EPIC Plans
Fee Plan
Single seniors with income up to $20,000 and married seniors with incomes up to $26,000 are eligible for the Fee Plan; the fee to join this plan varies depending on annual income. Seniors may pay their annual fee in quarterly installments. The current fee schedule is based on annual income.
Deductible Plan
The Deductible plan is available to single seniors with incomes between $20,001 and $35,000, and married seniors with incomes between $26,001 and $50,000. This plan is designed to help seniors with high drug costs. There is no fee to join the Deductible Plan. Those enrolled pay their own prescription costs (unless they have other coverage) until they meet an annual deductible which is also based on income. There is no need to send in receipts; EPIC automatically keeps track of how much Deductible Plan enrollees have spent at the pharmacy. After the deductible is met, these enrollees only pay the low EPIC co-payment for the rest of their coverage year.
Co-payments
At the pharmacy, Fee Plan and Deductible Plan seniors present both their EPIC and any other drug insurance cards, including Medicare Part D. The EPIC co-payment is based on the cost of the prescription remaining after being billed to the Part D or other drug plan. For seniors in the Fee Plan, EPIC will pay the deductible or co-payment required by their Part D or other drug plan, and the senior will only pay the EPIC co-payment. Seniors in the Deductible Plan will pay the deductible or co-payment required by their Part D or other drug plan, which is automatically credited toward their EPIC deductible. After the EPIC deductible is met, EPIC will pay the deductible or co-payment required by their other plan, and the senior will only pay the EPIC co-payment.
| Prescription Cost (after submitted to other insurance) |
EPIC Co-Payment |
|---|---|
| Up to $ 15 | $ 3 |
| $ 15.01 to $ 35 | $ 7 |
| $ 35.01 to $ 55 | $ 15 |
| Over $ 55 | $ 20 |