EPIC General Frequently Asked Questions

Can I qualify for EPIC if I am on Medicare disability and not yet 65 years of age?

You must meet the eligibility requirements for the EPIC program:

  • be 65 years old or older,
  • be a New York State Resident, and
  • have income up to $75,000 for a single person or up to $100,000 for a married couple living together.

Please contact your local Office for The Aging to inquire about other available programs for assistance.

Can I submit an EPIC application online?

You can only mail or fax your application.

Can I email an EPIC application?

Please mail or fax an EPIC application to:

EPIC
P.O. Box 15018
Albany, NY 12212-5018

Fax Number: (518) 452-3576

What is considered income?

EPIC looks at your previous calendar year's income, including your Social Security and total gross income. Examples of income include, but are not limited to: Pensions, Annuities/IRA Distribution (what was withdrawn - not the account balances), Interest and Dividends, Business Income or Losses, Net Rental Income, Unemployment, Wages, Alimony, Capital Gains, Farm Income and Other Income (Gambling, Lottery, Bingo).

What income does EPIC use on the Federal Tax Return to determine eligibility?

Your total adjusted gross income (including your Social Security income less Medicare Part B premiums) is used to determine EPIC eligibility.

Why doesn't EPIC use current income for eligibility determination if my previous year income was over the limit?

According to EPIC Elder Law, income eligibility is determined by the previous year annual income.

How to determine if I am enrolled in the Deductible plan?

You will receive a renewal determination letter that will indicate your annual EPIC deductible limit for the new calendar year. If your annual income for the previous calendar year has changed, you can send proof of income documentation to:

EPIC
P.O. Box 15018
Albany, NY 12203

How to determine if I am enrolled in the Fee plan?

You will receive a billing notice along with an EPIC program benefit letter. Please review the Billing FAQ for additional information. If your annual income for the previous calendar year has changed, you can send proof of income documentation to:

EPIC
P.O. Box 15018
Albany, NY 12203

Can I pay my EPIC bill online or by phone?

Payment can be mailed to:

State of NY Health Department
PO Box 70228
Philadelphia, PA 19176-0228

(Please list your EPIC Identification Number on the check, money order, or bank check.)

When do I receive a new identification card?

EPIC issues an identification card which is valid for the length of your enrollment in the program. If you need a replacement card, please contact the EPIC Helpline at 1-800-332-3742 (TTY 1-800-290-9138) then press option "2" for assistance.

Do I have to fill out Pages 2 and 3 of the application (formerly the Request for Additional Information) if I do not qualify for the assistance?

If you do not qualify for Extra Help benefits you will need to provide proof of your Extra Help determination letter from Social Security Administration (SSA). Otherwise, you will need to complete pages 2 and 3 of the application (or the RFAI form) to continue your EPIC membership. If you have questions, please contact the EPIC Helpline (800-332-3742).

How to determine if I am eligible for Medicare Part D premium assistance?

Your renewal determination letter will indicate whether you are eligible for Medicare Part D premium assistance.

If Medicare Part D covers a drug will EPIC provide coverage?

EPIC provides secondary coverage for prescriptions listed on your Medicare Part D plan's formulary and the prescriptions in which the drug manufacturer participates in the State Rebate Program. EPIC also covers approved Part D-excluded drugs such prescription vitamins as well as prescription cough and cold preparations once a member is enrolled in a Part D drug plan.

What do I do if my pharmacy has not submitted all claims purchased to EPIC for coverage?

A pharmacy can re-bill any claim(s) within 365 days that were not previously submitted to EPIC. Please have your pharmacy provider contact the EPIC Provider line (800-634-1340) for further assistance.

Do I have to re-enroll in EPIC each year?

EPIC will notify you by mail when you are required to renew your EPIC coverage.