Major changes have been implemented by the Elderly Pharmaceutical Insurance Coverage Program (EPIC) as of July 1, 2011 with additional changes becoming effective as of January 1, 2012.
The EPIC program is a New York State program that provides assistance in paying prescription drug expenses for seniors with an individual income of $35,000 and couples with a combined income of $50,000. Effective July 1, 2011, EPIC will no longer cover seniors who are not enrolled in a Medicare Part D prescription plan.
EPIC is comprised of two separate plans: The Deductible Program and the Fee Plan.
Prior to July 1, 2011, EPIC provided assistance in covering the cost of the Part D Medicare premiums to a maximum of $464 for the highest income EPIC enrollees of the Deductible Program. After July 1, 2011, EPIC will no longer cover these premiums and members in this program will have an increased deductible responsibility of $464.28 before EPIC copayments begin.
For members of the Deductible Program in the lower income levels, EPIC will pay the premium up to $464, and they will no longer have a deductible in 2012. Members in the Deductible Program who have their Part D premiums deducted from their Social Security income in addition to Part B premiums, must contact their Part D plan to discontinue this deduction should their incomes fall within $20,000- $23,000 for singles and for couples whose combined income is less than $29,000 per year.
For EPIC members under the Fee Plan assistance in paying the Part D premiums will continue for 2011 to the benchmark of $38.69 per month. Effective 2012, this assistance will be eliminated completely.
Effective January 1, 2012, EPIC will no longer cover the expenses during the “Initial Coverage Period” nor will EPIC cover the annual Part D deductible, and will cover drugs only during the Doughnut Hole (coverage gap) of Medicare Part D benefits.
It is strongly recommended that Seniors enrolled in EPIC confirm which “Plan” they are serviced under and what the plan’s limitations are for 2012. Further, new enrollees are encouraged to specifically inquire as to the changes for the new year.
Ronald A. Fatoullah, Esq. is the principal of Ronald Fatoullah & Associates, a law firm that concentrates in elder law, estate planning, Medicaid planning, guardianships, estate administration, trusts and wills. The firm has offices in Forest Hills, Great Neck, Manhattan, Brooklyn, and Cedarhurst, NY. Fatoullah has been named a “fellow” of the National Academy of Elder Law Attorneys and is a former member of its Board of Directors. He also served on the Executive Committee of the Elder Law Section of the New York State Bar Association for over 15 years. Fatoullah has been Certified as an Elder Law Attorney by the National Elder Law Foundation. Fatoullah is a co-founder of Senior Umbrella Network of Queens. This article was written with Stacey Meshnick, Esq., a senior staff attorney at the firm. Ronald Fatoullah & Associates can be reached by calling 718-261-1700, 516-466-4422, or toll free at 1-877-ELDER-LAW or 1-877-ESTATES