Senator Adams: Changes In Epic Means Seniors Save By Enrolling In Medicare Drug Program

Eric Adams

June 29, 2007

State Senator Eric Adams (D-Brooklyn) today announced that changes set to begin on July 1 in New York’s Elderly Pharmaceutical Insurance Coverage (EPIC) program represent a win-win situation for New York seniors. EPIC, a state-sponsored program to help seniors afford the high cost of prescription drugs, currently serves more than 360,000 New Yorkers.

"EPIC is by far one of our greatest success stories," Senator Adams said. "It’s hard to improve upon a program that helps seniors save, on average, over 80 percent of the costs of their prescriptions. But by also enrolling in a Medicare D prescription drug plan, EPIC members can expect to save an average of 95 percent on their drug costs – without losing any of their drug coverage."

Beginning July 1, most EPIC members will be required to join a Medicare D prescription drug plan to keep EPIC coverage. EPIC will automatically enroll members in a basic Medicare drug plan, based on the specific medicines and pharmacy they use. However, EPIC members are free to choose their own Part D drug plan. EPIC administrators are mailing letters to all EPIC enrollees to explain the new rules.

Some exceptions to the mandatory enrollment requirement will be made. For instance, EPIC members can opt out of joining a Medicare D drug plan if joining would hurt their health coverage or cause significant financial hardship.

"Many seniors have expressed concern about the upcoming changes," the Brooklyn lawmaker said. "They worry that by signing up for a Medicare plan, they’ll see reduced drug coverage or increased out-of-pocket costs. In fact, seniors can expect to see even greater savings when they combine the two prescription drug plans."

EPIC is a cost-sharing program. New York State residents can join if they are 65 years or older and have an annual income of $35,000 or less if single, or $50,000 or less if married. Seniors with moderate incomes pay a fee to join the program, known as the EPIC Fee Plan. Seniors with higher incomes meet an annual deductible, called the EPIC Deductible Plan.

Under the new rules:

For Fee Plan enrollees, EPIC will pay the Medicare Part D monthly premiums, up to $24.45 during 2007. Members will continue to pay their quarterly or annual EPIC fees unless they qualify for "Full Extra Help" under Medicare Part D, in which case their enrollment fee will be waived.

For Deductible Plan enrollees, seniors will receive a credit of $24.45 per month towards their EPIC deductible. They will be responsible for paying their own Part D premiums.

EPIC will provide additional coverage for drug costs not paid by Medicare D, such as deductibles and co-payments. It will also provide coverage for the gap that exists in many Medicare Part D plans.

EPIC is not changing its eligibility criteria or application process. Persons with questions about the EPIC program can call the State’s toll-free help line, available weekdays from 8:30 a.m. to 5:00 p.m., at 1-800-332-3742.

"The State is making this change to shift some of the costs for prescription drugs to Medicare, a federal program," Senator Adams concluded. "As a result, savings to the State are estimated at $63 million a year. But clearly, what matters most is that New York seniors can expect to see their out-of-pocket costs for prescription drugs go down."

For more information, interested seniors may call Senator Adams’s office at (718) 284-4700 for a free brochure.