Your AARP ; New York News
Copay help only in ‘doughnut hole’
EPIC Program Slashed
For the past several years, Muriel Kenitz, 72, has relied on Medicare Part D and New York’s Elderly
Pharmaceutical Insurance Coverage
(EPIC) program to help her pay for the 13
medications she takes daily.
The combination of Part D and EPIC
meant she paid about $150 a month for
her prescription drugs. But come January,
when changes to EPIC kick in, Kenitz’s
medications will cost her $591 a month, an
amount she says she can’t afford.
Gov. Andrew Cuomo, D, and the legislature
cut the EPIC budget by about $12 million
as part of reductions in state agencies to
eliminate a $10 billion deficit. EPIC will no
longer contribute toward copayments until
a Medicare enrollee and his or her insurer
has spent $2,930 on prescriptions, the point
where the “doughnut hole” begins in 2012.
The state Health Department said 190,000
of the 283,000 EPIC enrollees will see
benefits reduced to Medicare doughnut hole
coverage only; an additional 4,000 will no
longer be eligible.
“I don’t know what I’m going to do,” said
More eligible for subsidy
Kenitz, who lives in Galway in Saratoga
County. The $591 monthly medication cost
is “more than half my Social Security. I can’t
go without these drugs. But … if I get all
these medications, there’s nothing left.”
EPIC has helped low- to moderate-income
adults 65 and older afford their medication
in two ways: capping copays at $20 per pre-
scription and subsidizing Part D premiums.
One tier of the subsidy system paid up to
$38.69 a month to help extremely low-income people (a maximum $20,000 annual
income for single people, $26,000 for a
married couple) pay their Medicare Part D
premiums. That part of EPIC was expanded in July when the maximum income
levels were increased to $23,000 for single
people and $29,000 for couples.
The second tier was for people with
incomes of up to $35,000 for a single person, $50,000 for a married couple. They
received a credit of up to $464 toward their
Part D deductible. That program was eliminated in July.
Although there are no membership fees
or deductibles in the reconfigured EPIC
program, the elimination of the copay benefit for people like Kenitz will be a financial
squeeze that will be hard to bear, AARP
New York says.
“The only thing left is the doughnut hole
coverage and premium support for low-income individuals,” said Bill Ferris, AARP
New York legislative representative.
Part D plan required
To be eligible for EPIC, people will be
required to enroll in a Medicare Part D plan.
Previously, that was not always the case.
But beginning Jan. 1, “there are no excep-
tions,” EPIC director Alan Ball wrote to
EPIC participants in August. “If you are
not enrolled in a Part D plan you will not
receive EPIC assistance.”
Income rules won’t change. EPIC dough-
nut hole coverage is open to people 65-plus
who have incomes up to $35,000 for a single
person, $50,000 for a married couple.
In addition, EPIC will no longer pay for
three days of medicine while a beneficiary
appeals an insurance ruling when a Part D
plan denies coverage of a drug.
After EPIC sent the letter about the upcoming changes, “the phones started ringing
off the hook,” said Cathy Roberts, a senior
paralegal who works on health care access
issues for the Empire Justice Center, an
advocacy agency in Albany.
“We’re especially worried about people
who take expensive drugs like those [for]
cancer and MS,” she said.
AARP will push to roll back the cuts when
the legislature reconvenes in January.
Roberts said people may find some relief
through the assistance programs of pharmaceutical companies and charities. More
information is available at NeedyMeds.org.
—By Winnie Yu
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