How to apply for EPIC — Elderly Pharmaceutical Insurance Coverage in New York

Who it's for

EPIC is a New York state program that helps more than 325,000 income-eligible seniors age 65+ supplement their out-of-pocket Medicare Part D drug costs. Two plans: (1) FEE PLAN for income up to $20,000 single / $26,000 married — modest annual fee, lowest copays; (2) DEDUCTIBLE PLAN for income $20,001-$75,000 single / $26,001-$100,000 married — meet annual deductible first. EPIC also helps pay Medicare Part D premiums for income up to $23,000 single / $29,000 married. Requires Medicare Part D enrollment (or eligibility). Cannot enroll in EPIC if on Medicaid. Apply at health.ny.gov/health_care/epic or by calling 800-332-3742.

What you'll need

• Proof of age 65+
• Proof of New York residency
• Proof of all household income
• Medicare Part D plan enrollment (or eligibility)
• Social Security card

Where to apply

What to say when you call

"Hello, I'm calling to ask about EPIC — Elderly Pharmaceutical Insurance Coverage. I'd like to know whether I may qualify, what documents I need, and whether I can apply online, by mail, by phone, or in person. I understand I may need proof of age 65+, proof of New York residency, proof of all household income — is anything else required? What is the best next step?"

Tip: have a pen ready, ask for the person's name, and write down any case or reference number they give you.

Step by step

1. Confirm you meet the basic requirements: you must be age 65 or older, live in New York State, be enrolled in Medicare Part D (or be eligible for it), and NOT be enrolled in Medicaid.
2. Gather your required documents: proof of age 65 or older, proof of New York residency, proof of all household income, your Medicare Part D plan enrollment information (or proof of eligibility), and your Social Security card.
3. Choose your application method: apply online through the New York State Department of Health EPIC Program website, or call the EPIC Program directly at 800-332-3742 to apply by phone.
4. Complete the application by providing your personal information, household income details, and Medicare Part D enrollment information, and submit all required documents.
5. Keep a copy of your completed application and any confirmation you receive for your records.

What to expect: After submitting your application, the New York State Department of Health EPIC Program will review your information and documents. Processing times vary, so contact the EPIC Program at 800-332-3742 if you have questions about your application status. If approved, you will be placed on either the Fee Plan or the Deductible Plan based on your household income. EPIC coverage must be renewed every year, so watch for renewal notices and respond promptly to avoid a gap in coverage. Note that EPIC is designed for seniors who are not on Medicaid — it is not compatible with Medicaid enrollment. EPIC has higher income limits than many other state prescription drug programs, so even middle-income seniors who may not qualify elsewhere are encouraged to apply.

Renewals

annual