New York has a State Pharmaceutical Assistance Program (SPAP) to help low- to moderate-income older adults age 65+ pay for prescription drugs. The Elderly Pharmaceutical Insurance Coverage ( EPIC ) program is administered by the New York State Department of Health (NYSDOH). EPIC has gone through significant changes over the past couple of years. Benefits were severely reduced in January 2012; but much of the original EPIC benefit is restored in January 2013. Effective April 1, 2014, income limits increased dramatically - for singles from $35,000 to $75,000 a year and for couples from $50,000 to $100,000/year, subject to deductibles.
In 2020, EPIC released a more complicated application that had questions about ASSETS even though there is no asset limit for EPIC. They wanted the information so they could screen applicants to refer them to enroll in Extra Help. (Partial Extra Help has an income limit up to 150% FPL , which would qualify some people who are over income for any NYS Medicare Savings program for which highest income limit is 135% FPL.) But the added confusion of the new form and asking about assets would deter people from applying. With NYStatewide Senior Action Council advocacy, DOH agreed to continue accepting the old application form at least for now during COVID. However, EPIC's website has only the new a application . Here is the OLD application (fill-able version) that you can still use at least during the COVID emergency. In an April 29, 2020 letter signed by Donna Frescatore, of the NYS Dept of Health Office of Health Insurance Programs: "We understand your concerns regarding COVID-19 and ensuring that seniors get access to needed medications. As such, we will continue to accept the prior version of the EPIC application until after the emergency period and will also work closely with seniors to obtain the information needed so the EPIC program staff can facilitate their applications for the Extra Help program."
1) Part D premium assistance
Pays cost of monthly Part D premiums (up to benchmark)
Must have annual income at/below $23,000 year (single)/$29,000 (couple).
2) Coverage gap ("Doughnut Hole" )assistance
Helps with cost sharing for Part D. Since 2013, EPIC will subsidize the Part D co-insurance year-round, AFTER the member has met the Part D plan's deductible, if any. With EPIC's help,.the member's Part D co-pay will be no higher than $20 per drug; EPIC will pick up the balance.
EPIC cost sharing