Paying For Healthcare

Elderly Pharmaceutical Insurance Coverage Program (EPIC)

EPIC is New York State's pharmaceutical prescription plan for older adults. Eligible individuals can save more than half the cost on most of their brand name or generic prescription drugs, including insulin and insulin syringes. There are two plans under EPIC: the Fee Plan and the Deductible Plan.

Fee Plan. Those who join the Fee Plan pay an annual fee based on their income and are entitled to purchase their prescriptions at the EPIC discount price immediately. You can join the Fee Plan if you are single and have an annual income of $20,000 or less, or if you are married and have a joint income of $26,000 or less.

Deductible Plan. There is no annual fee to join the Deductible Plan. Participants pay the full price of the prescription costs until the deductible has been reached. Once the deductible has been satisfied, their prescriptions can be filled at the EPIC co-payment cost for the rest of the enrollment year. You can join the Deductible Plan if you are single and have an annual income between $20,000 and $35,000, or if you are married and have a joint income between $26,000 and $50,000.

What are the eligibility requirements?
To be eligible for EPIC, you must be 65 years of age or older and a resident of New York State for at least six months. Those with full Medicaid benefits or prescription drug coverage of 70 % or more do not qualify for EPIC.

Are there income limits?
For 2004, there is an annual income limit of $35,000 for a single person and $50,000 for couples. There is no limit on the amount of resources, but the earned interest or dividends from savings, checking, etc., is counted as income.

Where can I apply for EPIC?
Application forms are available at participating pharmacies. You may also call EPIC at 1-800-332-3742.

What documents should I include with my application form?

  • Proof of age
  • Proof of residence

Proof of income is not required when submitting an application, although documentation may be required later