin syringes and needles; Brand name and generic prescription drugs; Quantities up to your Part D plan's limits.
Does Epic cover Medicare Part D?
EPIC provides secondary coverage for Medicare Part D- and EPIC-covered drugs after any Part D deductible is met. EPIC also covers approved Part D-excluded drugs such prescription vitamins as well as prescription cough and cold preparations once a member is enrolled in a Part D drug plan.
What is the epic prescription drug program?
EPIC Prescription Drug Program Description: The Elderly Pharmaceutical Insurance Coverage Program, is a New York State program to help Senior Citizens, age 65 and over, pay for prescription drug costs, Application forms are available at most pharmacies or call EPIC at 1-800-332-3742
Will epic pay for Part D drug co-pays?
If Part D co-pay for a drug without EPIC is... EPIC will also pay for Part D excluded drugs in the coverage gap. Additionally, EPIC will help members enroll into the Part D Low Income Subsidy ("Extra Help") and Medicare Savings Programs.
What is epic medication?
The Elderly Pharmaceutical Insurance Coverage (EPIC) program is a New York State program for seniors administered by the Department of Health. It helps more than 325,000 income-eligible seniors aged 65 and older to supplement their out-of-pocket Medicare Part D drug plan costs.
Who qualifies for Epic in NY?
EPIC Eligibility Requirementsbe a New York State resident age 65 or older.have an annual income below $75,000 if single or $100,000 if married.be enrolled or eligible to be enrolled in a Medicare Part D plan (no exceptions), and.not be receiving full Medicaid benefits.
What is a drug plan's list of covered drugs called?
formularyA plan's list of covered drugs is called a “formulary,” and each plan has its own formulary.
Are all drugs covered under Part D?
Part D plans are required to cover all drugs in six so-called “protected” classes: immunosuppressants, antidepressants, antipsychotics, anticonvulsants, antiretrovirals, and antineoplastics.
What does NY epic cover?
Coverage Period EPIC provides secondary coverage for Medicare Part D- and EPIC-covered drugs after any Part D deductible is met. EPIC also covers approved Part D-excluded drugs such prescription vitamins as well as prescription cough and cold preparations once a member is enrolled in a Part D drug plan.
How does the EPIC program work?
The EPIC program provides prescription drug coverage (including coverage of insulin and insulin syringes) to qualifying seniors living in New York who either pay an annual fee or meet an annual deductible, and then pay a copayment for each prescription purchased at any participating pharmacy in New York (Table 1).
What type of medications are typically not covered on a formulary?
However, plans usually do not cover:Weight loss or weight gain drugs.Drugs for cosmetic purposes or hair growth.Fertility drugs.Drugs for sexual or erectile dysfunction.Over-the-counter drugs.
What are Tier 5 drugs?
Copayment Definitions for the Five-Tier FormulariesTier 1The prescription drug tier which consists of the lowest cost tier of prescription drugs, most are generic.Tier 5The prescription drug tier which consists of the highest-cost prescription drugs, most are specialty drugs.4 more rows
What is a Tier 3 drug list?
Tier 1: Least expensive drug options, often generic drugs. Tier 2: Higher price generic and lower-price brand-name drugs. Tier 3: Mainly higher price brand-name drugs. Tier 4: Highest cost prescription drugs.
What drugs are not covered by Medicare Part D?
Medicare does not cover:Drugs used to treat anorexia, weight loss, or weight gain. ... Fertility drugs.Drugs used for cosmetic purposes or hair growth. ... Drugs that are only for the relief of cold or cough symptoms.Drugs used to treat erectile dysfunction.More items...
Does Medicare pay for any drugs?
Medicare drug coverage helps pay for prescription drugs you need. Even if you don't take prescription drugs now, you should consider getting Medicare drug coverage. Medicare drug coverage is optional and is offered to everyone with Medicare.
Why are some medications not covered by insurance?
Why? Drugs are dropped from a formulary — as the list of medications covered by an insurance plan is called — if they're seldom used or if there are generic or more affordable options available. To get around these formulary changes and save on your next prescription, consider the following GoodRx-approved tips.
What is the New York prescription assistance program?
patient assistance programs which provide free prescription medications to people who have no insurance and qualify for their programs. New York City residents providing savings on both brand and generic medications, offering savings as high as 75%, with an average savings of 30%. free and low-cost prescription drugs.
What is Medicare Extra Help?
"Extra Help" is a Medicare program to help people with limited income and resources pay. Medicare drug coverage (Part D) Drug coverage (Part D) Extra coverage people with Medicare can choose to help lower costs of prescription drugs. Medicare-approved private plans offer this coverage.
How Much Does Part D cost in 2019?
around $41.21 per month2019 Medicare Part D premiums The average Part D plan premium in 2019 is around $41.21 per month, which is a 2 percent increase from the 2018 average premium. Part D plan premiums can also be subject to a Medicare IRMAA for higher income earners.
What is an epic in New York?
The Elderly Pharmaceutical Insurance Coverage (EPIC) program is a New York State program for seniors administered by the Department of Health. It helps more than 330,000 income-eligible seniors aged 65 and older to supplement their out-of-pocket Medicare Part D drug plan costs.
How much does EPIC pay for Medicare?
EPIC helps pay the Medicare Part D drug plan premiums for members with income up to $23,000 if single or $29,000 if married. Higher income members are required to pay their own Part D premiums but EPIC provides premium assistance by lowering their EPIC deductible. EPIC has two plans based on income.
Can seniors apply for EPIC?
Seniors can apply for EPIC at any time of the year and must be enrolled or eligible to be enrolled in a Medicare Part D drug plan to receive EPIC benefits and maintain coverage. EPIC provides secondary coverage for Medicare Part D and EPIC-covered drugs purchased after any Medicare Part D deductible is met.
What is EPIC benefit?
Your EPIC benefits are determined by whether you are eligible for the Fee plan or Deductible plan: EPIC Fee plan.
How much is the EPIC deductible?
Note: The EPIC deductible ranges from $530 to $3,215/year. The EPIC deductible is determined based on your income last year. Remember, EPIC works with your Part D plan to help you pay for your prescription drugs. You must have a Part D plan to have EPIC.
What is EPIC insurance?
EPIC (Elderly Pharmaceutical Insurance Coverage) is the New York State Pharmaceutical Assistance Program (SPAP) that helps older adults with Medicare pay for prescription drug costs. EPIC is available to New York State residents who:
How are EPIC benefits determined?
Your EPIC benefits are determined by whether you are eligible for the Fee plan or Deductible plan:
How much does EPIC cost?
You must pay an annual fee based on your income last year (fees range from $8 to $300). EPIC will mail you bills to pay this annual fee in quarterly installments (every three months). This fee is waived if you have Extra Help.
Does Part D deductible count toward EPIC?
The amount you pay toward your Part D deductible will not count toward your EPIC deductible. However, the out-of-pocket amounts you pay for covered drugs (copays, coinsurance) after you meet your Part D plan’s deductible will count toward your EPIC deductible.
Do you have to pay deductible for EPIC?
If your Part D plan requires you to meet a deductible, you must pay for it yourself. EPIC will not pay it for you. In addition to paying your Part D plan’s deductible (if you have one), you must also pay an EPIC deductible, which is separate from your Part D plan’s deductible.
How much is EPIC deductible?
The amount of the deductible ranges from $530 to $1,715, based on the household income. See Chart of Deductibles by Income.
When did EPIC benefits change?
Benefits were severely reduced in January 2012; but much of the original EPIC benefit is restored in January 2013. Effective April 1, 2014, income limits increased dramatically - for singles from $35,000 to $75,000 a year and for couples from $50,000 to $100,000/year, ...
What is the asset limit for EPIC 2020?
In 2020, EPIC released a more complicated application that had questions about ASSETS even though there is no asset limit for EPIC. They wanted the information so they could screen applicants to refer them to enroll in Extra Help. (Partial Extra Help has an income limit up to 150% FPL, which would qualify some people who are over income for any NYS Medicare Savings program for which highest income limit is 135% FPL.) But the added confusion of the new form and asking about assets would deter people from applying. With NYStatewide Senior Action Council advocacy, DOH agreed to continue accepting the old application form at least for now during COVID.
Does EPIC subsidize Part D?
Helps with cost sharing for Part D. Since 2013, EPIC will subsidize the Part D co-insurance year-round, AFTER the member has met the Part D plan's deductible, if any. With EPIC's help,.the member's Part D co-pay will be no higher than $20 per drug; EPIC will pick up the balance.
Does EPIC cover Part D?
Some EPIC members have plans which charge an annual Part D deductible. EPIC cannot cover the cost of the Part D deductible.
Is EPIC a fillable application?
However, EPIC's website has only the new a application. Here is the OLD applicatio n (fill-able version) that you can still use at least during the COVID emergency.
Applications -
- In 2020, EPIC released a more complicated application that had questions about ASSETS even though there is no asset limit for EPIC. They wanted the information so they could screen applicants to refer them to enroll in Extra Help. (Partial Extra Help has an income limit up to 150% FPL, which would qualify some people who are over income for any NYS Medicare Savings pro…
Eligibility
- Must be age 65 or older and a NYS resident.
- Income eligibility limit: Singles $75,000; Married couples $100,000/year (since 4/1/2014)
- No asset test.
- Must be enrolled in Medicare Part D.
Epic Helps in Three Ways
- 1) Part D premium assistance Pays cost of monthly Part D premiums (up to benchmark) Must have annual income at/below $23,000 year (single)/$29,000 (couple). 2) Coverage gap ("Doughnut Hole" )assistance Helps with cost sharing for Part D. Since 2013, EPIC will subsidize the Part D co-insurance year-round, AFTER the member has met the Part D plan's deductible, i…
Epic Has Two Tiers of Coverage
- 1) "Fee" program. Income eligibiilty threshold:$20,000 yearly/singles, $26,000/couples. Members are charged an annual fee on a sliding scale basis. Fee ranges from $8 to 300 and is waived for full "Extra Help" recipients. SEE CHART OF Fee Scale 2) "Deductible" program: Income eligibility threshold: $20,001-$75,000 yearly (single); $26,001-$100,000 ...