By: Ebey P. Soman<\/p>\n
–<\/p>\n
New York State\u2019s Elderly Pharmaceutical Insurance Coverage Program (EPIC) is a secondary prescription insurance program for over 280,000 income-eligible seniors aged 65 and older.\u00a0 The program supplements members\u2019 out-of-pocket Medicare Part D drug plan costs. \u00a0To be eligible, the senior must be a state resident with an annual income of less than $50,000 (if married) or less than $35,000 (if single). Up until December 31, 2011, these patients receive subsidized low-cost medication.\u00a0 The copayments ranged from $3.00 to $20, depending on the cost of the medication and the income category.<\/p>\n
On January 1, 2012, many seniors who were accustomed to the traditional EPIC coverage received an unexpected new year\u2019s \u201cgift.\u201d \u00a0Many patients found that the cost of their medications had increased.\u00a0 This was primarily due to the huge budget cuts and program changes that went into effect the beginning of this year.<\/p>\n
EPIC currently covers medication copayments when the member is in the \u201cdonut hole\u201d or the Medicare coverage gap. \u00a0The program also pays for medications excluded from Medicare Part D coverage, such as benzodiazepines and barbiturates.\u00a0 During this coverage gap period, the seniors will see their familiar $3, $7, $15, or $20 copayment amounts for their medications. \u00a0To obtain EPIC\u2019s benefits, patients must pay a deductible (up to $320) and exceed the Part D limit of $2,930 to fall into the coverage gap.<\/p>\n
Some patients had EPIC listed as their primary insurance, and pharmacies billed EPIC as a primary plan.\u00a0 This has also changed, as these members are now required to obtain Medicare Part D insurance. \u00a0Senior citizens who do not enroll in a Part D plan by the end of February (63 days after December 21, 2011) will receive a penalty in the form of an increased monthly premium. \u00a0On average, the monthly premium can increase by ><\/span>1% for each month that the patient does not enroll in a Medicare Part D plan.\u00a0 Additionally, patients will need to pay the increased premium rate after they obtain Part D coverage.<\/p>\n EPIC members have a Special Enrollment Period (SEP) to sign up for Medicare Part D.\u00a0 To avoid any penalties, they may contact EPIC and receive assistance in selecting the most appropriate plan. \u00a0EPIC members who wish to switch their Part D plans may do so only once during the 2012 year, with the exception of Medicare Advantage members (who must contact their plan to exercise this option). \u00a0Patients can obtain more information on this opportunity by calling the toll-free EPIC service number 1-800-332-3742 (TTY 1-800-290-9138) or the Spanish language service line by calling 1-800-332-3742.<\/p>\n SOURCES:<\/span><\/b><\/p>\n