Changes With Epic And Medicare Part D

David J. Valesky

May 31, 2007

The introduction of the Medicare Part D program left many seniors concerned about how this new benefit would affect their coverage under EPIC, New York's Elderly Pharmaceutical Insurance Coverage Program. When the plan was unveiled, I informed seniors that they did not have to choose between EPIC and Medicare Part D, but that the two programs work together.

This year, as part of the healthcare reform enacted in the budget, all EPIC enrollees will be required to enroll in Medicare Part D. The change affects about 25,000 seniors in Central New York. The State is mailing letters to EPIC enrollees explaining the new rules.

If you have EPIC and do not have Part D, EPIC will choose a plan that works with your health coverage and enroll you. EPIC will determine a plan based on drugs and pharmacies used. If you do not want the Part D plan EPIC has chosen, you must contact EPIC.

EPIC will pay the Medicare Part D premiums up to $24.45 -- the average cost of a Medicare drug plan in 2007 -- for those enrolled in the fee program, including those already enrolled in Medicare drug plans. Enrollees will continue to pay their quarterly EPIC fees. Seniors with low incomes who qualify for a full subsidy from Medicare will have their EPIC fees waived.

People enrolled in the EPIC deductible plan will be responsible for paying their own Part D premiums and will receive a credit of $24.45 per month toward their EPIC deductible. The result will be lower premiums and better coverage for many seniors across New York. The State will be saving money by shifting some prescription drug costs paid by EPIC to Medicare, saving an estimated $63 million a year.

There are some exceptions to the new Medicare Part D enrollment rules which could affect your coverage, so I encourage you to read your policy carefully. If you have questions on any senior program, you can contact your county’s Office for the Aging or EPIC at 1-800-332-3742.