New York State Pharmacy Assistance Programs (SPAP)
New York State Elderly Pharmaceutical Insurance Coverage (EPIC)
Eligiblity Requirements
You must meet the following requirements:- You must be a New York State resident (permanent home address),
- at least 65 years of age, and not receiving full Medicaid benefits.
- You must have an annual income below $75,000 if single, or a combined annual income below $100,000 if married.
- You must be enrolled or eligible to be enrolled in a Medicare Part D plan (no exceptions). Seniors enrolled in a Medicare Advantage (HMO) plan can only join EPIC if their HMO includes Medicare Part D coverage.
Important Note
EPIC provides secondary coverage for Medicare Part D and EPIC-covered drugs purchased after any Medicare Part D deductible is met. EPIC also covers approved Part D-excluded drugs once a member is enrolled in Part D.EPIC helps pay the Medicare Part D drug plan premiums (up to the New York state LIS benchmark of $40.45 in 2027 and $58.82 in 2026) for members with income up to $23,000 if single or $29,000 if married. Higher income members are required to pay their own Part D premiums but EPIC provides premium assistance by lowering their EPIC deductible.
EPIC has two plans based on income. The Fee Plan is for members with income up to $20,000 if single or $26,000 if married. The Deductible Plan is for members with incomes ranging from $20,001 to $75,000 if single or $26,001 to $100,000 if married.
Income (What to Include/Exclude)
For purposes of your EPIC enrollment, household gross income is the previous year's total annual income of the senior or married spouses. It includes, but is not limited to:- Federal adjusted gross household income as reported on your income tax return;
- Social Security payments (less Medicare premiums);
- Railroad retirement benefits;
- The taxable amount of IRA distributions and retirement annuities;
- Support money, including foster care support payments;
- Supplemental Security income;
- Tax-exempt interest;
- Worker's compensation;
- Gross amount of loss-of-time insurance;
- Cash public assistance and relief, other than medical assistance for the needy;
- Non-taxable strike benefits;
- Veterans' disability pensions;
- Lottery winnings.
It does not include:
- Food stamps;
- Medicare premiums;
- Medicaid;
- Scholarships;
- Grants;
- Surplus food;
- Payments made to veterans under the federal Veterans' Dioxin and Radiation Exposure Compensations Standards Act (Agent Orange);
- Payments made to individuals because of their status as victims of Nazi persecution.
Contact Information
Phone: (800) 332-3742Email:[email protected]
Address
EPIC,
P.O. Box 15018
Albany, NY 12212-5018
Website
www.health.state.ny.us/nysdoh/epic/faq.htm