Medicare is the main source of health insurance benefits for millions of senior citizens in America. Original Medicare is the primary government-supported health insurance program provided to most Americans when they turn 65 years old.
Given that prescription medications are taken daily by millions of Americans, they are usually among the most frequent and substantial costs within a medical budget. Having quality prescription drug benefits will substantially reduce your out-of-pocket costs for these necessities, enabling you to afford the drugs you need to remain healthy. Being able to pay for your medication means you won’t have to choose between taking your medicine or skipping it because you can’t afford it.
New York residents over 65 years old who are already enrolled in Medicare Part D can also enroll in a state-run program called the Elderly Pharmaceutical Insurance Coverage (EPIC) program to help them save more money on their prescription costs.
Learn more about Medicare Part D and EPIC below.
Medicare Part D
The primary Medicare prescription drug benefit is called Medicare Part D. This is specific prescription drug coverage that is provided by private insurers but still must meet standards set by federal Medicare regulations. Once you are enrolled in both Medicare Part A and Part B, you can add Part D benefits as supplementary coverage. While you will have to pay a premium for coverage, it will usually be a very affordable cost.
There are numerous Part D plans on the market, and though they must meet specific standards set by law, they can still differ based on the carrier that offers them. Each plan will offer different formularies, pricing tiers and cost-sharing options for all participants.
However, most Part D plans will cover the most-needed drugs for the majority of Americans. They will also offer a choice of drugs so patients can choose the one that best suits their needs. Your physician and insurer can work with you to select the most cost-effective drugs.
EPIC provides eligible New York seniors with cost savings on their prescription drugs and Medicare Part D premiums. Specifically, EPIC coverage kicks in after any Medicare Part D deductible is met to help covered individuals pay copays—and it also provides coverage for some Medicare Part D-excluded drugs.
There are two types of EPIC plans:
Fee Plans—With an EPIC Fee Plan, members pay an annual income-based fee for coverage. The drug copays under this plan range from $3 to $20, varying based on the drug’s cost. For Medicare enrollees that receive “Full Extra Help” from Medicare, EPIC fees are waived.
Deductible Plans—With an EPIC Deductible Plan, members must spend up to their annual income-based out-of-pocket deductible before EPIC coverage kicks in. Members are only responsible for drug copays.
Beyond drug coverage, EPIC may also provide premium assistance to qualified individuals making less than $23,000 or, if they’re married, $29,000. Members who make more than that amount are required to pay their Part D premiums but may have their EPIC deductibles lowered to the amount it costs to hold their Medicare Part D plan. In some areas, the EPIC deductible may be less than listed amounts.
It’s important to note that not everyone is eligible to enroll in EPIC. To be eligible to enroll, you must:
Be a resident of New York state
Be age 65 or older
Have an annual income up to $75,000 if single or $100,000 if married
Be enrolled or eligible to enroll in a Medicare Part D plan
If you meet the above requirements, you can apply to EPIC. Complete this application and report your income as well. Then, you’ll mail it to the address listed on the form. They’ll review your application, make a decision and notify you via mail. If you’re unhappy with the decision, you may submit a request for determination.
For more questions about EPIC or to request an application, call the EPIC helpline at 800-332-3742 (TTY 800-290-9138).
Don’t Wait Any Longer to Save
Our job is to help every client get the Medicare benefits that are best for them, which is why we’re committed to making sure your Medicare prescription benefits are right for you. By securing Medicare Part D and EPIC coverage, you can use the two plans to help keep your prescription drug costs low while still getting the medications you need.
We’re here to help you make sense of all your Medicare solutions. Come to us when you need assistance, and we’ll be by your side to get you the perfect coverage solutions. Contact us today at 516-319-2214 to learn more.