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Residents in New York State have excellent supplemental coverage to
their Part D prescription drug plan (or other insurance plan, such as a
creditable employer/union retirement plan) -- the Elderly Pharmaceutical Insurance Coverage (EPIC) program (1-800-332-3742). Many states have similar
programs. Examples of such plans in states near New York are New Jersey
-- 1-800-792-9745, Connecticut -- 1-800-423-5026, Massachusetts --
1-800-243-4636 and Pennsylvania -- 1-800-225-7223.
There were a
number of changes in New York State Epic 2007, 2008 and 2009 regarding
mandatory enrollment of Epic members in Medicare Part D.
Epic members
are now required to enroll in the Medicare Part D program with
exceptions noted below:
1. Seniors without Medicare
2. Medicare Advantage members of a
plan without Part D drug coverage whose costs would be increased if
they enrolled in another plan with drug coverage.
3. Part D “enrollment would
result in the loss of any health coverage through a union or employer
plan for the participant, the participant’s spouse or other
dependent.”
The
supplemental insurance will continue to cover Medicare D plan’s
deductible, co-payments, gaps in coverage and non-covered drugs. In addition, the supplemental coverage
will now include the following cost saving benefits:
1. Epic pays the monthly Part D
premium of Epic Fee Plan enrollees up to $33.32 per month (2010
benchmark).
2. Epic Deductible Plan enrollees
in Medicare Part D will receive an annual credit towards their Epic
deductible, which is equal to number of months enrolled in Part D at
the benchmark monthly premium amount ($33.32 during 2010) – to
help them pay their Part D premium.
3. Epic is now able to provide
supplemental coverage for mail order drug purchases from approved
out-of-state pharmacies.
4. All Epic members have a SEP
(Special Enrollment Period) to switch Part D Plan – only one
change pr calendar year.
The mechanics
of coordinating your Medicare Part D drug plan (or other insurance
plan) and Epic are really simple.
Show both cards, advising the pharmacist that your Medicare Part
D drug plan (or other insurance plan) is your primary prescription
coverage and the charge for payment must be submitted to them
first. The balance due after the
first submission will be charged to Epic. If the balance is $25, you will have
to pay the co-payment of $7 and Epic will pay $18.
I urge all
New York State Medicare beneficiaries to consider the appropriateness
of including EPIC in their prescription drug coverage. But first you need to know whether
you qualify, so do read the following three paragraphs:
The EPIC
programs covers only persons 65 years of age and over (seniors) and the
Fee Plans cover single seniors with incomes up to $20,000 and married
couples with a joint (including under 65 year old spouses) income up to
$26,000. Single seniors with incomes between $20,001 and $35,000, and
married couples with incomes (including under 65 spouses) between
$26,001 and $50,000 can join the EPIC Deductible Plan. The eligible
income for Year 2010 coverage is Year 2009 income (or 2008 income if
2009 is not available.
The fees are
progressive, depending on income, with a maximum annual fee of $230 at
$19,001-$20,000 annual income for the single individual, and a maximum
annual fee of $300 per senior in the married couple category of
$25,001-$26,000 combined annual income.
The
Deductible Plans for single persons range from a deductible of $530 to
a maximum $1230 at $34,001-$35,000, and for those married, from $650 to
$1715 per senior in the married couple category of $49,001-$50,000
combined annual income.
The
co-payment schedule is based on the prescription cost -- from a $3
co-payment for a prescription cost up to $15 that increases progressively
to a maximum co-payment of $20 for each prescription costing over
$55. There is additional
bonus. If your co-payments
during your coverage year are over a specific amount, Epic will pay all
the prescription costs for the remainder of your coverage year.
Please click
on Medicare segment 03 for
further perspective about this excellent alternative prescription drug
coverage.
Updated: January 25, 2010
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