Senior Life Matters

Question; I have a Part D plan, but a friend told me they have EPIC which covers their medications. Can I have EPIC and a Part D Plan? What do you recommend?

Question; I have a Part D plan, but a friend told me they have EPIC which covers their medications. Can I have EPIC and a Part D Plan? What do you recommend?

Answer; New York State is a state that provides extra Prescription Drug Coverage for those who qualify. New York State’s program is called EPIC (Elderly Pharmaceutical Insurance Coverage). EPIC is available to any resident of New York State who is over age 65 and make less than $75,000 for an individual and $100,000 for a married couple. I have talked with many individuals and couples who meet these criteria. You can join EPIC at any time. EPIC is always open enrollment all the time. If you were denied EPIC in the past, but your situation is now different you can apply now. If you just turned 65 or are turning 65 soon you may apply after you are 65. I recommend filling out the application in advance of your birthday, but mailing it ON your birthday to EPIC. If EPIC receives your application prior to your actual 65th birthday, they will deny your application. This is because you are NOT 65. So hold onto it and mail it on your birthday and they will process it quickly and mail you your EPIC membership card.

You can find information on their website . The website has information about EPIC, and explains the coverage you will receive. You can print an application from the website, but the application must be completed on paper and mailed in.

Once you apply for EPIC and are approved, they send you information explaining your coverage level and our EPIC card. You must bring your EPIC card to show it to your pharmacy staff. EPIC cannot help pay for your medications if the pharmacy doesn’t have the card on file. EPIC is always secondary coverage for your Prescription Drugs. EPIC is not in replacement of Part D it is in addition to Part D. So all your medications must first be processed (billed) through your Part D plan, then those same medication co-pays are processed through your EPIC coverage.

EPIC has two levels of coverage. Most individuals/couples fall into the Deductible Plan. This is coverage that keeps track of your medication expenses at the pharmacy, and uses those expenses towards your deductible, If you reach your EPIC deductible, EPIC reduces the cost of your prescription drugs even more because EPIC pays part of the copays.

For those individuals/couples with the EPIC Fee Plan you pay a Quarterly or Annual Fee for enrollment in EPIC and EPIC helps to pay for your medications immediately. The level of coverage you have with EPIC is a sliding scale depending on your income. If your personal income is less than $21,000 yearly, EPIC will pay up to $36 of your Prescription Drug Plan Premium. If as a couple you make less than $29,000 EPIC will pay both of your Prescription Drug Plan Premiums up to $36.

This may sound complicated, but it really isn’t. You simply fill out the one page application for EPIC and EPIC determines where you fall and then informs you of your coverage situation and rules.

Your question though was more about whether you are allowed to have EPIC and Part D. The answer to that question is YES you can. Part D and EPIC are NOT competing insurances. Your Part D plan will always be primary and your EPIC will always be secondary. This combination of benefits saves you the most possible money on your prescription medications.

You do need to inform your Part D that you have EPIC. Sometimes this is done when you enroll in the Part D plan and this information is passed on from the pharmacy billing process. If you already have EPIC, as you look at your monthly statements sent to you from your Part D Provider, you notice they have a column illustrating what (Others) have paid on your prescription drugs. That ‘Others’ column may be your EPIC coverage. If you have met your EPIC deductible or if you are in the EPIC fee plan, your medications cost $3, $7, $15, or $20 per fill. You may have been paying much more than that and suddenly your costs go down meaning your EPIC benefit has begun. You are saving money on the cost of your medications.

If you are not sure ‘how’ your EPIC benefit works, call EPIC to ask some questions. If you want to apply for EPIC, visit their website anytime or call EPIC to get an application at 1-800-332-3742 during normal business hours. You can also get EPIC applications at most pharmacies in New York State.

Remember that when you call your Part D plan, that Plan is available to those with Medicare all over the United States. Your Part D plan might not know what EPIC is or how it works, so call EPIC directly with questions. Those Prescription Drug Plans that are available nationally are not great about understanding or explaining benefits available to those that live in New York State. Each state is a little bit different, but Part D is required coverage for those with Medicare in every state!

I recommend that you enroll in Medicare Part D AND EPIC. You have wrap around benefits for prescription drugs which saves you the most money possible. Be sure to show both insurance cards to your pharmacists. Neither insurance products save you money if the pharmacy doesn’t know you have them.

To contact Janell Sluga, GCMC with questions or concerns, please call 716-720-9797 or e-mail her at