2007-06-22 / Community

Pheffer: EPIC Changes Help Seniors

Assemblywoman Audrey I. Pheffer has announced reconfiguration in New York's Elderly Pharmaceutical Insurance Coverage (EPIC) program in the 2007 state budget that will help reduce these costs so New York's seniors can afford their medicine and enjoy a healthy life.

"Seniors face increasing struggles to pay for needed prescription drugs as drug prices continue to skyrocket, especially when most live on fixed incomes," said Pheffer.

EPIC changes effective July 1, 2007

On July 1, 2007, new EPIC rules become effective. It's important to be aware of these new regulations, which may affect you and your family. Beginning July 1:

Everyone enrolled in EPIC must join a Medicare Part D drug plan. If seniors haven't already chosen a plan, EPIC will enroll them in one that works best for them, based on their drugs and the pharmacy they use.

EPIC will provide coverage for drugs not covered by the new Medicare Part D plan and for expenses falling within the Medicare Part D coverage gap.

For seniors enrolled in the EPIC fee plan and Part D, EPIC will pay up to $24.45 for the Part D premium. It will also reduce drug co-pays. You will pay the EPIC fee, which will be waived if you have full Extra Help (part of the EPIC plan), and a portion of the costs of every pharmacy.

For seniors enrolled in the EPIC deductible plan and Part D, EPIC will reduce the EPIC deductible and drug co-pays. You will pay the plan's premium, a reduced EPIC deductible and a portion of the costs of every pharmacy prescription. Show your EPIC card at the pharmacy, whether you are enrolled in the fee or deductible plan, and prescription prices will be adjusted to the following EPIC rates:

Prescription CostYour Cost

Up to $15.00$3.00

$15.01-$35.00$7.00

$35.01-$55.00$15.00

Over $55.00$20.00

EPIC Exceptions

Seniors who previously did not meet their EPIC deductible will not be required to join a Part D plan, nor will EPIC enrollees who would lose retiree health care coverage if enrolled in Part D. Seniors in Medicare Advantage plans that do not offer a cost-effective Part D option without reducing other medical benefits are also not required to join a Part D plan.

EPIC dates to note:

June 15-July: EPIC and Medicare Part D cards mailed.

June 20-July: Medicare Part D bills mailed, with three different payment options: automatic deduction from your monthly Social Security benefits; automatic monthly deduction from your checking account; or direct billing.

July 1: Begin using both EPIC and Medicare prescription cards for all prescription drugs.

EPIC will notify you about the changes that will affect your health care. In the meantime, for more information or to apply for EPIC, call the EPIC Hotline at 1-800-332-EPIC, extension 3742.

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