What's New?

Medicare Enrollment Required

Extra Help with Medicare Prescription Drug Costs

EPIC enrollees with limited income and resources should visit the Social Security Administration's Web site for Extra Help with Medicare Prescription Drug Plan Costs.

EPIC and Medicare

How does the Medicare Part D drug plan requirement work?

EPIC members without other primary drug coverage are required to enroll in a Medicare Part D plan (with limited exceptions). If seniors do not already have Part D, EPIC will help them select and enroll in a basic Medicare plan based on their drug and pharmacy needs. Medicare provides primary drug coverage and EPIC coverage is secondary. Using the two plans together results in greater savings, and drug costs that are not covered by Medicare (including deductibles, co-payments, co-insurance and coverage gap) can be submitted to EPIC.

  • EPIC pays the Medicare Part D premiums, up to the average monthly cost of a basic drug plan, for members in the Fee Plan.
  • EPIC lowers the deductible for Deductible Plan members to help pay for their monthly Medicare Part D premiums.

How is EPIC used with other prescription drug coverage including Medicare Part D?

EPIC supplements other prescription coverage for greater benefits and savings. When purchasing prescription drugs, the enrollee shows both EPIC and other insurance cards at the pharmacy. Any drug costs that are not covered by the other prescription coverage, including deductibles, co-insurance/co-payments and coverage gap, can be submitted to EPIC. This results in the lowest possible co-payment, and is often less than if EPIC or the other coverage is used alone. For example, if an EPIC enrollee also has other prescription drug coverage that requires a $25 co-payment on a brand-name drug that costs $100, the $25 co-payment will be covered by EPIC and the enrollee would pay only a $7 EPIC co-payment. In this example, if the senior did not use EPIC, $25 would have been paid. If they used EPIC alone, they would have paid a $20 EPIC co-payment. By using both plans together, they paid a much lower co-payment!

How does a senior apply for Extra Help?

EPIC seniors who are income eligible for Extra Help from Medicare are required to complete a Request for Additional Information (RFAI) form (PDF, 231KB, 4pg.) to enable EPIC to apply for this federal benefit on their behalf. Extra Help comes in two levels – full and partial. If approved for Extra Help, seniors pay lower co-payments. Those approved for full Extra Help from Medicare do not have to pay any EPIC fees.

Letters Sent to EPIC Enrollees About the New Medicare Drug Benefit