EPIC explained: New York's prescription help for people 65 and over
EPIC, the Elderly Pharmaceutical Insurance Coverage program, is a New York State benefit that sits behind your Medicare Part D plan and cuts what you pay at the pharmacy to a flat $3 to $20 per prescription. The income limits are higher than many people expect.
EPIC is a New York State program that sits behind your Medicare Part D plan and cuts what you pay at the pharmacy to a fixed $3 to $20 per prescription. You qualify at 65 or older with income up to $75,000 single or $100,000 married; there is no asset test, and lower-income members get their Part D premium paid as well. You must be enrolled in a Part D plan to use it. The application is short, and I help clients complete it as part of their Part D review.
What EPIC is
EPIC is a state pharmaceutical assistance program, run by the New York State Department of Health since 1987. It doesn't replace Medicare Part D; it works behind it. Your Part D plan pays first, and EPIC picks up most of what's left, so that what reaches you at the counter is a small fixed copay. It also plugs a few holes Part D leaves open, and for lower-income members it pays the Part D premium itself.
The reason so few people use it is the name. "Elderly Pharmaceutical Insurance Coverage" sounds like a program for the poor. The income limits, $75,000 for a single person and $100,000 for a married couple, take in most retired households in Saratoga, Albany, Schenectady and Rensselaer counties.
Who qualifies
- Age 65 or over.
- A New York State resident.
- Annual household income up to $75,000 if single, $100,000 if married.
- Enrolled in, or eligible for, Medicare Part D.
- Not receiving full Medicaid benefits. (People with the Medicare Savings Program only, or with a Medicaid spend-down, can still have EPIC.)
There is no asset test: savings, home and car don't matter. Income is measured for the household, so a married couple's incomes are combined against the $100,000 limit.
EPIC Fee Plan vs Deductible Plan
Which plan you're in is decided by income and nothing else.
| Detail | Fee Plan | Deductible Plan |
|---|---|---|
| Income (single) | Up to $20,000 | $20,001 to $75,000 |
| Income (married) | Up to $26,000 | $26,001 to $100,000 |
| What you pay to join | Annual fee, $8 to $300 by income, payable quarterly | Nothing |
| Before EPIC copays start | After any Part D deductible | After any Part D deductible, then an annual EPIC deductible set by income ($530 to $3,215 in 2026) |
| Part D premium | Paid by EPIC, up to the benchmark ($58.82 a month in 2026) | Paid by EPIC up to $23,000 single / $29,000 married; otherwise you pay it and your EPIC deductible is reduced by about $706 |
For married couples, the Department of Health's 2026 schedules set the fee or the deductible for each person, based on joint income. Source: EPIC 2026 program highlights.
The Deductible Plan is for incomes above the Fee Plan limits, and it's still worth having. The deductible is only what you'd have spent anyway on drugs and Part D cost-sharing (spending during your Part D plan's own deductible doesn't count toward it); once you've spent it, everything for the rest of the year drops to EPIC copays. For someone on one or two brand-name drugs, that can be the difference between a $1,000 year and a $2,100 year at the pharmacy (the 2026 Part D out-of-pocket cap).
What you pay at the pharmacy
After your Part D plan has paid and, on the Deductible Plan, once your EPIC deductible is met, each prescription costs:
| Cost of the prescription after Part D | Your EPIC copay |
|---|---|
| Up to $15 | $3 |
| $15.01 to $35 | $7 |
| $35.01 to $55 | $15 |
| Over $55 | $20 |
So a specialty drug with a $300 Part D coinsurance costs an EPIC member $20. EPIC is secondary coverage that starts after any Part D deductible: if your Part D plan has a deductible, you pay that first, on either EPIC plan. Fee Plan members then pay only EPIC copays; Deductible Plan members pay them once their EPIC deductible is also met.
What else EPIC does
- Pays the Part D premium for members with income up to $23,000 single or $29,000 married, up to the state's benchmark amount for a basic plan ($58.82 a month in 2026). If you pick a plan that costs more than the benchmark, you pay the difference.
- Covers some drugs Part D won't, such as certain prescription vitamins and cough and cold medicines, at the same copays.
- Gives you a Part D Special Enrollment Period. EPIC members can join or change a Part D plan once a year outside the Annual Enrollment Period, which is useful if a new prescription lands in April.
- Isn't drug coverage on its own. EPIC is not creditable coverage, and if you aren't enrolled in a Part D plan you get no EPIC benefits at all. Keep your Part D plan in force.
EPIC, Extra Help and the Medicare Savings Program are different programs
Extra Help is the federal Part D subsidy for lower incomes; the Medicare Savings Program pays the Part B premium. You can have EPIC alongside either. If your income qualifies you for Extra Help, that applies first and EPIC covers what remains; EPIC asks income-eligible members to apply for Extra Help and can file that application for you, and full Extra Help waives EPIC's Fee Plan fees. On a Part D review I screen for all three, because the combinations matter.
How to apply
- Get the application from the Department of Health's EPIC page or by calling the EPIC helpline, 1-800-332-3742, TTY 1-800-290-9138 (Monday to Friday, 8:00 to 5:00). You can also apply online.
- Send proof of age and residence and a copy of your most recent tax return or income statements. If you don't file taxes, Social Security and pension statements are enough.
- Once approved you'll receive an EPIC card. Show it at the pharmacy with your Part D card; the pharmacy bills Part D first and EPIC second, automatically.
EPIC benefits apply only while you're enrolled in a Part D plan. If you don't have one yet, joining EPIC gives you a Special Enrollment Period to join one at any time of year.
What I do
Every Part D comparison I run includes an EPIC screening, because the right Part D plan can change once EPIC is in the picture: with EPIC absorbing cost-sharing, a lower-premium plan with a bigger deductible often wins. If you qualify, I'll help you complete the application in the same sitting. No fee for any of it. Request a Part D and EPIC review.
By county: Albany · Saratoga · Schenectady · Rensselaer · Warren · Washington · Montgomery · Fulton · Columbia · Greene · Schoharie · Otsego · Herkimer · Hamilton · Essex · Ulster · Dutchess. Town pages: every town, grouped by county. Anywhere else in New York.
- EPIC program (NY State Department of Health) — income limits $75,000 single / $100,000 married; secondary to Part D after any Part D deductible; revised March 2026, read October 15, 2026
- EPIC 2026 program highlights, Fee Plan and Deductible Plan schedules (NY DOH) — fees $8–$300; deductibles $530–$3,215; married amounts are for each person; Part D deductible spending doesn't count toward the EPIC deductible; re-read October 16, 2026 (revised December 2025)
- EPIC Medicare Part D premium assistance (NY DOH) — $23,000 / $29,000 thresholds; $58.82 monthly benchmark and about $706 deductible reduction in 2026; read October 15, 2026
- EPIC and Medicare Part D (NY DOH) — Part D required; EPIC is not creditable coverage; Special Enrollment Period and one plan change a year; Extra Help application; read October 15, 2026
- EPIC eligibility requirements (NY DOH) — previous year's household income; permanent New York home; read October 15, 2026
- EPIC co-payments (NY DOH) — $3 / $7 / $15 / $20 schedule; read October 15, 2026
- EPIC application and contact information (NY DOH) — online application; helpline 8:00 to 5:00 weekdays, TTY 1-800-290-9138; read October 15, 2026
- EPIC program overview (Medicare Rights Center)
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Common questions
Short answers to what people ask before they call.
Still have a question? Call (518) 902-8822 or book a call.
Who qualifies for EPIC?
New York residents aged 65 or older with annual income up to $75,000 if single or $100,000 if married, who are enrolled in or eligible for Medicare Part D and who don't receive full Medicaid benefits. There is no asset test. Income is the previous year's household income: federal adjusted gross income plus items such as Social Security (less Medicare premiums) and tax-exempt interest.
What does EPIC actually pay?
Once your Part D plan has paid its share, EPIC pays the rest except a fixed copay: $3 for a prescription costing up to $15, $7 up to $35, $15 up to $55, and $20 for anything over $55. It also pays the Part D premium for lower-income members and covers some drugs Part D excludes.
What's the difference between the EPIC Fee Plan and the Deductible Plan?
It depends only on income. Singles up to $20,000 and couples up to $26,000 are in the Fee Plan: you pay a small annual fee, from $8 to $300 by income, and once any Part D deductible is met you pay only EPIC copays. Above that, up to the $75,000 and $100,000 limits, you're in the Deductible Plan: no fee, but you pay your Part D costs in full until you've met an annual EPIC deductible set by income ($530 to $3,215 in 2026), and then EPIC copays apply for the rest of the year. For married couples the fee or deductible applies to each person. What you spend during your Part D plan's own deductible doesn't count toward the EPIC deductible.
Do I have to have a Part D plan to use EPIC?
Yes. EPIC is secondary coverage and requires you to be enrolled in Medicare Part D, either a standalone plan or an Advantage plan with drug coverage. EPIC isn't creditable drug coverage on its own: without a Part D plan you get no EPIC benefits. Joining EPIC gives you a Special Enrollment Period to join a Part D plan at any time, and members can change plans once a year outside the usual windows.
Does EPIC help with the Part D premium?
For members with income up to $23,000 single or $29,000 married, EPIC pays the Part D premium up to a benchmark amount for a basic plan, $58.82 a month in 2026. Higher-income members pay their own premium, but EPIC lowers their EPIC deductible by about $706, the yearly cost of a benchmark plan in 2026.
How do I apply?
A short application to the New York State Department of Health, online, by mail, or by requesting one from the EPIC helpline at 1-800-332-3742 (TTY 1-800-290-9138). You'll need proof of age, residence and income. I help clients complete it as part of their Part D review; it takes about fifteen minutes.
Check whether EPIC applies to you
Income, prescriptions and your current Part D plan. I'll tell you what EPIC would change and help with the application.