EPIC Fee Plan
The Fee Plan is for members with income up to $20,000 if single or $26,000 if married. Members pay an annual fee to EPIC ranging from $8 to $300 based on their prior year's income (see Fee Plan schedule). This fee is billed in quarterly installments or can be paid annually. After any Part D deductible is met, if the member has one, Fee Plan members only pay the EPIC co-payment for drugs. Co-payments range from $3 to $20 based on the drug cost not covered by Part D. An EPIC identification card is mailed to the member upon successful enrollment. This card is issued once and should be kept and used for subsequent years. The coverage year runs through December 31st each year.
EPIC pays the Medicare Part D plan premiums up to $38.90 per month in 2023 for members in the Fee plan.
This is how EPIC works for Fee Plan members:
- Show both your Medicare Part D drug plan and EPIC ID cards when you go to the pharmacy to purchase your drugs.
- Your Medicare Part D drug plan is your primary drug coverage and you must maintain enrollment in a Part D drug plan to receive EPIC benefits.
- EPIC provides secondary coverage for Medicare Part D- and EPIC-covered drugs after you meet your Medicare Part D-deductible if you have one.
- Once enrolled in a Medicare Part D drug plan, EPIC also covers approved Medicare Part D-excluded drugs such as prescription vitamins and prescription cough and cold preparations.
- You will only pay the EPIC co-payments ranging from $3 to $20 based on the cost of your drug.
- If you have the full Extra Help Low-Income Subsidy (LIS) from Medicare, you will not be required to pay any EPIC fees and your co-payments will be lower.