Seniors see EPIC changes

08/23/2011 3:44 AM |

Seniors on the New York State Elderly Pharmaceutical Insurance Coverage, or EPIC, have been experiencing some changes to the state health assistance program that an EPIC spokeswoman Riva Wilkins described as “not as bad as we think it is.”

But there are some more changes to come.

Ms. Wilkins told seniors at the Southold Human Resources Center last Friday that as of July 1, participants are now responsible for meeting up to an additional $464 toward their EPIC deductible figure before they can resume paying only EPIC co-payments. The EPIC co-payment for drugs averages between $3 and $20 per prescription.

Any senior who had met the previous deductible and was receiving prescriptions at the EPIC co-pay will now be required to pay an additional $464 out of pocket before EPIC coverage resumes.

Some 40 area residents attending the session took the information about increased costs in stride, with no questions or comments about why the changes are occurring.

EPIC will expand its assistance toward the Medicare Part D drug insurance premium, paying up to $38.69 per month for those whose incomes are up to $23,000 if single and up to $29,000 for a married people. Until July, the cutoff income figures for assistance were at $20,000 for singles and $26,000 for a married individuals.

In January, the fee-based program is being eliminated and all seniors eligible for EPIC will be subject to deductibles before their EPIC coverage provides any assistance.

That means that a very low income senior earning only $6,000 a year won’t have to pay an $8 annual fee to qualify for EPIC, but will have to spend money out of pocket before any EPIC benefits are offered. How much that deductible will be depends on a sliding scale.

Those who earned up to $20,000 a year have been paying a $230 annual fee. But in January, they will pay no fee, but have to meet an undisclosed deductible before they can received their prescriptions for a $3 to $20 co-pay.

Others with incomes of more than $20,000 already don’t pay an annual fee, but they have to reach a sliding scale of deductibles. For singles earning more than $20,000 and up to $35,000, the deductibles have ranged from $530 to $1,230 per year. For married people earning more than $26,000 and up to $50,000, the deductible range has been $650 to $1,715 per year.

Seniors who are eligible for EPIC must also be enrolled in a Medicare Part D prescription drug program they’re responsible for their own Part D co-pays. But once they reach the Medicare coverage gap where they have purchased $2,800 of prescriptions in a given year, they are in what is known as the donut hole. EPIC coverage will kick in only when a member reaches that coverage gap.
For low-income seniors who need further assistance in paying for their medications, EPIC will assist them in applying for Medicare’s Low Income Subsidy and Medicare Savings Programs that can help some to save on prescriptions.

For assistance in determining your EPIC eligibility, call 1-800-332-3742 or download an application in English or Spanish at or write EPIC at P.O. Box 15018, Albany, NY 12212-5018.

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