New York EPIC Program: Prescription Drug Help for Seniors

What EPIC Does for New York Seniors

Your parent fills a prescription, the pharmacist runs their card, and a $180 generic suddenly costs $6. That is the Elderly Pharmaceutical Insurance Coverage program — EPIC — doing what New York designed it to do: wrap around Medicare Part D so seniors pay less at the pharmacy counter.

EPIC is run by the New York State Department of Health, not by a private insurer. It serves New York residents aged 65 and older with annual incomes up to $75,000 (single) or $100,000 (married couple). There is no asset test, so savings and home equity do not matter.

One requirement catches people off guard: you must be enrolled in a Medicare Part D plan. EPIC is secondary coverage. It pays after Part D pays, applying its plan's deductible and copayment rules to eligible drug costs left over.

Fee Plan vs Deductible Plan

EPIC sorts members into one of two plans based on income:

Fee Plan — for singles earning up to $20,000 or couples up to $26,000. Members pay an annual fee of $8 to $300 based on prior-year income, billed quarterly, and then low copays at the pharmacy.

Deductible Plan — for singles earning $20,001–$75,000 or couples $26,001–$100,000. Members pay an annual deductible that scales with income before EPIC starts covering prescriptions.

EPIC also pays the Part D plan premium for Fee Plan members, up to the benchmark of $58.82 per month in 2026. If the Part D plan premium exceeds the benchmark, the member pays the difference.

How EPIC, Extra Help, and MSP Fit Together

This is where families get confused. Three programs can stack:

1. Medicare Savings Programs (QMB or QI) pay the Part B premium. In New York, QMB covers up to 138% of the federal poverty level and QI covers up to 186% FPL.
2. Extra Help (LIS) reduces Part D costs — premiums, deductibles, copays. Getting approved for QMB or QI automatically triggers Extra Help.
3. EPIC layers on top of Part D and Extra Help, paying whatever drug costs remain.

A senior on all three pays nothing for the Part B premium, close to nothing for prescriptions, and keeps their full Social Security check.

EPIC itself also screens members for Extra Help eligibility during enrollment. If the member qualifies, EPIC submits the Extra Help application on their behalf — the member does not need to contact Social Security separately.

How to Apply for EPIC

Applications go directly to the EPIC program, not to the county Department of Social Services:

• Online: Complete the EPIC online application through the NYSDOH website; printable application forms are also available there
• Phone: Call the EPIC helpline at 1-800-332-3742
• Mail: Complete and mail the application; include an Extra Help or MSP determination letter if the applicant already receives either benefit

Once approved, the member receives an EPIC card to present at the pharmacy alongside their Part D card.

When to Look at EPIC

EPIC makes sense for any New York resident 65 or older who takes regular prescriptions and earns under the income caps. It particularly helps seniors in the Deductible Plan income range ($20,001–$75,000) who earn too much for Extra Help but still face high Part D out-of-pocket costs.

For seniors whose income falls below the QMB or QI thresholds, applying for a Medicare Savings Program first is the better starting point — it triggers Extra Help automatically and delivers broader savings than EPIC alone.

The New York Medicare Savings Programs, Extra Help & EPIC Guide walks through all three programs in the order a New York family should evaluate them, with income worksheets for each.

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