What's New?

2013 Program Changes

The 2013 EPIC program changes flyer is available. The document includes the 2013 EPIC Fee Plan and Deductible Plan schedules.

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 2013 Program Changes

Beginning January 1, 2013, many EPIC program benefits will be restored and some additional changes will be made. Members received a letter in August notifying them of the program changes along with a Renewal Form that they must complete, sign and return to EPIC in an enclosed postage paid envelope.

EPIC Program:

  • Members must be enrolled in a Medicare Part D drug plan to receive EPIC benefits.
  • Provides secondary coverage for Medicare Part D and EPIC covered drugs purchased after the Part D deductible, if any, is met.
  • Covers many Part D excluded drugs.
  • EPIC co-payments continue to be $3, $7, $15 or $20 based on the cost of the drug.
  • Provides Medicare Part D drug plan premium assistance for many members.
  • Fee and Deductible Plans are reinstated.

Fee Plan Members:

  • EPIC annual fees range from $8 - $300 based on the previous year's income.
  • EPIC pays the Part D monthly drug plan premiums up to the average cost of a basic Medicare drug plan, $43.22 per month in 2013.
  • Quarterly bills for EPIC fees will be mailed in early December 2012. Members with full Extra Help from Medicare will continue to have their EPIC fees waived.
  • Members will pay EPIC co-payments for Part D and EPIC covered drugs after the Part D deductible, if any, is met. Members will pay EPIC co-payments for Part D excluded drugs.

Deductible Plan Members:

  • EPIC deductibles range from $530 - $1,715 based on the previous year's income.
  • EPIC pays the monthly Part D drug plan premiums up to the average cost of a basic Part D drug plan for members with income up to $23,000 single or $29,000 married.
  • Members with higher incomes must pay their Medicare Part D premiums each month. Their EPIC deductible will be lowered by the annual cost of a basic Part D plan (approximately $519) to help them pay.
  • After a member meets their EPIC deductible, they will pay EPIC co-payments for covered drugs. Drug costs in the Part D deductible phase cannot be applied to the EPIC deductible.

Fee Plan:

The cost to join the Fee Plan is based on your previous year's income. You can pay your Annual Fee in total or pay a bill every three months. EPIC fees are waived for those with fill Extra Help from Medicare.

Single:
Who Pays PremiumAnnual IncomeAnnual Fee
EPIC pays Part D PremiumUp to $6,000$8
$ 6,001 - $ 7,000$16
$ 7,001 - $ 8,000$22
$ 8,001 - $ 9,000$28
$ 9,001 - $10,000$36
$10,001 - $11,000$40
$11,001 - $12,000$46
$12,001 - $13,000$54
$13,001 - $14,000$60
$14,001 - $15,000$80
$15,001 - $16,000$110
$16,001 - $17,000$140
$17,001 - $18,000$170
$18,001 - $19,000$200
$19,001 - $20,000$230
See Deductible PlanOver $20,000See Deductible Plan


Married:
Who Pays PremiumJoint Annual IncomeAnnual Fee
(Each Person)
EPIC pays Part D PremiumUp to $ 6,000$ 8
$ 6,001 - $ 7,000$12
$ 7,001 - $ 8,000$16
$ 8,001 - $ 9,000$20
$ 9,001 - $10,000$24
$10,001 - $11,000$28
$11,001 - $12,000$32
$12,001 - $13,000$36
$13,001 - $14,000$40
$14,001 - $15,000$40
$15,001 - $16,000$84
$16,001 - $17,000$106
$17,001 - $18,000$126
$18,001 - $19,000$150
$19,001 - $20,000$172
$20,001 - $21,000$194
$21,001 - $22,000$216
$22,001 - $23,000$238
$23,001 - $24,000$260
$24,001 - $25,000$275
$25,001 - $26,000$300
See Deductible PlanOver $26,000See Deductible Plan

Deductible Plan

There is no fee to join the Deductible Plan. You pay full price (Part D amount charged) for your drugs until you meet your Annual Deductible which is based on your previous year's income. EPIC tracks how much you spend. Drug costs in the Medicare Part D deductible phase cannot be applied to the EPIC deductible.

Single:
Who Pays PremiumAnnual IncomeAnnual Deductible
EPIC pays Part D PremiumUnder $20,000See Fee Plan
$20,001 - $21,000$530
$21,001 - $22,000$550
$22,001 - $23,000$580
Member pays their Part D
premium (shaded incomes).
EPIC Deductible shown is
lowered by approximately
$519 to help them pay.
$23,001 - $24,000$720
$24,001 - $25,000$750
$25,001 - $26,000$780
$26,001 - $27,000$810
$27,001 - $28,000$840
$28,001 - $29,000$870
$29,001 - $30,000$900
$30,001 - $31,000$930
$31,001 - $32,000$960
$32,001 - $33,000$1,160
$33,001 - $34,000$1,190
$34,001 - $35,000$1,230
Not EligibleOver $35,000Not Eligible


Married:
Who Pays PremiumJoint Annual IncomeAnnual Deductible
(Each Person)
EPIC pays Part D PremiumUnder $26,000See Fee Plan
$26,001 - $27,000$650
$27,001 - $28,000$675
$28,001 - $29,000$700
Member pays their Part D
premium (shaded incomes).
EPIC Deductible shown is
lowered by approximately
$519 to help them pay.
$29,001 - $30,000$725
$30,001 - $31,000$900
$31,001 - $32,000$930
$32,001 - $33,000$960
$33,001 - $34,000$990
$34,001 - $35,000$1,020
$35,001 - $36,000$1,050
$36,001 - $37,000$1,080
$37,001 - $38,000$1,110
$38,001 - $39,000$1,140
$39,001 - $40,000$1,170
$40,001 - $41,000$1,200
$41,001 - $42,000$1,230
$42,001 - $43,000$1,260
$43,001 - $44,000$1,290
$44,001 - $45,000$1,320
$45,001 - $46,000$1,575
$46,001 - $47,000$1,610
$47,001 - $48,000$1,645
$48,001 - $49,000$1,680
$49,001 - $50,000$1,715
Not EligibleOver $50,000Not Eligible

Questions? Call the EPIC Helpline at: 1-800-332-3742 (TTY 1-800-290-9138)

¿Necesita Ayuda? Llame al 1-800-332-3742

September 2012