EPIC 2013 Program Changes
- EPIC 2013 Program Changes is also available in Portable Document Format (PDF, 49 KB, 2 pgs.)
Beginning January 1, 2013, many EPIC program benefits will be restored and some additional changes will be made. Members received a letter in August notifying them of the program changes along with a Renewal Form that they must complete, sign and return to EPIC in an enclosed postage paid envelope.
EPIC Program:
- Members must be enrolled in a Medicare Part D drug plan to receive EPIC benefits.
- Provides secondary coverage for Medicare Part D and EPIC covered drugs purchased after the Part D deductible, if any, is met.
- Covers many Part D excluded drugs.
- EPIC co-payments continue to be $3, $7, $15 or $20 based on the cost of the drug.
- Provides Medicare Part D drug plan premium assistance for many members.
- Fee and Deductible Plans are reinstated.
Fee Plan Members:
- EPIC annual fees range from $8 - $300 based on the previous year's income.
- EPIC pays the Part D monthly drug plan premiums up to the average cost of a basic Medicare drug plan, $43.22 per month in 2013.
- Quarterly bills for EPIC fees will be mailed in early December 2012. Members with full Extra Help from Medicare will continue to have their EPIC fees waived.
- Members will pay EPIC co-payments for Part D and EPIC covered drugs after the Part D deductible, if any, is met. Members will pay EPIC co-payments for Part D excluded drugs.
Deductible Plan Members:
- EPIC deductibles range from $530 - $1,715 based on the previous year's income.
- EPIC pays the monthly Part D drug plan premiums up to the average cost of a basic Part D drug plan for members with income up to $23,000 single or $29,000 married.
- Members with higher incomes must pay their Medicare Part D premiums each month. Their EPIC deductible will be lowered by the annual cost of a basic Part D plan (approximately $519) to help them pay.
- After a member meets their EPIC deductible, they will pay EPIC co-payments for covered drugs. Drug costs in the Part D deductible phase cannot be applied to the EPIC deductible.
Fee Plan:
The cost to join the Fee Plan is based on your previous year's income. You can pay your Annual Fee in total or pay a bill every three months. EPIC fees are waived for those with fill Extra Help from Medicare.
| Who Pays Premium | Annual Income | Annual Fee |
|---|---|---|
| EPIC pays Part D Premium | Up to $6,000 | $8 |
| $ 6,001 - $ 7,000 | $16 | |
| $ 7,001 - $ 8,000 | $22 | |
| $ 8,001 - $ 9,000 | $28 | |
| $ 9,001 - $10,000 | $36 | |
| $10,001 - $11,000 | $40 | |
| $11,001 - $12,000 | $46 | |
| $12,001 - $13,000 | $54 | |
| $13,001 - $14,000 | $60 | |
| $14,001 - $15,000 | $80 | |
| $15,001 - $16,000 | $110 | |
| $16,001 - $17,000 | $140 | |
| $17,001 - $18,000 | $170 | |
| $18,001 - $19,000 | $200 | |
| $19,001 - $20,000 | $230 | |
| See Deductible Plan | Over $20,000 | See Deductible Plan |
| Who Pays Premium | Joint Annual Income | Annual Fee (Each Person) |
|---|---|---|
| EPIC pays Part D Premium | Up to $ 6,000 | $ 8 |
| $ 6,001 - $ 7,000 | $12 | |
| $ 7,001 - $ 8,000 | $16 | |
| $ 8,001 - $ 9,000 | $20 | |
| $ 9,001 - $10,000 | $24 | |
| $10,001 - $11,000 | $28 | |
| $11,001 - $12,000 | $32 | |
| $12,001 - $13,000 | $36 | |
| $13,001 - $14,000 | $40 | |
| $14,001 - $15,000 | $40 | |
| $15,001 - $16,000 | $84 | |
| $16,001 - $17,000 | $106 | |
| $17,001 - $18,000 | $126 | |
| $18,001 - $19,000 | $150 | |
| $19,001 - $20,000 | $172 | |
| $20,001 - $21,000 | $194 | |
| $21,001 - $22,000 | $216 | |
| $22,001 - $23,000 | $238 | |
| $23,001 - $24,000 | $260 | |
| $24,001 - $25,000 | $275 | |
| $25,001 - $26,000 | $300 | |
| See Deductible Plan | Over $26,000 | See Deductible Plan |
Deductible Plan
There is no fee to join the Deductible Plan. You pay full price (Part D amount charged) for your drugs until you meet your Annual Deductible which is based on your previous year's income. EPIC tracks how much you spend. Drug costs in the Medicare Part D deductible phase cannot be applied to the EPIC deductible.
| Who Pays Premium | Annual Income | Annual Deductible |
|---|---|---|
| EPIC pays Part D Premium | Under $20,000 | See Fee Plan |
| $20,001 - $21,000 | $530 | |
| $21,001 - $22,000 | $550 | |
| $22,001 - $23,000 | $580 | |
| Member pays their Part D premium (shaded incomes). EPIC Deductible shown is lowered by approximately $519 to help them pay. | $23,001 - $24,000 | $720 |
| $24,001 - $25,000 | $750 | |
| $25,001 - $26,000 | $780 | |
| $26,001 - $27,000 | $810 | |
| $27,001 - $28,000 | $840 | |
| $28,001 - $29,000 | $870 | |
| $29,001 - $30,000 | $900 | |
| $30,001 - $31,000 | $930 | |
| $31,001 - $32,000 | $960 | |
| $32,001 - $33,000 | $1,160 | |
| $33,001 - $34,000 | $1,190 | |
| $34,001 - $35,000 | $1,230 | |
| Not Eligible | Over $35,000 | Not Eligible |
| Who Pays Premium | Joint Annual Income | Annual Deductible (Each Person) |
|---|---|---|
| EPIC pays Part D Premium | Under $26,000 | See Fee Plan |
| $26,001 - $27,000 | $650 | |
| $27,001 - $28,000 | $675 | |
| $28,001 - $29,000 | $700 | |
| Member pays their Part D premium (shaded incomes). EPIC Deductible shown is lowered by approximately $519 to help them pay. | $29,001 - $30,000 | $725 |
| $30,001 - $31,000 | $900 | |
| $31,001 - $32,000 | $930 | |
| $32,001 - $33,000 | $960 | |
| $33,001 - $34,000 | $990 | |
| $34,001 - $35,000 | $1,020 | |
| $35,001 - $36,000 | $1,050 | |
| $36,001 - $37,000 | $1,080 | |
| $37,001 - $38,000 | $1,110 | |
| $38,001 - $39,000 | $1,140 | |
| $39,001 - $40,000 | $1,170 | |
| $40,001 - $41,000 | $1,200 | |
| $41,001 - $42,000 | $1,230 | |
| $42,001 - $43,000 | $1,260 | |
| $43,001 - $44,000 | $1,290 | |
| $44,001 - $45,000 | $1,320 | |
| $45,001 - $46,000 | $1,575 | |
| $46,001 - $47,000 | $1,610 | |
| $47,001 - $48,000 | $1,645 | |
| $48,001 - $49,000 | $1,680 | |
| $49,001 - $50,000 | $1,715 | |
| Not Eligible | Over $50,000 | Not Eligible |
Questions? Call the EPIC Helpline at: 1-800-332-3742 (TTY 1-800-290-9138)
¿Necesita Ayuda? Llame al 1-800-332-3742
September 2012
