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
Agenda
Background
- 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.
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.
Member Helpline:
- 1-800-332-3742
- (TTY 1-800-290-9138)
Web: Elderly Pharmaceutical Insurance Coverage (EPIC) Program
Email: NYSEPICOutreach@primetheraputics.com
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