EPIC 2015 Program Highlights
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 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, $36.94 per month in 2015.
- Bills are mailed quarterly for EPIC fee plan members. 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:
- Effective April 1, 2014, eligibility income brackets for the deductible plan were expanded from $35,000 to $75,000 for singles and from $50,000 to $100,000 for married couples. The new income brackets were added to existing ones and current EPIC members were not impacted. All other program requirements remain the same.
- EPIC deductibles range from $530 - $3,215 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 $444) 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 Schedule:
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 full 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 Schedule:
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 $444 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 | |
| $35,001 - $36,000 | $1,260 | |
| $36,001 - $37,000 | $1,290 | |
| $37,001 - $38,000 | $1,320 | |
| $38,001 - $39,000 | $1,350 | |
| $39,001 - $40,000 | $1,380 | |
| $40,001 - $41,000 | $1,410 | |
| $41,001 - $42,000 | $1,440 | |
| $42,001 - $43,000 | $1,470 | |
| $43,001 - $44,000 | $1,500 | |
| $44,001 - $45,000 | $1,530 | |
| $45,001 - $46,000 | $1,560 | |
| $46,001 - $47,000 | $1,590 | |
| $47,001 - $48,000 | $1,620 | |
| $48,001 - $49,000 | $1,650 | |
| $49,001 - $50,000 | $1,680 | |
| $50,001 - $51,000 | $1,710 | |
| $51,001 - $52,000 | $1,740 | |
| $52,001 - $53,000 | $1,770 | |
| $53,001 - $54,000 | $1,800 | |
| $54,001 - $55,000 | $1,830 | |
| $55,001 - $56,000 | $1,860 | |
| $56,001 - $57,000 | $1,890 | |
| $57,001 - $58,000 | $1,920 | |
| $58,001 - $59,000 | $1,950 | |
| $59,001 - $60,000 | $1,980 | |
| $60,001 - $61,000 | $2,010 | |
| $61,001 - $62,000 | $2,040 | |
| $62,001 - $63,000 | $2,070 | |
| $63,001 - $64,000 | $2,100 | |
| $64,001 - $65,000 | $2,130 | |
| $65,001 - $66,000 | $2,160 | |
| $66,001 - $67,000 | $2,190 | |
| $67,001 - $68,000 | $2,220 | |
| $68,001 - $69,000 | $2,250 | |
| $69,001 - $70,000 | $2,280 | |
| $70,001 - $71,000 | $2,310 | |
| $71,001 - $72,000 | $2,340 | |
| $72,001 - $73,000 | $2,370 | |
| $73,001 - $74,000 | $2,400 | |
| $74,001 - $75,000 | $2,430 | |
| Not Eligible | Over $75,000 | 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 $444 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 | |
| $50,001 - $51,000 | $1,745 | |
| $51,001 - $52,000 | $1,775 | |
| $52,001 - $53,000 | $1,805 | |
| $53,001 - $54,000 | $1,835 | |
| $54,001 - $55,000 | $1,865 | |
| $55,001 - $56,000 | $1,895 | |
| $56,001 - $57,000 | $1,925 | |
| $57,001 - $58,000 | $1,955 | |
| $58,001 - $59,000 | $1,985 | |
| $59,001 - $60,000 | $2,015 | |
| $60,001 - $61,000 | $2,045 | |
| $61,001 - $62,000 | $2,075 | |
| $62,001 - $63,000 | $2,105 | |
| $63,001 - $64,000 | $2,135 | |
| $64,001 - $65,000 | $2,165 | |
| $65,001 - $66,000 | $2,195 | |
| $66,001 - $67,000 | $2,225 | |
| $67,001 - $68,000 | $2,255 | |
| $68,001 - $69,000 | $2,285 | |
| $69,001 - $70,000 | $2,315 | |
| $70,001 - $71,000 | $2,345 | |
| $71,001 - $72,000 | $2,375 | |
| $72,001 - $73,000 | $2,405 | |
| $73,001 - $74,000 | $2,435 | |
| $74,001 - $75,000 | $2,465 | |
| $75,001 - $76,000 | $2,495 | |
| $76,001 - $77,000 | $2,525 | |
| $77,001 - $78,000 | $2,555 | |
| $78,001 - $79,000 | $2,585 | |
| $79,001 - $80,000 | $2,615 | |
| $80,001 - $81,000 | $2,645 | |
| $81,001 - $82,000 | $2,675 | |
| $82,001 - $83,000 | $2,705 | |
| $83,001 - $84,000 | $2,735 | |
| $84,001 - $85,000 | $2,765 | |
| $85,001 - $86,000 | $2,795 | |
| $86,001 - $87,000 | $2,825 | |
| $87,001 - $88,000 | $2,855 | |
| $88,001 - $89,000 | $2,885 | |
| $89,001 - $90,000 | $2,915 | |
| $90,001 - $91,000 | $2,945 | |
| $91,001 - $92,000 | $2,975 | |
| $92,001 - $93,000 | $3,005 | |
| $93,001 - $94,000 | $3,035 | |
| $94,001 - $95,000 | $3,065 | |
| $95,001 - $96,000 | $3,095 | |
| $96,001 - $97,000 | $3,125 | |
| $97,001 - $98,000 | $3,155 | |
| $98,001 - $99,000 | $3,185 | |
| $99,001 - $100,000 | $3,215 | |
| Not Eligible | Over $100,000 | 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
February 2015
