New York State EPIC Program

Late Enrollment Penalty(LEP) Assistance Changes Effective 10/1/19

  • Document is also available in Portable Document Format (PDF)
July 30, 2019


  1. Background
  2. LEP Changes & Timeline
  3. Q &A


  • The Late Enrollment Penalty (LEP) is an amount added to the Medicare Part D premium when the member did not enroll in a Part D plan, or have creditable coverage when first eligible.
  • The cost of the late enrollment penalty depends on how long the member went without Medicare Part D or creditable prescription drug coverage.
  • The Medicare Part D monthly premium, plus the LEP payment, cannot exceed the monthly Benchmark amount & the member is responsible for any remaining balance over the Benchmark amount.
  • EPIC´s financial assistance for LEPs was intended to support members through the Medicare Part D implementation and transition period.
  • Awareness of LEP support is typically through EPIC outreach activities and/or the member´s interaction with Part D plans, or individuals providing enrollment assistance such as HIICAP counselors or NY Connects staff.
  • Significant improvements to assure member awareness of enrollment requirements have been made, since the inception of Medicare Part D in 2006.
  • For 2018, EPIC paid LEPs for ˜1300 members at an annual cost of ˜$37.00 per member.
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LEP Changes – Effective 10/1/19

  • Existing EPIC members that have not had LEP assistance, and new EPIC members, will not be entitled to such assistance.
  • EPIC members that are currently being provided with LEP assistance will be “grandfathered” and will continue to get such assistance.
  • This change aligns with other historical EPIC changes that support Medicare Part D requirements and coverage parameters.

LEP Changes –Timeline

Step Target Date
Respond to stakeholder questions Ongoing
Webinar (if needed) for stakeholders with direct member contact (e.g. HIICAP Counselors, NY Connects Staff) By 8/15/19
Written Notices to Part D Plans & direct contact stakeholders (e.g. HIICAP Counselors, NY Connects Staff) 9/1/19
Go Live 10/1/19

Member Helpline:

  • 1–800–332–3742
  • (TTY 1–800–290–9138)



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