To join EPIC, a senior must:
- be a New York State resident age 65 or older
- have an annual income below $35,000 if single or $50,000 if married
- be enrolled or eligible to be enolled in a Medicare Part D plan (no exceptions), and
- not be receiving full Medicaid benefits.
- You can join EPIC at any time during the year. Once enrolled, you will receive a 'Special Enrollment Period' to join a Medicare Part D drug plan. You are not eligible to receive EPIC benefits until you are enrolled in a Part D drug plan.
- Seniors who are not eligible to join a Medicare Part D drug plan cannot join EPIC (e.g. seniors with a retiree drug subsidy program, seniors that do not have Medicare Part A, Medicare Part B or Medicare Advantage (HMO) health insurance without drug coverage, etc.).
To enroll in EPIC, you must be a resident of New York State. This means that your permanent home (not just a summer or winter home) is located in New York State. It also means you live in the State on a regular, on-going basis, and your New York State address is listed as your home address on official and legal documents. You need to notify EPIC whenever you change your address.
For purposes of your EPIC enrollment, household gross income is the 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;
- 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;
- Surplus Food;
- Payments made to veterans under the Federal Veteran's Dioxin and Radiation Exposure Compensations Standards Act (Agent Orange);
- Payments made to individuals because of their status as victims of Nazi persecution.
Eligibility for Extra Help:
Individuals with limited income and resources who are receiving Medicare may qualify for Extra Help to lower drug costs if your annual income level is not over $16,335 (in 2011, 2012 dollar limits not yet set) for a single person or $22,065 (in 2011, 2012 dollar limits not yet set) for a married couple. Your resources (such as savings, CDs, IRAs, stocks, bonds – not your home or car) can be no more than $12,640 (in 2011, 2012 dollar limits not yet set) if single and $25,260 (in 2011, 2012 dollar limits not yet set) if married. If your assets are higher, you may qualify for partial 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. The application for Extra Help will also be submitted to the New York State Medicaid program for eligibility in a Medicare Savings Program that provides additional benefits.