EPIC Providing Clients With Expanded Coverage

On Jan. 1, the Elderly Pharmaceutical Insurance Coverage Program changed back to a fee and deductible program and is providing clients with expanded prescription coverage. All members must be enrolled in a Medicare Part D drug plan to receive EPIC benefits. There are no exceptions. Enrollees in EPIC must be New York State residents, 65 years of age or older and have annual incomes of $35,000 (if single) and $50,000 (if married).

Please note the following information regarding EPIC billing:

Bills for EPIC Fee Plan members were mailed in early December. Second notice bills were mailed at the end of December. To date, approximately 10 percent of these members have still not paid their EPIC fee. A final bill is being mailed this week with a notice explaining that EPIC coverage ended on Feb. 11 if payment was not received. This means that EPIC will no longer pay the Medicare Part D drug plan premium or provide secondary coverage of claims after Feb. 11.

If a member missed the Feb. 11 due date for payment, they should call the EPIC Helpline at 1-800-332-3742. Coverage will not be reinstated until payment is received but notification will expedite processing of the payment.

Listed below are more details regarding the EPIC program:

EPIC provides secondary coverage for Med D and EPIC covered drugs purchased after the Part D deductible, if any, is met.

EPIC covers many Part D excluded drugs such as prescription vitamins and prescription cough and cold preparations.

EPIC co-payments continue to be $3, $7, $15 or $20 based on the cost of the drug.

EPIC will pay the Medicare Part D premiums for members with income up to $23,000 or less (single) and $29,000 or less (married).

EPIC pays the Medicare Part D monthly premiums up to $43.22 per month in 2013.

EPIC members receive a Special Enrollment Period (SEP) that enables them to join Part D or make a change in their Medicare Part D coverage outside the Annual Enrollment Period.

Members with Full Extra Help have their EPIC fees waived.