Changes in EPIC coverage are effective July 1

Staff Writer
The Chronicle Express

The Fiscal Year 2011-2012 New York State Budget includes changes in the law that will affect seniors who are enrolled in both the Elderly Pharmaceutical Insurance Coverage (EPIC) program Deductible Plan and Medicare Part D.

Beginning July 1, EPIC will expand Part D premium assistance to include more members. EPIC will begin paying monthly Medicare drug plan premiums (up to $38.69/month) for all single deductible members with annual income up to $23,000 and for all married deductible members with annual income up to $29,000.  

If an EPIC member’s Part D premiums currently are being deducted from their Social Security check, the member will need to call their Part D plan as soon as possible to cancel these deductions if their income falls within these limits.

Deductible members with income above the new limits must continue to pay their monthly Part D premiums.

Additionally, the EPIC deductible credit (up to $464) that was applied annually to offset Medicare drug plan premiums will be eliminated and deductibles will be raised for all those in the deductible plan who have Part D.

Members who met their EPIC deductible before July 1, 2011 will be required to meet an additional $464 before they can resume paying only EPIC co-payments.  

There are no changes to the EPIC co-payments once the new EPIC deductible is reached and they will remain between $3 and $20 depending on the cost of the prescription.

As always, prescription drugs must be covered first by a Part D plan. However, there is an exception. Primary coverage for the Medicare Part D excluded drugs, such as benzodiazepines and barbiturates, will remain the same through Dec. 31, 2011. EPIC eligibility requirements also are unchanged.

All EPIC members affected by these changes are being notified. If there are any questions EPIC members and the general public should call the toll-free Helpline at 1-800-332-3742 or Jeff Angell, Aging Services Coordinator, ProAction Yates Office for the Aging, 315-536-5515.  

Another change in the law, whereby the EPIC program will transition to a Medicare Part D coverage gap benefit only, will take effect on Jan. 1, 2012. All EPIC members and partners will be notified of the details before they are implemented.