Prescription Assistance

Elderly Pharmaceutical Insurance Coverage (EPIC)

Low and moderate income New York State residents over the age of 65 can qualify for premium-free prescription cost-sharing assistance for their Medicare D plans if and/or when they reach their plan’s coverage gap (the donut hole).

EPIC requires all members to be enrolled in a Medicare D prescription plan and only provides assistance in the coverage gap. Some members can qualify for EPIC assistance for their Part D plan premiums.

New York State EPIC Prescription Plan

Extra Help Program

Extra Help, also known as Low Income Subsidy (LIS), is available to reduce or eliminate the Part D premium and significantly lower the cost-sharing requirements. Some people receive this Extra Help automatically while others need to apply in order to receive it. Full Extra Help recipients will pay no monthly premium if they are enrolled in a basic benchmark Part D plan.

People enrolled in Medicaid (dual eligibles) or the Medicare Savings Program receive Full Extra Help automatically. Others may be eligible for the Full or Partial Help based on their income and resources. Income limits are based on the Federal Poverty level, which changes every year. Apply through the Social Security Administration for this assistance at any time of the year. Apply for Extra Help here

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