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New York State Pharmacy Assistance Programs

New York State Elderly Pharmaceutical Insurance Coverage (EPIC)



:: Eligiblity Requirements
:: Important Notes
:: Income (What to Include/Exclude)
:: Contact Information


Eligiblity Requirements

You must meet the following requirements:
  • You must be a New York State resident (permanent home address),
  • at least 65 years of age, and not receiving full Medicaid benefits.
  • You must have an annual income below $75,000 if single, or a combined annual income below $100,000 if married.
  • You must be enrolled or eligible to be enrolled in a Medicare Part D plan (no exceptions). Seniors enrolled in a Medicare Advantage (HMO) plan can only join EPIC if their HMO includes Medicare Part D coverage.

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Important Notes

EPIC provides secondary coverage for Medicare Part D and EPIC-covered drugs purchased after any Medicare Part D deductible is met. EPIC also covers approved Part D-excluded drugs once a member is enrolled in Part D.

EPIC helps pay the Medicare Part D drug plan premiums (up to the state LIS benchmark of $36.94 in 2015) 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. The Fee Plan is for members with income up to $20,000 if single or $26,000 if married. The Deductible Plan is for members with incomes ranging from $20,001 to $75,000 if single or $26,001 to $100,000 if married.

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Income (What to Include/Exclude)

For purposes of your EPIC enrollment, household gross income is the previous year's total annual income of the senior or married spouses. It includes, but is not limited to:

  • Federal adjusted gross household income as reported on your income tax return;
  • Social Security payments (less Medicare premiums);
  • Railroad retirement benefits;
  • The taxable amount of IRA distributions and retirement annuities;
  • Support money, including foster care support payments;
  • Supplemental Security income;
  • Tax-exempt interest;
  • Worker's compensation;
  • Gross amount of loss-of-time insurance;
  • Cash public assistance and relief, other than medical assistance for the needy;
  • Non-taxable strike benefits;
  • Veterans' disability pensions;
  • Lottery winnings.

It does not include:

  • Food stamps;
  • Medicare premiums;
  • Medicaid;
  • Scholarships;
  • Grants;
  • Surplus food;
  • Payments made to veterans under the federal Veterans' Dioxin and Radiation Exposure Compensations Standards Act (Agent Orange);
  • Payments made to individuals because of their status as victims of Nazi persecution.

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Contact Information

Phone: (800) 332-3742
Email: epic@health.state.ny.us

Address
EPIC,
P.O. Box 15018
Albany, NY 12212-5018

:: New York State Elderly Pharmaceutical Insurance Coverage (EPIC)
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