The EPIC Program for New York Seniors

EPIC Program for New York Seniors

The Elderly Pharmaceutical Insurance Coverage (EPIC) program is quite similar to Medicare Supplement Insurance plan. The difference is that while Supplement Plans offer coverage for Part A and Part B of Original Medicare, EPIC offers extra coverage to those who can’t cover medication costs through Part D of Medicare. In some cases it also covers some degree of premium to be paid for Part D.

It must be noted that the EPIC program is only applicable for senior citizens in New York and no one else.

Eligibility Criteria

Eligibility Criteria

The government of New York has set out conditions that individuals must meet before they can qualify for EPIC. These conditions are:

  • You must be a citizen of New York and be 65 years old or older
  • Must have an annual income of $75,000 if single and $100,000 if married
  • You must be enrolled in or eligible to be enrolled in Part D of Medicare
  • You must not be receiving full Medicaid Benefits

Types of Epic Plans

Types of Epic Plans

There are two types of EPIC plans that senior citizens can opt for.  The one characteristic common to either of these is that they only apply once all Part D payments have been met.  EPIC is not applicable on members who have yet to cover their Part D deductibles.

The two types of plans have been decided based on the income levels of the applicants and as such have different payment schemes that differentiate the two. Each plan also covers up to $39.33 in Part D premiums. The two types of EPIC plans for Senior citizens are:

  • EPIC Fee Plan
  • EPIC Deductible Plan

EPIC Fee Plan

The plan is specified as follows:

  • Applicable to individuals making $20,000 annually if single or $26,000 if married
  • Members are required to pay annual fees from $8 to $300
  • The fees can be paid in quarterly installment or the full amounts at the end of the year
  • The copayments for the plan range from $3 to $20, depending on the cost that is not covered by Part D. If your Part D coverage by 10$, then EPIC will pay some part and you will be required to pay some part of the medication.

EPIC Deductibles Plan

The deductible plan has the following conditions:

  • The plan applies to individuals who make $20,001 to $75,000 per year if single or between $26,001 and $100,000 a year if they are married
  • The members are required to pay the EPIC annual deductibles, before any copayments can be made.  For example, before EPIC starts covering some part of your medication costs, you must pay them a fixed amount before they can do so
  • This plan covers the Part D premium if and only ifyou make $20,000–$23,000 annually if single or between $26,001–$29,000 if married
  • Co-payments range between $3 and $20

Pick out any of the two payment plans depending on whether you meet the eligibility criteria and your financial requirements. With a combination of health plans working for you in addition to Medicare, you stand to save a lot on your medical expenditures.

Seniors for Medicare are licensed Medicare Advisors in New York and New Jersey. We help our clients reduce the financial burdens from their healthcare to enable a better life.

Get in touch with our Medicare healthcare plan consultants at 1-800-276-1753 for the best advice on the ideal medicare plans in NY for yourself.

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