EPIC Medicare Part D Premium Assistance
EPIC will pay the Medicare Part D premium up to the benchmark amount of $42.27 in 2021 per month for members with incomes up to $23,000 if single or $29,000 if married. The benchmark amount is equivalent to the average cost of a Medicare Part D drug plan in New York State. It changes each year. If your Part D plan premium is higher than this amount, you are responsible to pay the difference each month.
If EPIC is paying your Part D premium and you currently have your premium deducted from your Social Security check, you must contact your Part D drug plan to stop the deduction.
If an EPIC member's income is above $23,000 if single or $29,000 if married then the member is required to pay their Part D premium each month. To help them pay, their EPIC deductible on the Deductible Plan schedule is further reduced by approximately $508, the annual cost of a benchmark Part D plan in 2021.
When a member is approved for the full Medicare Low Income Subsidy (LIS) from Extra Help from Medicare, the Medicare Savings Program, or a Medicaid Spenddown, EPIC will also provide additional premium assistance up to the benchmark amount of $42.27 in 2021 if Medicare does not cover the entire premium.
When a member is approved for Extra Help from Medicare with a partial (25%, 50%, or 75%) LIS, EPIC will provide additional premium assistance towards the member's Medicare Part D plan drug premium up to the benchmark amount of $42.27 per month in 2021.