What's New?

2014 Program Highlights

The 2014 EPIC program highlights flyer is now available. The document includes the 2014 EPIC Fee Plan Schedule and the Deductible Plan schedule.

Attention Members, Prescribers and Pharmacists - July 2012

There were articles in the July 2012 Medicaid Update for EPIC members, prescribers and pharmacy providers giving information regarding the upcoming 2013 program changes to EPIC coverage.

SFY 2012-2013 Key Points and Additional FAQs

Beginning January 1, 2013, Executive Budget Changes have restored the EPIC program with additional provisions. The frequently asked questions are listed in SFY 2012-2013 Key Points and Additional FAQs.

EPIC Eligibility Requirements

To join EPIC, a senior must:

  • be 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.

Note:

  1. You can join EPIC at any time during the year. Once enrolled, you will receive a 'Special Enrollment Period' to join a Medicare Part D drug plan. You are not eligible to receive EPIC benefits until you are enrolled in a Part D drug plan.
  2. Seniors who are not eligible to join a Medicare Part D drug plan cannot join EPIC (e.g., seniors with a union/retiree drug subsidy program that is not a Part D plan, seniors without Medicare Part A or Medicare Part B).
  3. Seniors with Medicare Advantage (HMO) health insurance can only join EPIC if they have Part D drug coverage with their HMO.

Residency

To enroll in EPIC, you must be a resident of New York State. This means that your permanent home (not a summer or winter home) is located in New York State. It also means you live in the State on a regular, ongoing basis, and your New York State address is listed as your home address on official and legal documents. You need to notify EPIC whenever you change your address.

Income

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.