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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.
As a result
of changes in the New York State law early 2007, Epic members are
required, as of July 1, 2007, to enroll in the Medicare Part D program
(with exceptions noted below).
The supplemental insurance will continue to cover Medicare Part
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. In 2008 Epic will pay the
monthly Part D premium of Epic Fee Plan enrollees up to $24.18 per
month.
2.Epic Deductible Plan
enrollees in Medicare Part D will receive an annual credit towards
their Epic deductible equal to number of months enrolled at the
benchmark monthly premium amount ($24.18 during 2008)
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.
Epic also is
Creditable Coverage -- expected to pay, on average, at least as much as
the standard Medicare drug coverage.
Therefore, Epic members also had the second option of using
their Epic coverage as primary drug coverage – they did not have
to enroll in Medicare Part D.
This is no
longer true.
As a result of changes in the New York State law, access to Epic
as primary drug coverage is limited only to the groups in the following
sub paragraphs “…if their enrollment in Medicare Part D
would result in significant additional financial liability by the
participants…”
1. Medicare Advantage members
of a plan without Part D drug coverage whose “cost sharing would
be increased” if they enrolled in another plan with drug
coverage. Or the Medicare
Advantage plan member is not offered a Part D option without reducing
their current medical benefits.
2. 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.”
3. Another example of Epic
members incurring significant additional costs as a result of enrolling
in Medicare Part D is those in the (Epic) Deductible Plan who never
meet their Epic deductible because of low drug costs.
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 2008 coverage is Year 2007 income.
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.
As of July 1,
2007 Epic Deductible Plan enrollees in Medicare Part D will receive an
annual credit towards their Epic deductible equal to number of months
enrolled in the Epic coverage year at the monthly benchmark premium
amount ($24.18 during 2008)
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
4, 2008
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