State Health, Office for the Aging: EPIC Program Continues to Provide Affordable Comprehensive Coverage

ALBANY, NY - June 7, 2007 - Department of Health Commissioner Richard F. Daines, M.D., and State Office for the Aging Director Michael J. Burgess want to let New York's senior citizens know that recent statutory changes to New York State's Elderly Pharmaceutical Insurance Coverage (EPIC) program will now save them even more because EPIC will be covering the cost of basic Medicare Part D coverage for participants to use in combination with their EPIC coverage. Seniors will not incur any additional cost to join Part D and, by using the two plans together, will actually save more at the pharmacy while having access to all the same drugs they currently do with EPIC.

"The federal Medicare Part D program offers an opportunity for New York to provide more affordable and comprehensive prescription drug coverage to seniors enrolled in the EPIC program. Both the Department of Health and the Office for the Aging are working closely with EPIC to ensure that seniors understand how they will be affected by the changes," said Dr. Daines. "It is important that seniors know they will not lose their EPIC coverage, and that EPIC will be covering those drug costs not paid for by Medicare."

Director Burgess added, "The requirement that EPIC enrollees join a Medicare Part D plan as part of their overall health care coverage does not mean that seniors will no longer benefit from EPIC membership. On the contrary, the federal Medicare Part D plans generally have deductibles, co-payments, and the infamous "donut hole" [the approximate $3,000 gap in coverage after Part D participants accumulate $2,400 in prescription drug costs], and EPIC provides coverage for these out-of-pocket expenses."

"The State Office for the Aging operates Health Insurance Information, Counseling and Assistance Programs (HIICAP) in every county of the State to help people identify and obtain the very best and most comprehensive coverage possible. Certainly, EPIC will continue to play an important role in providing that coverage."

Many EPIC seniors are already using EPIC and Medicare Part D drug coverage together to save on their prescriptions. As a result of the new legislation, seniors will now save even more because EPIC will help them pay the premiums for their Part D coverage.

Changes as of July 1st

  • All EPIC Enrollees - Will be required to join a Medicare Part D drug plan as a condition of EPIC eligibility. EPIC will help enrollees pay for Part D premiums so seniors will not be disadvantaged by this new requirement. EPIC will enroll seniors into a basic Medicare drug plan based on the drugs and pharmacy they use, or the senior can choose a plan on their own. (Medicare Advantage members will be enrolled in a plan offered by their HMO, if available.) EPIC will continue to provide wrap-around coverage for drug costs not paid for by Medicare drug plans such as deductibles, co-payments, coinsurance, drugs not covered and gap coverage. The Extra Help application requirement will be expanded to include enrollees potentially eligible for the partial subsidy.

  • Fee Plan Enrolles - EPIC will pay the Medicare Part D monthly premiums up to the benchmark amount ($24.45 during 2007) for all fee plan enrollees, including those already enrolled in Medicare drug plans. Enrollees will continue to pay their quarterly EPIC fees. However, those receiving full Extra Help from Medicare will continue to have their EPIC fees waived.

  • Deductible Plan Enrollees - Seniors enrolled in Medicare Part D will receive an annual credit toward their EPIC deductible equal to the benchmark premium amount (prorated based on the number of months remaining in their EPIC coverage year). Enrollees will be responsible for paying their own Part D premiums.

  • Exceptions - Seniors who will be disadvantaged by joining Part D are excluded. They include:

    1. Deductible enrollees who do not meet their EPIC deductible;
    2. Seniors in Medicare Advantage plans that do not offer a cost-effective Part D options without reducing other medical benefits; and
    3. Enrollees who would lose, or their dependents would lose, retiree health coverage by enrolling in Medicare Part D plans.

To make it easy for seniors, EPIC will facilitate the enrollment of EPIC enrollees into Part D effective July 1, 2007 by matching their recent drug utilization and pharmacy preference with benchmark plans. If they prefer, seniors can select a different plan. EPIC also will help Medicare Advantage (MA) seniors enroll in Part D, to the extent an appropriate option is available from their MA health plan that does not affect their other health benefits or costs.

These changes to the EPIC program were made as part of the State's 2007-2008 budget, with the changes authorized to take effect on July 1, 2007.

Seniors with questions about EPIC should call the Department of Health's EPIC Hotline at 1-800-332-3742 or visit For the State Office for the Aging, call the Health Insurance Information, Counseling and Assistance Programs Hotline at 1-800-701-0501.