New EPIC Law Requires Medicare Part D Enrollment

Starting July 1, 2007, seniors with EPIC will have to join a Medicare Part D drug plan in order to keep their EPIC coverage. EPIC will help seniors pay the Part D premiums so that they will not incur any additional cost. EPIC will cover the Part D plan deductibles, co-payments, coverage gap, and drugs not covered by the Part D plan. By using Medicare Part D and EPIC together, seniors will save even more on their co-payments.

Many seniors are already using Medicare and EPIC together and saving more at the pharmacy on their co-payments. With this recent change, these seniors will save even more by EPIC covering the cost of their Part D premiums as described below. For those not yet enrolled in Medicare Part D, EPIC will help them select and enroll in a basic Part D plan at no additional cost – only savings.

EPIC Fee Plan Enrollees

Members of the EPIC Fee Plan will receive free Medicare coverage because EPIC will pay the monthly premiums (up to $24.45 a month, the average cost of a basic Medicare drug plan) for any Part D plan. These seniors will only pay their quarterly EPIC fee as they do now, except seniors receiving full Extra Help from Medicare will have their EPIC fee waived. By using Medicare and EPIC together the co-payments will be lower, bringing additional savings. Seniors receiving full Extra Help from Medicare will still have their EPIC fees waived.

EPIC Deductible Plan Enrollees

For seniors with the Deductible Plan, the EPIC deductible will be reduced by $24.45 for each month remaining in their EPIC coverage year, regardless of which Part D plan they join. The lower deductible will provide savings to offset the cost of the Medicare drug plan premiums which seniors will now be required to pay each month. The deductible will be lowered by the full year amount when their coverage is renewed.

Because Medicare deductibles are lower than EPIC deductibles, seniors should start saving sooner. All out-of-pocket prescription drug costs, including the Medicare deductible and co-payments will automatically be credited toward the new lower EPIC deductible. Once the EPIC deductible is met, the co-payments will be lower by using Medicare and EPIC together.

Seniors with low drug costs who never reach their EPIC deductible will not be required to join Part D, but will be offered the opportunity to receive a lower EPIC deductible by enrolling in a Medicare drug plan.

Enrollment in Part D Made Simple

EPIC will help seniors select and enroll in a basic Medicare drug plan that covers the most of their prescription drugs at their pharmacy. Starting in May, seniors will receive a letter with the name of the selected Part D plan and will have 30 days to contact EPIC if they prefer to join a different Medicare drug plan. Seniors in Medicare Advantage health plans will be enrolled in a Medicare Part D plan offered by their Medicare Advantage plan, but only if that plan does not affect their current health plan benefits.

Exceptions

There are limited situations where seniors would be negatively affected by and, therefore, will not be required to enroll in Medicare Part D. These are seniors who:

  • are not eligible or enrolled in Medicare Part A or Part B;
  • are in Medicare Advantage health plans that do not offer a Part D option without reducing their current medical benefits;
  • would lose, or their spouse or dependent would lose, retiree or union health coverage; or
  • would incur significant added costs if enrolled in Part D, such as seniors in the EPIC Deductible Plan who never meet their deductible because of low drug costs.

Using Medicare and EPIC Together at the Pharmacy

Once enrolled in a Medicare Part D drug plan, seniors will receive a new EPIC identification card to be used with their Medicare Part D card. Seniors should show both cards at the pharmacy, so their pharmacist knows to bill Medicare and then EPIC. This will ensure that seniors pay the lowest possible co-payments because EPIC will automatically be billed for drug costs not paid for by Medicare such as deductibles, co-payments, coinsurance, drugs not covered and gap coverage.

For example, an EPIC enrollee without Part D coverage would pay a $20 co-payment for a $100 drug. If that enrollee joins a Part D plan that requires a $25 co-payment for that drug, that $25 would be billed to EPIC and the senior would pay only a $7 EPIC co-payment and save $13.

Requirement to Apply for Extra Help Benefit from Medicare

The recent change in New York State law expands the existing requirement that seniors potentially eligible for full Extra Help with Medicare Part D supply EPIC with the information needed to apply on their behalf for the low-income subsidy. Now, seniors potentially eligible for partial Extra Help will also be required to apply for the subsidy with EPIC assistance.

  • EPIC enrollees potentially eligible for partial Extra Help (incomes up to 150 percent of the Federal Poverty Level) will automatically receive a Request for Additional Information (RFAI) form that must be completed and returned. EPIC will apply to the Social Security Administration (SSA) for the Extra Help benefit on their behalf.
  • If approved for full Extra Help, enrollees will receive free Medicare drug coverage and their EPIC fee will be waived. They will also save by paying much lower co-payments on drugs covered by their Part D plan: $2.15 for generics and $5.35 for brand drugs.
  • Enrollees approved for partial Extra Help will not pay any Medicare drug plan premiums and would only pay their EPIC enrollment fee. They also will save by paying lower co-payments.

Questions?

If you have any questions about the changes to the EPIC program, please call the toll-free EPIC Helpline at: 1-800-332-3742 (TTY 1-800-290-9138) between 8:30 am – 5:00 pm, Monday through Friday.

Necesita Ayuda? Llame 1-800-332-3742.