Important News About Coverage Changes

EPIC New York State Senior Prescription Plan
P.O. Box 15018
Albany, NY 12212-5018

August 2011

Dear EPIC Member:

On January 1, 2012, the Elderly Pharmaceutical Insurance Coverage (EPIC) program will change. EPIC will only provide drug coverage for prescription drugs while you are in your Medicare Part D coverage gap (donut hole). Until you reach your coverage gap, you will need to pay the price charged by your Part D plan for your drugs. EPIC assistance will begin once you reach your coverage gap. EPIC co-payments will be $3-$20 depending on the cost of the drug.

In order to receive EPIC benefits while in the coverage gap, all members must have Medicare Part D. There are no exceptions. If you are not enrolled in a Part D plan you will not receive EPIC assistance. Since EPIC is no longer covering drugs before you reach your coverage gap, it is very important that you re-examine your Medicare Part D plan. You should make sure it covers all your drugs at the lowest possible price, especially the most expensive drugs you are taking. For assistance in selecting a Part D plan you can consult your pharmacist or contact your local Office for the Aging to talk with a counselor.

EPIC will pay Medicare Part D premiums, up to the amount of a basic plan, for all members with annual income below $23,000 if single and $29,000 if married. EPIC members with higher incomes will be responsible for paying their own Medicare Part D premiums. Under the new EPIC program, there will no longer be EPIC fees or deductibles.

See the reverse side for a summary of benefits. Also, enclosed is a copy of the notice of non-creditable coverage. If you have any questions about these changes, call the EPIC Helpline at 1-800-332-3742 Monday through Friday from 8:30AM to 5:00PM.


Alan D. Ball

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

New EPIC Program Beginning January 1, 2012
Part D StageMedicare Part D Drug Plan CostsEPIC Member PaysEPIC Program Pays
1Medicare Deductible — $0 to $320EPIC member pays 100% of the cost of Part D plan covered drugs if the plan has a Part D deductible.No EPIC coverage
2Initial Coverage — total drug cost* up to $2,930EPIC member pays all of the Part D plan co-payments or co-insurance for Part D plan covered drugs based on drug tier.No EPIC coverage
3Part D Coverage Gap — total drug cost* between $2,930 and $6,657.50EPIC member pays $3 - $20 EPIC co-payment based on cost of drug for Part D covered drugs and Part D excluded drugs (e.g. anti-anxiety or anti-seizure drugs) purchased in the Part D coverage gap.EPIC pays for Medicare Part D covered drugs and Medicare Part D excluded drugs purchased in the Part D coverage gap.
4Catastrophic Coverage — total drug cost* greater than $6,657.50EPIC member pays 5% of the cost of Part D covered drugs.No EPIC coverage
Member not enrolled in Part DEPIC member pays 100% of cost of drugs; no Part D coverage; may incur penaltyNo EPIC coverage

*Total drug cost is cost of drug paid by Part D plan plus member co-payments or co-insurance.

  • EPIC program is Free — no fees or deductibles
  • Must be enrolled in Medicare Part D drug plan to receive EPIC benefits
  • EPIC pays the Medicare Part D plan premium up to the basic amount for members with income up to $23,000 single or $29,000 married
  • EPIC pays the Medicare Part D plan premium for members with Extra Help