Medicare’s Impact On New York’s EPIC Program

The federal Medicare Prescription Drug Discount Card Program offers another choice to current EPIC enrollees. Seniors can choose between Medicare and EPIC and, in some cases, enroll in both programs to maximize their benefits.

When comparing EPIC to the Medicare Prescription Drug Program:

• Most seniors will receive greater benefits for less cost with EPIC because: EPIC does not have a gap in coverage based on out-of-pocket expenses; EPIC has either a fee or a deductible, but not both as with Medicare; EPIC co-payments do not exceed $20; EPIC does not have a restricted drug formulary.
• Some low-income seniors will benefit more under Medicare from their subsidized premiums and co-payments. However, the asset test provides an obstacle to these subsidies. For seniors with incomes below 135 percent of the federal poverty level (FPL), assets must be below $6,000 for singles and $9,000 for married couples (indexed to inflation). For seniors with incomes from 135 percent to 150 percent of the FPL, assets must be below $10,000 for singles and $20,000 for married couples (indexed to inflation). Personal property, including houses and cars, is excluded from assets. The asset test will reduce the number of those eligible for subsidies, and of those who do qualify many may refuse to apply due to the welfare stigma and the burdensome process.
• Some higher-income seniors in the EPIC deductible program could also join Medicare to save money while meeting their EPIC deductible. Since Medicare is the primary insurer, EPIC coverage would wrap around the Medicare benefit.Under the federal Medicare Modernization Act of 2003, the new Prescription Drug Discount Card Program will provide an annual credit, through 2006, of $600 to all eligible low-income Medicare beneficiaries.
• Individuals with annual incomes up to $12,569 and married couples with annual incomes totaling up to $16,862 may qualify for the $600 annual credit.
• Legislation will now allow New York to automatically enroll low-income EPIC members in the Medicare Prescription Drug Discount Card Program. The legislation also waives their EPIC fees, making the program seamless and helping recipients reap additional savings on their prescription drugs while providing additional savings for the state’s EPIC Program.
• New Yorkers who enroll in the Medicare Prescription Drug Discount Card Program are expected to save an average of 10 percent to 25 percent on selected prescription drugs.
• Individuals who qualify for the annual $600 Medicare credit under the Prescription Drug Discount Card Program may use their discount card with their EPIC card to increase their savings.
• To ensure recipients receive the best savings under both programs, EPIC enrollees eligible for the $600 credit should not enroll in a discount card program until they hear from EPIC.
• The New York State Office for the Aging sponsors the Health Insurance Information Counseling and Assistance Program (HIICAP), which has more than 350 trained counselors available to answer New York seniors’ questions about Medicare, managed care, Medigap and other types of health and long-term care insurance and, now, the new federal discount drug cards. The hot line number of the Office for the Aging is (800) 333-4114 and office hours are 9 a.m. to 3 p.m. Monday through Thursday, or visit http://hiicap.state.ny.us.